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PRINCIPLES  AND  PRACTICE 

OF 

DENTISTRY. 


Valuable  Works  Connected  with  Dentistry 

PUBLISHED   BY 

P.    BLAKISTON,   SON   &   CO., 

1012    WALNUT    STREET, 
PHILADELPHIA. 


HARRIS  (CHAPIN  A.),  M.D.,  D.D.S.  .,     ,  t.    •    ^ 

The  Principles  and  Practice  of  Dentistry.  Tenth  Kevised 
Edition.  In  great  part  Rewritten,  Rearranged,  and  with  many  new 
and  important  Illustrations.  Edited  by  P.  H.  Austen.  M.D.,  Professor 
of  Dental  Science  and  Mechanism  in  the  Baltimore  College  of  Dental 
Surgerv.     With  nearly  400  Illustrations.     Royal  octavo. 

Price,  in  cloth,  6.50 ;  in  leather,  7.50 

HARRIS  (CHAPIN  A.),  M.D.,  D.D.S. 

A  Dictionary  of  Medical  Terminology,  Dental  Sur- 
gery, and  the  Collateral  Sciences.  Fourth  Edition, 
Carefiillv  Revised  and  Enlarged.  By  Ferdinand  J.  S.  Gorgas,  M.D., 
D.D.S.,  Professor  of  Dental  Surgery  in  the  Baltimore  College,  etc. 
Roval  octavo.  Price,  in  cloth,  6.50 ;  in  leather,  7.50 

RICHARDSON  -JOSEPH),  D.D.S. 

A  Practical  Treatise  on  Mechanical  Dentistry.  Third 
Edition,    much   Enlarged.      "With  185    Illustrations.     Octavo. 

Price,  in  cloth,  4.00;  in  leather,  4.75 

TAFT  (JONATHAN),  D.D.S. 

A  Practical  Treatise  on  Operative  Dentistry.  Third 
Edition,  thoroughly  Revised,  with  Additions.  Over  100  Illustrations. 
Octavo.  "  Price,  in  cloth,  4.25  ;  in  leather,  5.00 

WEDL  (CARL),  M.D. 

Dental  Pathology.  With  Special  Reference  to  the  Anatomy  and 
Physiology  of  the  teeth,  and  notes  by  Thos.  B.  Hitchcock,  M.D., 
Prof,  of  Dental  Pathology,  Harvard  University.     105  Illustrations. 

Price,  in  cloth,  3.50 ;  in  leather,  4.50 

HANDY  (WASHINGTON  R.),  M.D. 

Handy's  Text-Book  of  Anatomy  and  Guide  to  Dis- 
sections.    For  the  use  of  Students.     312  Illustrations.     Octavo. 

Price,  cloth,  3.00 

LEBER  AND  ROTTENSTEIN  (Drs.) 

Dental  Caries  and  Its  Causes.  An  Investigation  into  the 
Intiuence  of  Fungi  in  the  destruction  of  the  Teeth.  With  Illustra- 
tions. "  Price,  cloth,  1.25 

SEWILL  (H.  E.),  M.R.C.S.,  En?.,  L.D.S. 

The  Student's  Guide  to  Dental  Anatomy  and  Sur- 
gery.    With  77  Illustrations.  Price,  paper,  75  cts. ;  cloth,  1.25 

SANSOM  (ARTHUR  ERNEST),  M.B. 

Chloroform.     Its  Action  and  Administration.         Price,  cloth,  1.50 

TURNBULL  (LAURENCE),  M.D. 

The  Advantages  and  Accidents  of  Artificial  Anaes- 
thesia. A  Manual  of  Anaesthetic  Agents,  Modes  of  Administration, 
etc.    Second  Edition,  Enlarged.    25  Illustrations.     Price,  cloth,  1.50 


THE 


PRINCIPLES  AND  PRACTICE 


OF 


DENTISTRY, 

INCLUDIXG 

ANATOMY,  PHYSIOLOGY,  PATHOLOGY,  THERAPEUTICS, 
DENTAL  SURGERY  AND  MECHANISM. 

I 

BY 
CHAPI^  A.  HARRIS,  M.D.,  D.D.S., 

LATE  PEESIDEXT  OF  THE  BALTIMORE  DENTAL  COLLEGE,  AUTHOR  "  OF  WUTIONAKT 
OF  MEDICAL  TEEMIXOLOGT  A>rD  DENTAL  SURGEBT." 

WiwWx  (tdlimu 

REVISED  AND  EDITED  BY 

PHILIP  H.  AUSTEN,  M.D., 

WITH  FOUE   HUNDRED  AND  NINE  ILLUSTEATIONS. 


PHILADELPHIA: 
P.  BLAKISTON,  SON  &  CO. 

1882. 


Entered,  according  to  Act  of  CoDgress,  in  the  year  1871,  by 

LINDSAY  AND  BLAKISTON, 

in   the  Office  of   the  Librarian   of   Congress,   at   Washington. 


PBINTED  BT  SHERMAN  ft  CO. 


DEDICATION  TO  THE  SEVENTH  EDITION. 


TO 

THOMAS   E.  BOND,  M.D., 

PEOFESSOE  OF  SPECIAL  PATHOLOGY  ANB  THEEAPEDTICS  IX  THE  BALTIMOEE  COLLEGE  OP 
DENTAL  SUEGERT, 


AS  A  TOKEN  OF  GRATITUDE  FOR  MUCH  KINDNESS,  AND  AS  A  TESTIMONY 

OF  RESPECT  AND  ESTEEM  FOR  GREAT  PROFESSIONAL  AND 

PRIVATE  TVORTH, 


<^*   . 


IS  RESPECTFULLY  DEDICATED, 


BY    HIS    FEIEND, 

AND    OBEDIENT    SEATANT, 

THE  AUTHOR. 


EDITOE^S   PREFACE. 


TT^EOM  the  date  of  its  publication,  in  1841,  Harris's  "  Principles 
-*-  and  Practice  "  has  taken  the  first  place  among  Dental  Text- 
Books —  a  precedence  which  the  author,  by  careful  revision  of  suc- 
ceeding editions,  maintained  for  twenty  years.  In  pursuance  of 
the  author's  plan,  the  present  editor  made  many  additions,  chiefly 
in  the  specialty  of  Mechanism,  to  the  first  posthumous  edition, 
issued  in  1863  and  republished  in  1866. 

The  great  advances  made,  since  the  death  of  the  author,  in 
Dental  Physiology,  Pathology,  Surgery,  and  Mechanism,  demand 
now,  for  the  maintenance  of  the  deservedly  high  reputation  of  the 
work,  a  revision  in  all  its  parts  more  complete  than  any  preceding 
one.  At  tlie  earnest  solicitation  of  the  author's  family  and  of  the 
publishers,  the  editor  has,  with  much  dif&dence,  undertaken  this 
task.  He  has  carefully  revised  that  part  which  an  experience  of 
twenty  years,  as  a  teacher,  has  made  him  competent  to  investigate. 
The  other  parts  he  assigned  to  gentlemen  of  acknowledged  profi- 
ciency in  their  respective  departments. 

To  Thomas  S.  Latimer,  M.  D.,  Prosector  in  the  Baltimore 
Dental  College,  was  assigned  Part  I.,  Anatomy  and  Physiology, 
and  a  portion  of  Part  II.  Minute  details  of  microscopical  and 
physiological  research,  and  the  full  discussion  of  speculative  the- 
ories, are  out  of  place  in  a  text-book.  Avoiding  such  minuteness, 
Dr.  Latimer  has-  given  the  present  state  of  Dental  anatomy,  physi- 
ology, and  pathology  in  a  manner  worthy  of  his  well-known  fine 
scholarship  and  extensive  professional  knowledge. 

To  Feedinaxd   J.  S.  GoRGAS,  M.  D.,  D.D.S.,  Professor   of 


viii  editor's  preface. 

Dental  Surgery  in  the  Baltimore  College,  was  assigned  the  re- 
mainder of  Part  II.  and  the  entire  Part  III.,  Surgery.  His  long 
experience  in  surgical  j^ractice,  and  as  a  teacher,  eminently  qualify 
him  for  a  revision,  the  excellence  of  which  will  be  acknowledged, 
whatever  the  difterences  of  opinion  and  practice  in  this  department 
of  Dentistry. 

Norman  W.  Kingsley,  D.  D.  S.,  late  Professor  in  the  New 
York  Dental  College,  has  prepared,  expressly  for  this  edition, 
the  entire  Chapter  on  Palatine  Defects.  His  world-wide  reputa- 
tion, in  this  Dental  Specialty,  is  ample  guarantee  for  his  faithful 
rendering  of  this  important  subject. 

To  each  of  these  gentlemen  was  given  entire  control  of  the 
extent  and  manner  of  revising  the  parts  severally  entrusted  to 
them ;  the  editor  having  simplified  the  author's  original  arrange- 
ment of  parts,  and  suggested  throwing  together  certain  chapters  and 
sections,  the  separation  of  which,  in  previous  editions,  was  a  source 
of  some  confusion. 

The  Editor,  in  his  revision  of  Part  IV.,  Mechanism,  has 
found  it  necessary  entirely  to  re-arrange  his  revision  of  1863,  and 
greatly  to  enlarge  it.  By  the  omission  of  some  obsolete  processes 
and  unimportant  details,  by  shortening  certain  descriptions,  and  by 
the  utmost  conciseness  consistent  with  clearness  of  explanation,  he 
has,  within  the  same  number  of  pages,  given  nearly  twice  the 
amount  of  information.  He  has  aimed  to  omit  no  subject  of  pres- 
ent or  prospective  importance.  As  a  teacher,  it  has  been  his  duty 
to  examine  all  subjects  impartially,  yet  to  express  very  decidedly 
his  own  views.  As  editor,  he  has  aimed  at  equal  impartiality, 
tempering  his  dissent  with  courtesy,  when  its  expression  is  neces- 
sary. 

The  last  ten  years  have  nearly  revolutionized  Dental  Mechanism, 
by  the  unprecedented  rapidity  with  which  hard  rubber  has  taken 
the  place  of  gold  and  other  materials.  Unfortunately,  this  change 
has  been  accompanied  by  certain  principles  and  methods  of  prac- 
tice which  have  greatly  injured  Dentistry  as  an  Art.  Reference  is 
made  to  this  evil  and  its  danger,  in  the  Introduction :  the  earnest 


EDITOE  S    PREFACE.  IX 

desire  to  aid  in  arresting  it,  is  the  editor's  only  apology  for  an  oc- 
casional severity  of  comment  found  in  this  Fourth  Part. 

The  editor's  name  is  sometimes  introduced  for  various  reasons, 
unnecessary  to  state ;  but  at  no  time  with  the  intention  of  arrogat- 
ing to  himself  the  exclusive  right  to  ideas  which,  very  probably, 
have  also  occurred  to  others,  and  been  acted  upon  within  the  limits 
of  their  practice.  It  is  altogether  unimportant  who  discovers  or 
makes  known  a  process  or  material ;  it  is  very  important  that  it 
should  not  be  lost  to  the  profession,  even  at  the  rather  mortifying 
risk  of  repeating  an  old  story. 

The  editor  acknowledges  the  courtesy  of  Dr.  Samuel  S.  White, 
in  tendering  the  free  use  of  so  many  of  his  valuable  wood-cuts. 
He  would  also  express  his  indebtedness  to  the  admirable  treatise 
of  Prof.  Joseph  Eichardson  for  a  number  of  very  fine  illustrations. 
To  Prof  Wildman,  and  others,  he  has  acknowledged  his  obliga- 
tions in  the  text. 

He  submits  to  the  Profession  the  Tenth  Edition  of  Harris's 
"  Principles  and  Practice  of  Dentistry,"  hoping  that  it  will  be  found 
to  meet  the  demands  of  the  present  advanced  state  of  Dental  Sci- 
ence, and  that  it  will  continue  to  be  what  its  distinguished  author 
designed  it  —  a  text-book  for  the  student,  and  a  useful  guide  and 
companion  for  the  experienced  practitioner, 

P.  H.  A. 
Baitimore,  May  1,  1871. 


PREFACE 

TO  THE   EIGHTH   EDITION. 


rpHE  Publishers,  in  preparing  this,  the  first  posthumous  edi- 
-*-  tion  of  the  late  President  Harris's  "  Principles  and  Prac- 
tice of  Dental  Surgery,"  have  spared  no  pains  to  make  it  in 
every  way  worthy  of  its  own  high  reputation  and  that  of  its 
distinguished  author. 

It  has  been  subjected  to  a  very  thorough  revision  by  compe- 
tent professional  gentlemen,  and  will  be  found  to  contain  many 
and  important  additions,  bringing  the  work  fully  up  to  the  pres- 
ent state  of  Dental  Science  and  Art. 

The  Publishers  desire  to  acknowledge  the  valuable  assistance 
rendered  by  Prof  Austen,  to  whom  they  are  indebted  for  the 
entire  chapter  on  Vulcanite,  most  of  the  chapter  on  Soldering, 
and  much  new  matter  in  the  chapter  on  Irregularity,  and 
throughout  the  entire  Mechanical  Division  of  the.  work.  They 
would  also  acknowledge  important  additions  by  Prof.  Christo- 
pher Johnston,  of  the  Baltimore  College,  a  valuable  section  on 
Artificial  Palates  by  Dr.  William  H.  Dwindle,  and  a  number 
of  useful  practical  suggestions  from  Dr.  Edward  Maynard. 

The  illustration  of  the  work  has  been  greatly  improved.  A 
few  unimportant  designs  have  been  omitted ;  several  others  have 
been  replaced  by  improved  drawings,  and  many  new  illustra- 
tions have  been  added,  for  a  large  number  of  which  they  are 
indebted  to  the  courtesy  of  Dr.  Samuel  S.  Wliite. 

The  Publishers  lay  this  edition  before  the  Profession  in  the 
confident  assurance  that  it  will  be  found  to  be  what  its  author 
designed  it  —  a  thorough  elementary  treatise,  a  text-book  for 
the  student,  and  a  useful  companion  and  guide  for  the  practi- 
tioner, xi 
Philadelphia,  September  1,  1863. 


PREFACE 

TO   THE    SECOND   EDITION. 


IN  submitting  to  the  profession  a  Second  Edition  of  his 
Dental  Practice,  the  author  is  happy  to  avail  himself  of  the 
opportunity  to  express  his  grateful  appreciation  of  the  appro- 
bation which  the  First  has  received.  He  trusts  that  the 
additions  which  he  has  made  to  the  primary  work  mil  make 
the  one  now  presented  still  more  acceptable.  The  alteration 
in  tlio  plan,  which  has  resulted  from  the  effort  at  improvement, 
has,  however,  rendered  a  slight  change  of  title  necessary,  in 
order  to  express  the  character  of  the  present  book. 

In  the  First  Edition,  the  Anatomy  of  the  Mouth  was  omitted, 
because  a  thorough  knowledge  of  it  can  be  obtained  from  works 
on  General  Anatomy.  But  it  has  been  suggested  that  such 
works  may  not  be  at  hand  when  wanted  by  the  dental  student, 
and  the  author  has  thought  it  better  to  furnish  a  description 
of  the  several  structures  which  enter  into  the  formation  of  this 
cavity.  He  has,  however,  confined  himself  to  brief  expositions 
of  the  parts ;  not  wishing  to  encumber  the  work,  or  distract  the 
student  with  the  consideration  of  matters  foreign  to  the  purpose 
for  which  it  was  written,  and  for  which,  he  trusts,  it  will  be 
read.  He  is  indebted  to  Bourgery's  Anatomy,  Quain  and 
Wilson's  Anatomical  Plates,  "Wilson's  Anatomy,  and  Smith 
and  Horner's  Anatomical  Atlas,  for  a  number  of  the  illustrations 
used  in  this  part  of  the  work. 

The  Second  and  Fifth  Parts  embody  the  substance  of  two 
papers  by  the  author,  which  were  written  subsequently  to  the 
publication  of  the  first  edition.  The  subjects  of  them  came 
properly  within  the  plan  of  the  present  work. 

The  object  of  the  author  in  the  preparation  of  this  edition 
has  been  to  provide  a  thorough  elementary  treatise  on  Dental 
Medicine  and  Surgery,  which  might  be  a  text-book  for  the 
student  and  a  guide  to  the  more  experienced  practitioner;  and 
he  hopes  that  the  modifications  he  has  introduced,  and  the 
additions  he  has  made,  will  entitle  it  to  be  so  considered,  at 
least,  until  an  abler  hand  shall  prepare  a  better. 


CONTENTS. 


INTRODUCTION. 
PART  FIRST. 

ANATOMY  AND  PHYSIOLOGY. 

CHAPTER  I. 

PAGJS 

Development  of  Cell  Doctrine 38 

CHAPTER  11. 

Anatomy  and  Physiology  of  the  Mouth 46 

CHAPTER  III. 

Osteology „ , 47 

CHAPTER  IV. 

Bones  of-  the  Mouth  and  Face. 

Superior  Maxillary 49 

Inferior  Maxillary 54 

Palate 56 

CHAPTER  V. 

Muscles  of  the  Mouth  and  Face. 

Myology 58 

Nasal  Group  of  Muscles 60 

Superior  Maxillary  Group 60 

Inferior  Maxillary  Group ■. 62 

Temporo-Maxillary  Group 62 

Pterygo-Maxillary  Group 64 

Lingual , 65 

Pharyngeal 66 

Palatal 68 

Soft  Palate,  Fauces,  and  Tonsils 69 

xiii 


xiv  CONTENTS. 

CHAPTER  VI. 

Blood-Ves.sei.s  of  the  Mouth  and  Face.  page 

Interuiil  Carotid  Artery "0 

External  Carotid  Artery  and  Branches 70 

Veins ""* 

CHAPTER  VII. 

Nerves  of  the  Mouth  axd  Face. 

Fifth  Pair  —  Trigemini 75 

Ophthalmic  Branches 75 

Superior  Maxillary  Branches 77 

Inferior  Maxillary  Branches... 79 

Facial  Nerve  and  Branches. 80 

CHAPTER  VIII. 

Salivary  Glands,  Tongue,  Gums. 

Parotid  Glands  and  Saliva 83 

Submaxillary  Glands • 85 

Sublingual  and  Mucous  Glands 8G 

Saliva  from  all  Glands 86 

Tongue 87 

Mucous  Membrane 88 

Gums  and  Periosteum 80 

Relations  of  the  Mouth,  Anatomical 90 

"                   "              Physiological 91 

CHAPTER  IX. 

The  Teeth. 

Deciduous  or  Temporary  Teeth. 92 

Permanent  Teeth  —  Incisors ' 93 

Cuspids  or  Canines ,'....  95 

Bicuspids  or  Pre-Molars 96 

Molars 97 

Articulation  with  Maxillae 98 

Comparison  of  Temporary  with  Permanent 98 

Antagonism  of  Upper  and  Lower 99 

Origin  and  Formation  of  Teeth 100 

Goodsir  on  Development lO-S 

Dental  Pulp  or  Nerve 109 

CHAPTER  X. 

Osseous  Tooth  Structures. 

Dentine 112 

Enamel 117 

Cement  um 120 

Structural  Classification 128 


COS'TENTS.  XV 

PAET  SECOND. 

PATHOLOGY  AND  THERAPEUTICS. 

CHAPTER  I. 

PAGE 

Genekal  Considerations , ,.,, 129 

CHAPTER  II. 

Classification  of   Teeth 136 

CHAPTER  III. 

Diseases  of  the  Mucous  Membeane. 

Stomatitis 143 

Erythematic 144 

Ulcerative 145 

Gangrenous 146 

Mercurial 150 

Scorbutic 151 

CHAPTER  IV. 

Diseases  of  the  Gums. 

General  Considerations 153- 

Inflammation,  Acute  and  Chronic 160 

Hypertrophy 170^ 

Mercurial  Inflammation 172 

Ulceration,  with  Exfoliation  of  Bone 17o- 

Adhesion  of  Gums  to  Cheek 177 

Tumors  of  the  Gums 178 

Cystic  Tumors 181 

CHAPTER  V. 

Salivary  Calculus. 

Classification  of  Varieties .^ 193 

Chemical  Composition 197 

Origin  and  Deposition.., 198 

Efi"ects  upon  Teeth,  Gums,  and  Alveoli 200 

Manner  of  Removing ■•-  202 

Mucous  Deposits  upon  Teeth ...-. -... 204 

CHAPTER  VI. 

The  Fluids  of  the  Mouth -■- 20o' 

CHAPTER  yil. 

Symptomatology  of  the  Lips 207" 


XVi  CONTENTS. 

CHAPTER  VIII. 

PAGE 

Symptomatology  of  the  Tongue 209 

CHAPTER  IX. 

Diseases  of  the  Dental  Pulp. 

General  Remarks 213 

Irritation 214 

Inflammation 219 

Spontaneous  Disorganization 227 

Fungous  Growth 228 

Ossification 229 

CHAPTERS  X.  — XIV. 

Diseases  of  the  Alveolar  Processes, 

X.  Periostitis 230 

XI.  Abscess 233 

XII.  Necrosis  and  Exfoliation 240 

XIII.  Absorption = 244 

XIV.  Hypertrophy  of  Walls  of  CA^aTiES 247 

CHAPTERS  XV.— XXII. 

Diseases  of  the  Teeth. 

XV.  Atrophy 248 

XVI.  Necrosis 255 

XVII.  Exostosis  258 

XVIII.  Denudation 261 

XIX.  Chemical  Abrasion 264 

XX.  Mechanical  Abrasion 266 

XXI.  Fractures,  and  other  Injuries 267 

XXII.  Caries  —  Classification...,., 270 

Liability  of  Teeth  to  Caries 273 

Causes  of  Caries 278 

Prevention  of  Caries 281 


PART  THIRD. 

DENTAL    SURGERY. 

CHAPTER  I. 

Prevention  and   Arrest   of   Caries    by  the  Use  of  Files  and  Enamel- 
Chisels  285 

CHAPTER  II. 

Arrest  of  Caries  by  the  Operation  of  Filling. 

General  Considerations 295 

Materials  used  for  Filling 297 


CONTENTS.  xvii 

PAGE 

Gold:  Non-adhesive  Foil 297 

Adhesive  Foil 298 

Crystal  or  Sponge 299 

Tin  Foil  and  Fusible  Alloys.... 300 

Amalgam 301 

Gutta-Percha :  Hill's  Stopping 302 

Os-Artificiel 303 

Formation  of  the  Cavity  303 

Instruments  used 304 

ules  for  shaping  Cavity 309 

Separation  of  Teeth  to  gain  Space 311 

Protection  against  Saliva 313 

Drying  the  Cavity 316 

Filling  the  Cavity:  Instruments  used 317 

Preparation  and  Use  of  Materials 319  , 

Non-adhesive  Foil:  Rope  and  Folds 319 

Redman's  Cylinders 322 

Pellets 325 

Adhesive  Foil  325 

Heavy  Foil 326 

Crystal  or  Sponge  Gold 327 

Condensation  of  Filling  with  Mallet 328 

Finishing  Surface  of  Filling 329 

Non-Conductors  over  Sensitive  Pulp 332 

Filling  Particular  Cavities  in 334 

Superior  Incisors  and  Cuspids 334 

Superior  Bicuspids  and  Molars 343 

Inferior  Incisors  and  Cuspids 349 

Inferior  Bicuspids  and  Molars 351 

Restoration  of  all  or  part  of  the  Crown 355 

CHAPTER   III. 

Filling  Teeth  over  an  Exposed  Nerve 361 

CHAPTER  IV.     . 

Filling  Pulp  Cavity  and  Roots  of  Teeth. 

General  Considerations 367 

Destruction  and  Removal  of  Pulp 370 

Preparation  of  Cavity  and  Root 375 

Operation  of  Filling  '■ 377 

CHAPTER  V. 

Causes  and  Treatment  of  Odontalgia 379 

CHAPTER  VI. 

ExTRjiCTION    OF    TeETH. 

General  Remarks • 386 

2 


XVUl  CONTENTS. 

PAOK 

Indications  for  Extraction 387 

Instruments 389 

Key  of  Garengeot 389 

Manner  of  Using 391 

Forceps:  Various  Forms 392 

Manner  of  Using 401 

Extraction  of  Roots 404 

CHAPTER  yil. 

Use  of  Anesthetics  in  Extkaction. 

General  Anaasthesia  by  Ether 410 

Cliloroform 410 

Nitrous  Oxide 412 

Other  Antesthetics 414 

Local  Anaesthesia  by  Cold 415 

Electro-Magnetism 417 

Spray  Apparatus 418 

CHAPTER  yill. 

Irkegularitt  in  Development  and  Arrangement  of  the  Teeth. 

General  Considerations 420 

Abnormal  Formation  and  Growth 421 

Osseous  Union  of  Teeth 422 

Supernumerary  Teeth 424 

Third  Dentition 425 

Method  of  Directing  Second  Dentition 430 

Abnormal  Arrangement 434 

Treatment  of  Irregularity 436 

Excessive  Development  of  Lower  Teeth 450 

Protrusion  of  Lower  Maxilla 452 

CHAPTER  IX. 

Dislocation  and  Fracture  of  the  Jaw 454 

CHAPTER  X. 

Diseases  of  the  Maxillary  Sinus 460 


PART  FOURTH. 

DENTAL     MECHANISM. 
Classification  of  Operations... ~ 485 

CHAPTER  I. 

Prosthesis  of  Dental  Organs 488 


CONTENTS.  XIX 

CHAPTER  II. 

Sqbstances  used  as  Dental  Substitutes.  page 

Human  Teeth 491 

Teeth  of  Cattle 492 

Elephant  and  Hippopotamus  Ivory 493 

Porcelain,  or  Incorruptible  Teeth 494 

CHAPTER  III. 

Different  Methods  of  Inserting  Teeth. 

Placed  upon  Natural  Roots 495 

Secured  by  Clasps 497 

Retained  by  Spiral  Springs 499 

Held  by  Atmospheric  Pressure 500 

CHAPTER  IV. 

Preparatory  Treatment  of  the  Mouth 503 

CHAPTER  Y. 

Preparation  of  Natural  Root  and  Attachment  of  Artificial  Crown...  507 

CHAPTER  VI. 

Refining  and  Alloying  Gold  and  Calculating  Fineness  of  Gold  Plate. 

Quality  of  Gold  for  Plate 521 

Refining  Gold 523 

Alloying  Gold 528 

Calculating  Fineness  of  Gold  Plate , 530 

CHAPTER  VII. 

Gold  Plate,  Spiral  Springs,  Gold  Solder. 

Ingot  Moulds 532 

Rolling  Mills 533 

Gauge-  and  Draw-Plates 535 

Gold  Solder 536 

CHAPTER  VIII. 

Cups  and  Materials  for  Impressions  of  the  Mouth. — Plaster  Models. 

Impression  Cups 538 

Impression  Materials 541 

Comparative  Value 547 

Plaster  Models 549 

CHAPTER  IX. 

Metallic  Dies  and  Counter-Dies.  —  Process  of  Swaging. 

Methods  of  Making  Dies  and  Counter-Dies 556 

Metals  used  for  Dies  and  Counter-Dies 561 

Processes  of  Swaging. ^ 566 

CHAPTER  X. 

Articulation,  or  Antagonism  of  Teeth 571 


XX  COJ^TENTS. 

CHAPTER  XI. 

Principles  and  Appliances  of  Solueeing.  page 

Principles  of  Soldeiiug 577 

Soldering  Lamps 578 

Blowpipes  :   Mouth 579 

Self-acting 5S0 

Mechanical , 581 

Hydrostatic 585 

Other  Appliances  of  Soldering 587 

CHAPTER  XII. 

Adjustment  of  Porcelain  Teetu  to  the  Plate.  —  Finishing  Process. 

Varieties  of  Porcelain  Teeth 589 

Dental  Lathes 590 

Grinding  and  Arranging  Teeth 593 

Investing  and  Backing  Teeth 595 

Soldering  Backings  to  Teeth  and  Plate 601 

Finishing  Process C03 

CHAPTER  XIII. 

Eetention  of   Base-Plates  in  the  Mouth.  —  Their  Size  and  Form   of  Out- 
line.—  Materials  of  Swaged  Plates. — Continuous-Gum  Work. 

Different  Methods  of  Eetention , 605 

Spiral  Springs 606 

Clasps:  Utility  and  Application 607 

Shape  and  Adjustment 610 

Partial  Clasps  or  Stays 614 

Size  and  Outline  of  Clasp-Plates 615 

For  Upper  Incisors 616 

For  Upper  Bicuspids 618 

For  Alternate  Spaces 620 

Atmospheric  Pressure  Principle  622 

Adhesion  of  Contact 625 

Vacuum  Cavity 628 

Various  Materials  of  Swaged  Plates 632 

Continuous-Gum  Work 638 

CHAPTER  XIV. 

Moulded  Plates,  or  Plastic  Work.  —  Cbramo-Plastic  Work. 

Classification  of  Plastic  Work 640 

Comparison  of  Varieties 641 

Ceramo-Plastic  Work..„ 642 

CHAPTER  XV. 

Metallo-Plastic  Work. — Vulcano-Plastic  AVork. 

Tin  and  its  Alloys 643 

Cheoplastic  Process 645 

Stanno-Plastic  Process 656 

Aluminum 659 

Alumino-Plastic  Process 662 

Refining  Aluminum 675 


CONTENTS.  Xxi 

PAGE 

Vulcano-Plastic  Work - 678 

Corallite gyg 

Vulcanite  :   History 679 

Compositioa  and  Varieties 680 

Effect  of  Vermilion • 681 

Vulcano-Plastic  Process:  Impressions 682 

Models  and  Articulators 683 

Selection  and  Arrangement  of  Teeth 685 

Vulcanizing  Flasks 688 

Forms  of  Flask 690 

Forms  of  Vulcanizer 691 

Thermometer  and  Steam-Gauge 693 

Vulcanizing  Lamp 696 

Preparation  and  Packing  of  Matrix 697 

Time  of  Vulcanizing 700 

Finishing  Process 703 

Repairing  and  Piefitting  Plates 705 

Vulcanite  Attachment  of  Teeth  to  Swaged  Plates 708 

Use  of  Vulcanite  for  Pivot-Teeth 710 

Directions  to  Patients 712 

General  Remarks  on  A'alue  of  Vulcanite 713 

CHAPTER  Xyi. 

Composition,  Manufacture,  and  ^Esthetics  of  Porcelain  Teeth. 

General  Considerations 716 

Porcelain  Materials:  Silica,  Feldspar 717 

Kaolin:  Coloring  Materials 718 

Formulas  for  Body  and  Enamel 719 

Process  of  Manufacture  of  Dental  Porcelain 720 

Esthetics  of  Dental  Porcelain,  with 722 

Illustrations  of  Form  and  Arrangement 726 

Carving  Blocks  for  Special  Cases 737 

Dr.  Calvert's  Method 741 

Porcelain  Plates.  —  Ceramo-Plastic  Work 743 

CHAPTER  XYII. 

Defects  of  the  Palatine  Organs. 

Classification  and  Description 745 

Fissure  of  the  Soft  Palate 749 

Staphyloraphy  :  History 749 

Early  Form  of  Operation 753 

Mr.  Cartwright's  Preparation  of  Patient 754 

Sir  Wm.  Fergusson's  Operation 757 

Fissure  of  Hard  and  Soft  Palate 758 

Obturators 762 

Kingsley's  Artificial  Palates 766 

Replacing  Accidental  Defects 766 

Replacing  Congenital  Defects 771 

Obturator  and  Palate  combined 775 

Construction  of  Artificial  Palates 778 


INTRODUCTION. 


DE:N'TISTRY  is  the  Science  and  Art  of  Medicine,  applied  to 
the  Dental  Organs.  Placed  at  the  beginning  of  the  ali- 
mentary canal,  these  organs  hold  an  important  relation  to  the 
digestive  function  and,  through  it,  to  the  entire  body.  They 
have  also  inseparable  connections  with  the  nervous,  circulatory 
and  respiratory  systems.  Hence,  whilst  their  preservation 
constitutes  an  important  Art  in  medicine,  the  Science  which 
teaches  their  structure,  functions,  diseases  and  treatment  must 
necessarily  be  comprehensive.  It  must  include  those  sciences 
which  lie  at  the  foundation  of  all  medical  art,  and  embrace  so 
much  of  physical,  mechanical  and  aesthetic  science  as  its  sjDecific 
duties  demand. 

The  Anatomy,  Physiology  and  Pathology  of  dentistry  differ 
in  no  respect  from  that  taught  in  medical  schools.  The  limits 
of  a  special  text-book  or  curriculum  of  study,  or  a  curtailment 
of  the  term  of  preparation  may  require  the  omission  of  some 
details,  to  give  op^^ortunity  for  a  fuller  exposition  of  others; 
but  a  dentist's  knowledge  of  these  fundamental  sciences  admits 
no  limitation,  except  that  imposed  by  mental  capacity.  A 
single  volume  upon  the  "  Principles  and  Practice  of  Dentistry  " 
must  of  necessity  be  rigidly  eclectic  in  those  sciences,  each  of 
which  occupies  many  volumes  for  its  full  exposition ;  whilst  it 
must  give,  in  complete  detail,  all  apphcations  of  science  to  its 
specific  duties.  Again,  the  eclecticism  of  teaching,  both  in  the 
office  and  the  college,  is  dependent  upon  the  time  over  which 
it  extends.  Thus  neither  printed,  oral,  nor  dem.onstrative  sys- 
tems of  instruction  can  be  taken  as  any  correct  measure  of  the 
amount  of  knowledge  essential  to  professional  excellence;  for, 
in  most  cases,  the  knowledge  thus  gained  is  insufficient  to  give 
fall  value  to  the  subsequent  lessons  of  ex[3erience.  The  prob- 
lem of  professional  education  is  one  of  difficult  solution.    While 


XXIV  INTRODUCTION. 

European  systems  seek  to  make  "  experts  "  of  students,  Ameri- 
can systems  are  content  to  make  tliem  "  experimenters."  The 
Old-world  regards  three  or  four  years  of  extra  study  a  small 
matter,  compared  with  the  lives  and  welfare  of  the  community: 
the  ^STew-world  considers  any  risk  preferable  to  such  delay  in 
entering  upon  the  practical  duties  of  life. 

The  Therapeutics  of  dentistry,  unlike  its  anatomy,  physiology 
and  pathology,  dilfers  from  that  taught  in  the  medical  schools. 
It  is  Medical,  Surgical  and  Prosthetic.  In  so  far  as  it  is  a  direc- 
tion of  medical  science  to  the  prevention,  modification  or  re- 
moval, by  medicinal  and  hygienic  remedies,  of  the  causes  and 
etfeets  of  disease  in  the  dental  organs,  it  forms  part  of  a  phy- 
sician's practice,  just  as  does  the  treatment  of  cerebral,  cardiac, 
or  pulmonary  disease.  In  so  far  as  it  is  an  application  of  sur- 
gical skill  to  the  extraction  of  teeth,  the  removal  of  tumors,  to 
the  treatment  of  fractures  or  to  staphyloraphy,  it  is  simply  Oral 
surgery,  invohdng  onl}^  such  knowledge  and  sldll  in  the  use  of 
instruments  as  every  surgeon  must  possess.  But  dental  thera- 
peutics includes  a  class  of  operations  not  taught  in  medical 
schools  and  not  practised  in  the  offices  of  physicians  or  sur- 
geons :  which,  for  their  successful  performance,  require  sur- 
roundings and  appliances  such  as  no  other  class  of  operations 
call  for ;  demanding  also  an  amount  of  time  and  special  expe- 
rience, which  it  IS  impossible  for  the  general  surgeon  to  devote 
to  any  one  part  of  the  bod3\  Hence,  by  universal  consent,  this 
branch  of  therapeutics,  under  the  name  of  Dental  Surgery,  is 
assigned  to  a  special  clas^  of  practitioners,  who,  like  the  oculist 
and  obstetrician,  perfect  their  art  by  limiting  the  sphere  of  its 
duties. 

The  prevailing  and  distinguishing  feature  of  dental  therapeu- 
tics IS  Prosthetics  —  the  art  of  replacement:  replacement  of 
dental  sfinicture,  in  such  manner  and  with  such  material  as  shall 
prevent  further  action  of  the  destructive  agencies ;  replacement 
of  dental  organs,  by  substitutes  which  shall  physiologically  re- 
store impairment  of  function  and  aesthetically  restore  the  nat- 
ural exi^ression  of  the  face.  The  medical  therapeutics  and  oral 
surgery  of  dentistry  are  insuflicient  to  establish  it  as  a  distinct 
branch  of  medical  art ;  whilst  the  operations  of  filing  and  regu- 
lating the  teeth  form  a  small  proportion  of  its  specific  duties. 
It  owes  its  extent  to  the  universal  liability  of  the  teeth  to  decay 


INTRODUCTION.  XXV 

•and  loss ;  it  owes  its  difficulty,  as  an  art,  to  the  complex  nature 
of  the  methods  by  which  this  loss  and  decay  must  be  remedied. 
In  other  words  Prosthetic  Mechanism  constitutes  by  far  the 
largest  and  most  difficult  part  of  dentistry,  makes  it  a  distinct 
branch  of  the  art  of  medicine,  and  gives  to  it  the  power  to  add 
as  it  does  to  health,  comfort,  and  the  enjoyment  of  life. 

The  physician,  surgeon  and  dentist  have  necessarily  many 
practical  duties  in  common;  but  each  has  a  clearly  defined 
limitation  of  sphere,  requiring  specific  direction  of  that  general 
culture  which  all  must  possess.  The  Physician  is  a  specialist ; 
for,  although  he  treats  diseases  which  afiect  more  or  less  the 
entire  body,  his  therapeutics  is  restricted  to  hygiene  and  the 
materia  medica,  and  there  are  many  accidents,  defects  and 
pathological  conditions,  which  are  beyond  the  reach  of  his  skill. 
Moreover,  the  physician's  specialty  tends  constantly  to  sub- 
division ;  nor  do  W6  look  for  the  most  valuable  contributions 
to  medical  science,  except  from  those  who  apply  themselves 
exclusively  to  some  one  class  of  diseases.  Few  minds  can  even 
approach  that  universality  of  genius,  which  characterized  Hip- 
pocrates and  John  Hunter  :  hence  devotion  to  a  specialty  of 
medical  art  detracts  nothing  from  the  position,  which  a  man's 
education  and  talent  entitle  him  to  assume. 

The  Surgeon  is  a  specialist,  although  few  confine  themselves 
to  a  practice  purely  surgical,  excejDt  in  cities  and  hospitals. 
Richerand  correctly  defined  the  specialism  of  surgical  therapeu- 
tics as  the  ^^  quod  in  thercqma  mechanicum  ;''  its  well-known  ety- 
mology conveys  the  same  idea.  Yet  the  element  of  mechanism 
and  necessity  for  the  exercise  of  "hand-craft"  enter,  more  or 
less,  into  all  physical  sciences.  Astronomy,  chemistry,  phar- 
macy, microscopic  analysis  and  modern  medical  diagnosis  de- 
mand extreme  accuracy  of  manipulation ;  and  all  great  discov- 
erers in  these  sciences  display  the  ability,  not  only  to  use,  but 
also  to  invent  and  construct  apparatus.  The  universal  recog- 
nition of  the  great  value  of  this  element  in  every  department  of 
Physics  has  given  the  scientific  world  a  more  correct  idea  of  the 
true  dignity  of  highly-educated  mechanical  skill  —  skill,  with- 
out which  the  physician's  art  is  crippled,  surgery  becomes  im- 
potent and  dentistry  has  no  existence. 

The  two  departments  of  dental  prosthetics.  Structural  and 
Organic,  are  usually  classified  as    Operative  and  Mechanical 


XXVI  INTRODUCTION. 

dentistry.  We  have  given  preference,  in  tiiis  work,  to  the 
terms  dental  Surgery  and  dental  Mechanics.  Another  classifi- 
cation is  dentistry  of  the  Chair  and  dentistry  of  the  Laboratory. 
Each  of  these  three  classifications  indicate  prevailing  charac- 
teristics, but  all  fail  to  point  out  the  true  basis  both  of  the 
unity  and  the  diversity  of  the  two  branches  of  dental  practice. 
The  editor  does  not  feel  at  liberty  to  deviate,  in  the  present 
volume,  so  widely  from  the  author's  arrangement :  yet  he  may 
here  suggest  the  following  classification  of  dental  therapeutics, 
or  the  Art  of  Dentistry.  I.  Medical.  11.  Surgical :  (1.  Oral 
surgery ;  2.  Dental  surgery.)  HE.  Prosthetic :  (1.  Structural ; 
2.  Organic.) 

As  medicine  and  surgery  are  combined  in  the  practice  of  the 
majority  of  medical  men,  so  the  two  classes  of  prosthetic  mechan- 
ism are  usually  practised  together :  but  such  practice,  although, 
in  a  large  number  of  cases,  unavoidable,  does  not  tend  to  the 
development  of  highest  excellence  in  either  department.  Cer- 
tain details  of  the  laboratory  unfit  the  hand  for  some  of  the  more 
delicate  operations  of  structural  prosthetics;  whilst  the  engross- 
ing and  more  remunerative  duties  of  the  chair  almost  ine^dtably 
lead  to  a  hasty  and  negligent  performance  of  laboratory  work. 
The  usual  method  of  meeting  this  difficulty,  that  is  by  dividing 
the  duties  of  organic  prosthesis,  cannot  be  too  severely  con- 
demned. It  is  like  requiring  an  artist  to  paint  a  correct  portrait 
from  verbal  description :  it  ignores  every  principle  of  dental 
Eesthetics,  and  its  results  are  artificial  dentures,  so  devoid  of 
expression  and  indi^dduality,  as  to  mar  the  features  they  are 
intended  to  adorn.  But  the  prosthetic  character  of  dentistry 
subjects  it  to  a  danger  more  serious  than  this  unwise  division 
of  inseparable  duties. 

Scientific  mechanism  implies  not  only  skill  in  construction, 
but  judgment  and  purpose  in  application.  Unfortunately  a  few 
months'  use  of  tools  enables  one,  who  has  natural  aptitude  in 
handling  them,  to  produce  specimens  of  workmanship,  which 
are  accepted  as  evidence  of  peculiar  fitness  for  dentistry.  K  no 
early  education  has  given  habits  of  study,  the  fascinations  of 
hand-work  are  permitted  to  engross  time,  that  should  be  given 
to  the  harder  and  more  distasteful  head-work.  The  training,, 
thus  commencing  and  ending  in  mechanism,  is  discreditable  not 
because  of  its  mechanism,  but  because,  being  one-sided  and 


INTRODUCTION.  XXvi'l 

partial,  it  necessarily  fails  to  accomplisli  tliat  wMcli  it  promises. 
Such  training  may  make  dental  laborers,  tradesmen,  or  artisans: 
but  never  dental  artists,  or  scientific  mechanicians :  nor  can  the 
dentistry  which  they  practise  be,  in  any  respect,  identified  with 
that  which  we  have  defined  as  a  branch  of  the  art  of  med- 
icine. 

A  preparation  begun  in  pure  science  may  end  in  correct 
practice,  and  the  early  habits  of  student-life  may  follow  the 
professional  man  throughout  his  career;  but  a  preparation,  be- 
gun in  practice,  will  end  there.  The  routine  of  professional 
duties  often  tempt  the  scholar  to  sink  into  the  mere  practitioner; 
it  is  rare  indeed  that  one  reverses  the  order  of  nature  and  sets 
aside  the  claims  and  emoluments  of  practice,  to  acquire  slowly 
those  habits  of  study  so  easily  learned  in  youth.  It  requires 
the  broadest  literary  and  classical  education  of  boyhood  to 
counteract  the  necessarily  narrowing  influence  of  the  profes^ 
sional  studies  of  manhood;  and  it  demands  the  largest  possible 
infusion  of  purely  scientific  teaching,  during  professional  pupil- 
age, to  correct  the  matter-of-fact  influence  of  practice.  In  this 
lies  the  great  error  of  American  practical  systems  of  education. 
They  teach  boyhood  to  take  a  utilitarian  view  of  every  lesson 
learned,  and  encourage  young  men  to  neglect  studies  in  which 
they  cannot  see  some  prospective  pecuniary  value.  It  is  the 
application  to  science  and  art,  of  that  philosophy  of  life,  which 
subordinates  mind  and  body  to  the  one  idea  of  making  a  living; 
that  spirit  of  trade,  which  regards  classical  study  a  waste  of  the 
years,  in  which  plastic  youth  can  best  be  moulded  into  the  mer- 
cantile idea  of  Profit  and  Loss.  Limitation,  first  in. the  amount 
of  mental  culture,  secondly  in  its  direction,  is  thus  made  to 
combine  with  the  inevitable  influence  of  all  exclusive  pursuit, 
whether  of  science  or  business;  the  result  is  a  rapid  increase,  in 
all  professions,  of  men  whose  vision  is  limited  by  the  narrow 
horizon  of  their  special  occupation,  and  who  possess  none  of 
that  large-minded  liberality,  which  is  the  outgrowth  of  a  gen- 
erous education.  It  is  by  such  early  restriction  of  thought  and 
action  within  the  narrow  grooves  of  life's  future  pursuits  that 
a  merchant  so  often  loses  all  power  to  enjoy  the  fruit  of  his 
toil,  a  physician  is  unknown  beyond  the  sick-room,  a  surgeon 
contributes  nothing  to  the  cause  of  science,  and  a  dentist  holds 
no  social  position.    This  inevitable  tendency  of  purely  practical 


XXVIH  INTRODUCTION. 

education  was  recognized  l)y  Lord  Brougham  when  he  recom- 
mended Dante,  as  a  text-book,  to  an  inquii-ing  student  of  law. 

The  antagonism  of  trade  and  pure  science  is  seen  not  only 
in  the  result  of  attempting  to  make  all  education  utilitarian. 
It  appears  whenever,  in  professional  life,  the  laws  of  barter 
come  to  be  applied  to  brain-work  and  its  products.  Mercantile 
relations  of  cost  and  price  are  capable  of  definite  adjustment, 
Avhen  applied  to  commodities  of  known  values,  enhanced  by 
labor  at  given  rates;  there  are  data  also,  upon  which  the  specu- 
lative fluctuations  of  prospective  supply  and  demand  are  based: 
so  that  in  all  bargains,  buyer  and  seller  may  stand  upon  the 
ground  of  equal  ability  to  judge  these  questions.  But  jDrofes- 
sional  service  is  amenable  to  no  such  standard :  the  client 
cannot  estimate  the  cost  of  his  lawyer's  pleading,  nor  can  the 
patient  know,  until  long  afterwards,  tlie  full  value  of  his  phy- 
sician's prescription.  The  conditions  of  honest  barter  are  absent, 
for  client  and  patient  are  alike  dependent  upon  the  integrity 
of  the  professional  man ;  hence  professional  bargaining  is  dis- 
honorable, and  inevitably  leads  to  the  rendering  of  a  disrepu- 
table grade  of  service.  The  common  practice  of  valuation  by 
the  visit  or  the  hour  is  so  manifestly  unequal  in  its  working, 
that  it  is  only  another  proof  of  the  impracticability  of  measuring 
science  and  art  work  by  commercial  standards. 

The  medical  fee  is  a  valuation  of  thought  and  skill,  exercised 
for  the  preservation  of  life  and  health.  On  the  part  of  the 
patient,  it  is  considered  a  gratuity,  by  those  who  fail  to  perceive 
the  elements  of  cost  in  such  work ;  a  compensation,  by  those 
who  recognize  an  equivalent  received;  an  acknowledgment, 
by  the  few  who  refuse  to  believe  that  money  can  adequately 
reward  such  service.  Viewed  from  the  professional  side,  the 
fee  has  nothing  to  do  with  the  quality  of  the  service,  nor  does 
it  enter  into  the  mind  of  any  right-thinking,  man,  whilst  ren- 
dering it.  Mr.  Ruskin  says  with  great  truth  "it  is  impossible 
for  a  well-educated,  intellectual  or  brave  man  to  make  money 
the  chief  object  of  his  thoughts;  yet  a  healthy-minded  man 
enjoys  the  honest  winning  of  money,  and  will  insist  upon  a  fair 
valuation  of  his  work.  But  ^vith  all  brave  men,  the  work  is 
first  and  the  fee  second;  whilst  there  is  a  vast  class,  ill  educated, 
cowardly,  and  more  or  less  stupid,  with  whom  the  fee  is  first 
and  the  work  second." 


INTRODUCTION.  XXIX 

All  professions  have  suffered  mncli  by  tliis  perverted  appli- 
cation of  mercantile  law  to  professional  fees;  but  none  so 
severely  as  dentistry.  This  is  due  to  the  prevalent  idea,  that  the 
gold  filling  and  the  artificial  denture  are  as  legitimate  objects 
of  barter  and  contract,  as  any  other  tangible  article  of  manu- 
facture :  whereas,  in  reality,  they  are  no  more  so  than  the 
surgical  operation,  or  the  medical  ad^dce.  "When  the  dentist 
forsakes  the  vantage  ground  of  a  professional  fee  for  "  services 
rendered,"  and  condescends  to  bargain  for  the  definite  products 
of  his  skill,  he  at  once  destroys  the  professional  character  of  his 
position,  ^ot  only  does  he  lose  caste;  but  in  the  class  to  which 
he  has  descended,  the  question  of  price  invariably  leads  to  con- 
siderations of  cost,  and  the  quality  of  his  work,  slowly  perhaps, 
but  surely  deteriorates.  .  The  disastrous  influence  of  vulcanite 
abundantly  proves  that,  when  cost  of  material  is  permitted  to 
enter  as  an  element  in  determining  the  value  of  scientific  art- 
work, it  inevitably  degrades  it;  and  the  entire  history  of 
prosthetic  dentistry  shows  that  competition  in  price  (the  devel- 
opment of  Mr.  Ruskin's  "fee  first  and  work  second")  is  fatal 
to  all  progress  in  art  or  advancement  in  science.  The  results 
of  such  competition  are,  to  honest  men,  a  life  o"^  slavish  toil, 
with  no  time  for  self-improvement;  to  others,  a  deliberate 
slighting  of  work  which  destroys  all  the  nobility  of  a  man's 
nature.  Dentistry,  thus  learned  and  thus  practised,  has  no  just 
claim  to  be  caPcd  a  profession ;  it  has  neither  the  liberality, 
generosity,  nor  culture,  which  men  are  accustomed  to  associate 
with  professional  life ;  and  its  pretentious  claims  serve  only  to 
call  to  mind  the  satire  of  Jitvenal,  "  Scire  volunt  omnes,  mer- 
cedem  solvere  nemo." 

Dentistry,  as  a  true  science  and  art,  is  built  upon  the  founda- 
tion of  a  generous  early  education,  is  enlightened  by  a  complete 
medical  course  of  instruction,  is  specially  trained  by  a  full  term 
of  practical  pupilage,  and  recognizes  no  sliding-scale  in  the 
quality  of  the  service  it  renders.  Such  dentistry  will  exercise 
influence  in  its  own,  and  command  respect  among  kindred, 
professions ;  for  it  becomes  thus  a  curative  work,  second  in  im- 
portance and  extent  of  its  usefulness  to  no  specialty  of  the  great 

Art  of  Healing. 

P.  H.  A. 


PART    FIRST. 


ANATOMY,  PHYSIOLOGY. 


XXXI 


Fig.  I.    rig.  1. 


rig.  5. 


Youngest  layer. 


UiJJlc  layer. 


Prclnctlon  nf  fnrmcil  mntcrinl  fromFrnolnKi  tuwtcr  In  EplthelUl  oeUa,  from  aectloD  Uirou^'j  l^erui  EpItbeUom 
Corcriug  papUlj}  of  tlio  tuui^uu.     X  700. 


Fig.  to. 


'/ 


-V 


FORMATION  OP  PCS. 

To  Illostrate  the  change  In (rcrmlnalmrti'T  of  nn  Enithclial  cell.  rcmilCngft-omincrenfeanotTltirn,  showing  tli« 

manner  iu  wbicb  thdgcrmiaai  uiaUur  cl  a  uoiiual  cell,  if  supplied  frcelir  tritli  pabulum,  may  ;i\  e  riae  to  pua. 

F  •    '.  <  Fig.  12.  Fig. «. 


\-\i% 


a,  Sorcolcmmo.    6,  Contractile  matter. 
MUSCLE. 


Young. 


Fig.  a. 


ELASTIC  TISSUE. 


The  arrow  shows  tlie  direction  in  irbich  germinal 
matter  \»  suppaiied  to  be  uoviog 


( 


Fig.  IS. 


/ 


KERVK. 

DerclopTncnt  of  young,  dark-Uordcrcd  nerre  fibres,  at  an  early 
peril)  1,  Bliowini;  prmlnal  msuer  and  formed  material  of 
elementary  parts.     X ISOO. 


Fig.  n. 


KeiT  centre  or  nucicolos. 


crmuukl  voMXijBr  inucleu. 


JMfEBA. 
rarenrTmiaai  matter.      XSOOO. 


r^innte  of  pabuiur 


PLATE  ILLUSTRATING  DE.  BEALE'S  VIEWS, 


From  Tyeon'e  Cell  Doctrine. 


THE 


PRINCIPLES  AND  PRACTICE 


OP 


DENTISTRY. 


CHAPTER  I. 

DEVELOPMENT   OF   THE   CELL   DOCTRINE. 

THE  point  of  departure  in  the  study  of  anatomy  and  physiology, 
of  all  the  phenomena  of  life,  indeed,  is  the  cell ;  and  so  general 
is  the  attention  now  directed  to  this  point  of  investigation  by  scientific 
and  learned  men  of  all  classes,  that  no  work,  professing  to  treat  of 
physiology,  can  be  considered  complete  that  does  not,  at  least,  give  an 
epitome  of  the  most  popular  views  on  the  subject  of  cell  constitution 
and  cell  growth.  Before  directing  attention  to  that  theory  which,  in 
the  opinion  of  the  writer,  seems  most  worthy  of  acceptance,  we  propose, 
therefore,  to  give  a  very  brief  exposition  of  the  state  of  scientific  in- 
formation on  this  subject,  together  with  a  statement  of  those  investiga- 
tions that  have  finally  culminated  in  the  present  accepted  views;  and 
then,  with  as  much  brevity  as  is  compatible  with  clearness,  state  that 
doctrine  which  seems  to  embody  most  of  truth,  without  pausing  to 
consider  the  objections  that  may  have  been  brought  against  it.  In 
1670,  Malpighi  recognized  the  blood  corpuscles,  and"  elaborately  in- 
vestigated the  cell  structure  of  plants,  to  which  Robert  Hook  had 
called  attention,  1667.  He  showed  that  the  "cells,"  or  "vesicles," 
were  separable,  that  each  "cell"  was  an  independent  entity,  to  which 
he  gave  the  name  "  utriculus."  In  1687,  the  blood  corpuscles  were 
well  described  by  Leuwenhoeck,  who  also  discovered  the  spermatozoids, 
which  he  believed  to  be  sperm  animals  of  distinct  sexes.  Haller  was, 
however,  the  first  to  attempt  to  construct  the  tissues  by  the  association 
of  their  ultimate  anatomical  elements.  His  elements  were  the  "  fibre  " 
8  33 


34  DEVELOPMENT    OF    THE    CELL    DOCTRINE. 

and  an  "  organized  concrete,"  the  office  of  the  latter  being  simply  to 
bind  the  fibres  together  as  a  glue.  Wolf,  in  1759,  advanced  the 
theory,  that  in  a  clear  viscous  tluid  without  organization  of  any  kind, 
cavities  were  developed,  which,  if  rounded  or  polygonal,  became  cells; 
if  elongated,  vessels ;  and  that  the  law  was  the  same  for  both  plants 
and  animals,  except  that  in  the  plants  the  cells  were  finally  separated 
from  each  other,  whilst  "  in  the  animals  they  always  remained  in  com- 
munication. In  each  case  they  are  mere  cavities,  and  not  independent 
entities ;  organization  is  not  effected  by  them,  bxit  they  are  the  visible  re- 
sults of  the  organizing  power  inherent  in  the  living  mass,  or  what  Wolf 
calls  the  vis  essentialis."  *  Mailer's  doctrine  continued,  however,  to  main- 
tain ascendency  until  near  the  close  of  the  eighteenth  century,  when 
it  gave  place  to  the  "globular"  theory,  originally  advanced  by  Leu- 
wenhoeck  in  1687,  but  which  had  attracted  little  attention  at  that  time. 
Near  the  close  of  the  eighteenth  century,  quite  a  formidable  array  of 
great  names  are  associated  with  it.  The  term  "globule,"  understood 
by  most  writers  of  this  day  to  mean  a  spherical  body,  with  a  dark  out- 
line and  a  bright  centre,  was  then  used  indiscriminately  with  granule 
and  molecule,  which  are  now  commonly  held  to  be  bodies  of  inde- 
terminate shape,  though  Virchow  and  other  German  writers  sometimes 
use  them  as  convertible  terms.  "  Prochaska,  in  1779,  described  the 
brain  as  made  up  of  globules  eight  times  smaller  than  blood  globules. 
In  the  year  1801,  the  philosojjhic  mind  of  Bichat  elaborated  his  ex- 
cellent classification  ;  but  he  seems  to  have  made  no  original  investi- 
gations in  minute  structure,  or  to  htive  adopted  any  special  theory  of 
an  ultimate  physical  element.  The  brothers  Joseph  and  Charles 
Wenzel,  in  1812,  described  the  brain  as  composed  of  globules  of  small 
size.  Among  the  earliest  histologists  worthy  of  mention  is  Treviranus, 
whose  elements,  according  to  Henle,  were  first,  a  homogeneous,  form- 
less matter ;  second,  fibres ;  third,  globules  (Kiigelchen).  Mr.  Bauer, 
quoted  as  a  most  experienced  microscopic  observer  by  Sir  Everard 
Home,  in  1818,  and  again  in  1823,  describes  the  ultimate  globules  of 
the  brain,  and  of  muscular  fibre,  as  of  the  size  of  a  globule  of  blood 
deprived  of  its  coloring  matter,  or  about  tto'utj  ^^  ^^  ^^^ch  in  diameter. 
The  fibre  was  excluded  as  an  ultimate  element  of  organization  by 
Heusinger  in  1822-4,  who  started  all  tissues  from  the  globule,  still, 
however,  retaining  the  formless  material  of  Haller  and  Treviranus. 
Heusinger  formed  the  fibre  by  the  linear  apposition  of  the  globular 
elementary  parts,  and  even  explained  how  canals  and  vessels  W'ere 
formed  by  a  similar  arrangement  of  vesicles  which  had  originated 
from  the  globules»"t     Milne  Edwards  must   be  credited  more  than 

*  Huxley,  as  quoted  in  Tyson's  Cell  Doctrine.      f  Tyson's  Cell  Doctrine,  23. 


DEVELOPMENT    OF    THE    CELL    DOCTRINE.  35 

any  other  writer  with  the  establishment  of  the  globular  doctrine.  He 
held  that  all  tissues,  both  animal  and  vegetable,  were  formed  by  the 
aggregation  of  globules.  Baumgartner  and  Arnold  maintained  a 
somewhat  similar  doctrine.  Dr.  Hodgekins  showed  the  fallacy  of  Ed- 
ward's view,  and  the  globular  theory  began  to  lose  ground  except  in 
the  more  limited  sense  of  "granule."  Dr.  Robert  Brown,  in  1833, 
discovered  the  nucleus,  though  he  seems  not  to  have  appreciated  its 
importance.  Raspail,  in  1837,  tells  us  that  development  takes  place 
from  "cells"  or  vesicles,  capable  of  indefinite  multiplication,  endowed 
with  life,  and  capable  of  absorbing  oxygen,  and  of  spherical  form ; 
that  the  cell  is  made  up  of  atoms  crystallizing  about  an  ideal  centre, 
the  cell  being  represented  by  the  crystal  rather  than  the  atoms  of 
which  it  was  composed.  Dutrochet  held  that  the  solids  and  fluids  of 
the  body  were  alike  composed  of  cells ;  that  in  the  solids  they  were 
more  closely  attached,  while  in  the  liquids  they  moved  freely,  whilst 
other  structures,  also  composed  of  cells,  were  difficult  to  refer  either  to 
the  solids  or  liquids.  Animal  fibres  he  considered  made  up  of  elon- 
gated cells,  and  that  vegetable  structures  were  formed  on  the  same 
general  plan.  After  the  discovery  of  the  nucleus  by  Dr.  Robert 
Brown,  it  was  observed  by  quite  a  number  of  investigators,  among 
whom  were  Valentin,  Purkinje,  Turpin,  Schultze,  Rudolph,  Wagner, 
and  Henle,  most  of  whom  had  observed  the  development  of  cells 
about  a  pre-existing  nucleus ;  and  Valentin  had  traced  in  the  nucleus  of 
epidermic  cells  a  resemblance  to  the  nucleus  of  vegetable  cells,  and 
had  shown  in  the  crystalline  lens,  and  in  muscular  fibre,  the  develop- 
ment of  fibres  from  cells,  while  Quatrefages  and  Dumourier  had  ob- 
served the  origin  of  young  cells  from  old  in  the  embryo  of  the  snail, 
all  before  the  appearance  of  Schleiden's  work.  To  Schleiden  is  due 
the  credit  of  first  establishing  (1838)  a  uniform  system  of  cell  de- 
velopment in  vegetable  structusss,  of  which  the  cell  was  the  unit, 
and  to  Schwann  the  extension  of  the  theory  to  animal  structures.  To 
the  nucleus  Schleiden  gives  the  name  "  cytoblast,"  or  cell  germ.  He 
also  calls  attention  to  the  nucleolus,  which  he  thinks  is  formed  before 
the  cytoblast.  "The  entire  growth  of  the  plant,"  says  he,  "consists 
only  of  the  formation  of  cells  within  cells."  Schwann  applied  Schlei- 
den's theory  of  vegetable  growth  to  animal  tissues.  The  nucleolus  is 
first  formed  in  a  granular  or  structureless  cytoblastema,  and  around  it 
is  deposited  a  substance,  granular  or  structureless,  in  which  new  mole- 
cules are  deposited  between  those  already  formed  around  about  the 
nucleolus,  thus  forming  the  nucleus.  When  this  deposition  "  goes  on 
equally  throughout  the  entire  thickness  of  the  stratum,  the  nucleus 
may  remain  solid ;  but  if  it  goes  on  more  vigorously  in  the  external 
part,  the  latter  will  become  more  dense,  and  may  become  hardened 


36  DEVELOPMENT    OF    THE    CELL    DOCTRINE. 

into  a  membrane,  and  such  are  the  hollow  nuclei."*  After  reaching 
a  certain  stage,  there  is  deposited  about  the  nucleus  a  stratum  of  sub- 
stance, differing  from  the  cytoblastema,  by  whicli  the  complete  cell  is 
formed.  This  substance  may  be  either  homogeneous  or  granular,  more 
frequently  the  latter.  At  first  the  cell  wall  and  cell  cavity  cannot 
be  distiniiuished  from  each  other;  but  as  the  deposition  continues,  the 
cell  wall  becomes  denser  and  more  clearly  defined,  until  the  external 
layer,  when  the  stratum  is  thick,  or  the  entire  stratum,  when  it  is 
thin,  becomes  consolidated  into  a  membrane,  whilst  many  cells  that 
seem  to  be  continuously  solid,  present  only  a  little  greater,  density  on 
the  surface.  After  the  formation  of  the  membrane  it  continues  to  grow 
by  the  pontinued  deposition  of  new  molecules  between  the  pre-existing 
ones,  becoming,  at  the  same  time,  separated  from  the  nucleus  ;  the 
space  tlius  left  subsequently  becomes  filled  with  fluid.  Thus,  Schlei- 
den  and  Schwann  seem  to  have  anticipated  most  of  -what  is  now 
known  in  refei-ence  to  tissue  formation  from  cells,  whilst  differing  con- 
siderably from  present  theories  concerning  the  growth  of  the  cell 
itself,  and  the  situation  of  its  nucleus,  which  they  placed  near  the  cell 
wall,  while  most  writers  of  the  present  day  place  it  centrally,  though 
not  uniformly  so ;  nor  do  more  recent  writers  hold  that  either  the  cell 
wall  or  nucleus  is  essential  to  the  ultimate  anatomical  element,  as  was 
held  by  them.  Henle,  in  1841,  recognized  three  modes  of  cell  forma- 
tion,—  budding,  endogenous  growth,  and  segmentation,  —  which  latter 
had  been  denied  by  Schleideu  and  Schwann  ;  nor  did  he  seem  to  recog- 
nize the  nucleus  as  an  essential  part  of  the  cell.  Eichart,  in  1840, 
failed  to  find  it  uniformly  present.  Karsten,  in  1843,  stated  "  that  cells 
originate  without  a  pre-existing  nucleus,  and  by  the  expansion  of 
amorphous  granules  of  organic  matter."  Kolliker,  in  1844,  dissented 
from  the  idea  of  a  single  method  of  cell  formation,  and  Mr.  Paget,  in 
1846,  "  declared  that  cells  might  arise  in  some  other  way  than  from  a 
nucleus."  In  1841,  Dr.  Martin  Barry  writes,y  "I  am  very  much  in- 
clined to  believe  that  in  the  many  instances  in  which  authors  on  '  cells 
have  described  and  figured  more  than  one  nucleolus  in  a  nucleus,  there 
has  been  either  an  apparent  division  of  the  nucleus  into  discs,  or  the 
nucleus  has  consisted  of  two  or  more  discs  ;  the  nucleoli  of  those  authors 
have  been  the  minute  and  highly  refracting  cavities  or  depressions  in  the 
discs.  If  this  has  really  been  the  case,  it  affords  additional  evidence,  I 
think,  that  reproduction  of  cells  hy  the  process  I  have  described,  namely, 
division  of  the  nucleus  of  the  present  cell,  is  universal,  so  numerous  have 
been  the  instances  in  question.'  ....  The  nuclei  which  various  ob- 
servers have  found  lying  among  the  fibres  of  various  tissues,  have 

*  Schwann,  as  quoted  by  Tyson,  p.  48. 

t  Philosophical  Transactions  for  1841,  pp.  207,  208. 


DEVELOPMENT    OF    THE    CELL    DOCTRINE.  37 

been  considered  by  them  as  the  '  remains  of  cells.'  This  may  have 
been  the  case ;  but  so  far  from  thinking,  with  those  observers,  that  the 
nuclei  in  question  were  '  destined  to  be  absorbed,'  I  am  disposed  to 
consider  that  they  are  sources  from  which  would  have  arisen  new 
cells."  In  1845,  Prof.  John  Goodsir  published  a  paper  on  "  Centres 
of  Nutrition,"  in  which  is  embodied  the  two  most  important  facts  in 
the  cell  doctrine  of  this  day,  viz. —  the  activity  of  these  centres  (nuclei ), 
the  manner  in  which  they  derive  nutriment  from  the  capillaries  or 
other  sources,  distributing  it  "  by  development  to  each  organ  or  tex- 
ture after  its  kind,"  and  the  development  of  all  such  centres  from  pre- 
existing centres  or  nuclei.  *  "  As  the  entire  organism  is  formed  at 
first,  not  by  simultaneous  formation  of  its  parts,  but  by  the  successive 
development  of  these  from  one  centre,  so  the  various  parts  arise  each 
from  its  own  centre,  this  being  the  original  source  of  all  the  centres 
with  which  the  part  is  ultimately  supplied."  Thus,  not  only  does  the 
whole  organism  consist  of  "  simple  or  developed  cells,"  with  an  inde- 
pendent vitality,  "  but  that  there  is  in  addition,  a  division  of  the  whole 
into  departments,  each  containing  a  certain  number  of  developed  cells, 
all  of  which  hold  certain  relations  to  one  central  or  capital  cell,  around 
which  they  are  grouped.  It  would  appear  that  from  this  central  cell 
all  the  other  cells  of  its  department  derive  their  origin.  It  is  the 
mother  of  all  those  within  its  own  territory."  He  divides  these  centres 
of  nutrition  into  two  kinds  —  those  that  are  "peculiar  to  the  textures, 
and  those  that  belong  to  the  organs."  The  former  are  generally  perma- 
nent, whilst  the  latter  last  only  during  embryonic  life,  and  finally  dis- 
appear or  "break  in  the  various  centres  of  the  textures  of  which  the 
organ  is  composed."  "A  nutritive  centre,  anatomically  considered,  is 
merely  a  cell,  the  nucleus  of  ivhich  is  the  permanent  source  of  successive 
broods  of  young  cells."  Prof  Huxley  taught,  in  1853,  that  vitality 
Was  "  a  property  inherent  in  certain  kinds  of  matter,"  and  that  there 
is  a  condition  of  all  kinds  of  living  matter,  in  which  it  is  simply  an 
amorphous  germ,  possessing  no  structure,  its  external  form  depending 
exclusively  on  physical  laws,  and  that  the  successive  differentiations 
or  changes  of  this  amorphous  mass  will  depend  on  previously  existing 
conditions.  This  differentiation  may  be  of  two  kinds,  in  "unicellular 
organisms"  it  is  "external ;"  that  is,  is  concerned  only  in  the  shape 
of  the  organism,  without  reference  to  any  internal  structure ;  but  in 
all  higher  organism  the  external  differentiation  is  preceded  or  accom- 
panied by  an  internal  change,  and  the  "homogeneous  germ"  is  con- 
verted into  a  central  portion  or  endoplast  and  a  peripheral  or  periplast, 
thus  constituting  the  germ  a  vesicle  with  a  nucleated  centre.  He  said 
there  was  "  no  evidence  whatever  "  that  the  vital  forces  were  resident 

*  Tyson,  p.  46, 


38  DEVELOPMENT    OF    THE    CELL    DOCTRINE. 

exclusively  in  either  the  endoplast  or  the  periplast,  or  that  they  exerted 
any  attraction  over  each  other;  that  thougli  they  were  in  harmony,  the 
changes  which  tliey  subsequenily  underwent  had  no  "  causal  'con- 
nection." That  the  endoplast,  so  far  from  being-  the  seat  of  especial 
vital  action,  underwent  no  morphological  change  whatever,  except 
growth  and  division,  while  the  ])orij)last  was  the  subject  of  the  most 
important  metamorphic  changes,  morphological  and  chemical ;  by  its 
differentiation  all  the  various  tissues  are  produced  through  molecular 
changes  in  its  structure,  under  the  guidance  of  the  vital  force.  This 
metamorphosis  of  the  periplast  is  of  two  kinds,  "  chemical  and  struc- 
tural,"—  the  former  may  consist  in  "conversion,"  as  of  cellulose  into 
xylogen,  etc.,  or  in  "deposit,"  as  of  earthy  matter  in  the  bone  of  ani- 
mals, and  in  plants. 

The  peculiarities  of  Prof.  Huxley's  doctrine  at  that  time  were  the 
substitution  of  the  term  "endoplast"  for  "nucleus,"  "periplast"  for 
"  cell  wall;"  the  perfectly  passive  nature  of  the  "  endoplast "  as  well  as 
of  the  periplast,  so  far  as  the  determination  of  change  was  concerned, 
though  itself  the  seat  of  very  active  change.  He  also  held  that  the 
*'  vital  phenomena  arc  not  necessarily  preceded  by  organization,  nor 
are  in  any  way  the  result  or  effect  of  formed  parts,  but  that  the 
faculty  of  manifesting  them  resides  in  the  matter  of  which  living  bodies 
are  composed  as  such ;  or,  to  use  the  language  of  the  day,  that  the  vital 
forces  are  molecular  forces."  He  also  denied  the  invariable  presence 
of  the  nucleus,  and  believed  that  all  cell  development  occurred  by 
division,  except  in  some  vegetable  organism  which  he  specified. 

Dr.  J.  Hughes  Bennett  also  held  that  the  "ultimate  parts  of  organi- 
zation" were  not  "cells  "  or  "nuclei,"  but  the  "molecules"  of  which  they 
were  formed ;  and  that  these  molecules,  by  virtue  of  some  "  independent 
physical  and  vital  property  "  were  enabled  to  unite  so  as  to  form  the 
various  tissues.  To  these  molecules  he  gives  the  names  "  histogenetic," 
or  "  tissue  forming,"  and  "  histolytic,"  or  disintegrative.  With  him  the 
first  step  in  organization  is  the  formation  of  an  "  organic  fluid,"  and 
the  precipitation  therefrom  of  "organic  molecules,"  from  which,  ac- 
cording to  the  molecular  theory,  "  all  textures  are  derived."  He  is 
also  an  advocate  of  spontaneous  generation,  and  "admits  the  produc- 
tion of  cells  by  buds,  division  or  proliferation,  without  a  new  act  of 
generation."  As  late  as  1856,  Messrs.  Todd  and  Bowman  are  found 
advocating  the  free-cell  formation  theory  of  Schleiden  and  Schwann. 
They  say,  taking  up  the  ovum  after  fecundation,  "  at  this  period  the 
embryo  consists  of  an  aggregate  of  cells,  and  its  further  growth  takes 
place  by  the  development  of  new  ones.  This  may  be  accomplished  in 
two  ways  :  first,  by  the  development  of  new  cells  within  the  old,  through 
the  subdivision  of  the  nucleus  into  two  or  more  segments  and  the  forma- 


DEVELOPMENT    OF    THE    CELL    DOCTEINE.  39 

tion  of  a  cell  around  each,  which  then  becomes  the  nucleus  of  a  new 
cell,  and  may  in  its  turn  become  the  parent  of  other  nuclei ;  and 
secondly,  by  the  formation  of  a  granular  deposit  between  the  cells,  in 
which  the  development  of  the  new  cells  takes  place.  The  granules 
cohere  to  each  other  in  separate  groups  here  and  there,  to  form  nuclei, 
and  around  each  of  these  a  delicate  membrane  is  formed,  which  is  the 
cell  membrane.  The  nuclei  have  been  named  cytoblasts,  because  they 
appear  to  form  the  cells;  and  the  granular  deposit  in  which  these 
changes  take  place  is  called  cytoblastema."  *  In  one  of  these  ways, 
according  to  these  observers,  all  cells  are  formed;  the  precise  manner 
in  which  the  tissues  are  formed  from  the  cells,  they  declare  themselves 
unable  to  state. 

The  probable  changes  which  occur  in  the  cell,  they  describe  under 
two  heads, —  those  that  take  place  in  the  cell  membrane  and  those  that 
take  place  in  the  nucleus.  In  all  real  or  apparent  fibrous  structures,  as 
"  areolar  and  fibrous  tissues,  the  cell  membrane  becomes  elongated," 
and  gives  the  appearance  of  being  divided  into  minute  fibres  ;  in  the 
tissues  which  are  composed  of  homogeneous  tubes  filled  with  a  peculiar 
substance,  the  cells  become  attached  end  to  end,  the  partition  is 
absorbed,  and  the  tube  formed  in  which  is  deposited  the  proper  nerve 
or  muscular  substance.  The  capillaries  are  likewise  formed  by  the 
coalescence  of  the  cells  at  many  points  by  pointed  processes  which  are 
given  oflT  from  them.  Dr.  Carpenter  also  gives  in  detail  the  mode  of 
free  cell  development  as  "  one  of  two  principal  modes  "  in  which  cells 
"may  originate,"  whilst  at  the  same  time  he  declares  himself  an  advo- 
cate of  the  views  entertained  by  Dr.  Lionel  Beale.  Prof.  Virchow,  on 
the  other  hand,  in  his  "  Cellular  Pathology,"  published  in  1858,  states 
that  cells  can  only  originate  from  pre-existing  cells,  and  describes  the 
typical  cell  as  consisting  of  "  cell  wall,"  "  cell  contents,"  nucleus,  and 
in  the  fully  developed  cell,  usually  a  "nucleolus,"  though  it  is  not 
essential.  Later,  he  is  reported  as  holding  f  "  that  a  nucleus  surrounded 
by  a  molecular  blastema  was  sufficient  to  constitute  a  cell; "  the  "  cell  wall " 
being  unessential.  The  cell  he  considers  the  centre  of  activity  beyond 
which  life  cannot  be  removed,  and  from  it  proceed  all  physiological  and 
pathological  processes,  and  though  each  cell  is  an  independent  centre  of 
vitality,  yet  as  they  are  necessarily  associated  in  the  construction  of  vari- 
ous tissues,  they  are  in  so  much  mutually  dependent ;  and  as  they  are 
severally  associated  for  the  attainment  of  particular  ends,  he  divides  them 
into  certain  districts  or  "  cell  territories,"  as  previously  taught  by  Good- 
sir,  the  intercellular  substance  deriving  peculiar  properties  from  its  par- 
ticular association.   On  the  nucleus,  according  to  this  writer,  depends  the 

*  Todd  and  Bowman,  Physiological  Anatomy,  p.  63,  Amer.  Edit.,  1857. 
f  Tyson's  Cell  Doctrine,  p.  61. 


40  DEVELOPMENT    OF    THE    CELL    DOCTRINE. 

lite  of  the  cell,  while  to  the  cell  contents  over  and  above  the  nucleus 
belongs  the  function  of  the  structure,  neurility,  contractility,  secretion, 
for  nerve,  muscle,  and  gland  respectively.     Nor  does  he  believe  in  the 
oo-called  etlusioiis,  holding  rather  tliat  all  plastic  deposits  are  the  result 
of  excessive  cell  proliferation  of  the  tissue  concerned,  and  are  not  an  effu- 
sion from  the  blood,  as  is  thought  by  Beale ;  nor  does  he  except  even  fibrin 
found  external  to  the  bloodvessels.    Another  peculiarity  of  his  doctrine 
is  —  not  as  Schleiden  and  iSclnvann  taught,  and  as  is  generally  believed, 
that  all  tissues  healthy  or  morbid  result  from  the  apposition  of  cells  — 
that  all  physiological  and  pathological  growths  result  from  si.  particular 
cell,  the  cell  of  the  connective  tissue;  from  it  are  formed  muscular  and 
nerve  fibres,  and  by  the  too  rapid  proliferation  of  these  cells  pus  is 
formed,  and  by  their  perverted  growth  tubercle,  cancer,  and  all  morbid 
growths  ;  though  he  admits  that  pus  may  also  be  formed  in  the  develop- 
ment of  epithelium,  either  of  mucous  membrane  or  cuticle ;  and  lastly, 
he  supplements  the  lymphatic  and  capillary  systems  by  a  peculiar 
system  of  tubes  or  canals,  resulting  from  the  anastomosis  of  one  cell 
with  another,  which  he  classes  with  the  gi-cat  canalicular  system,  and 
to  it  refers  the  "  cord-like  fibres  of  yellow  elastic  tissue,"  which  he 
thinks  originate  in  the  connective  tissue  corpuscle.     Singularly  enoutrh, 
after  stating  that  every  tissue  is  formed  from  cells,  he  says,  that  "  pure 
white  fibrous  tissue  docs  not  have  its  origin  in  cells,  but  is  a  modifica- 
tion of  a  previously  homogeneous  intercellular  substance,  deposited 
between  the  cells.*     Dujardin,  in  1835,  discovered  a  moving  substance, 
to  which  he  gave  the  name  "sarcode,"  in  the  lower  animals,  which  was 
thought  by  Huxley,  Meyer,  Schultze,  and  Miiller,  to  be  peculiar  to 
them,  and  possessed  of  "  irritability  without  nerves."    Siebold  observed 
similar  movements  in  the  yolk  globules  of  planaria,  which  led  Kolliker 
to  suppose  that  all  cell  contents  were  contractile.     Virchow  thought 
these  movements  due  to  a  contractile  substance,  Leydig  thought  them 
phenomena  of  life,  but  all  believed  them  to  be  "something  diflferent 
from  the  animal  cell,  as  a  body  sui  generis.'' 

Prigsheim,  in  18.54,  declared  the  entire  vegetable  cell  contents  to 
consist  of  protoplasm  and  fluid,  and  denied  the  existence  of  a  primor- 
dial utricle,  though  admitting  that  the  protoplasma  might  be  arranged 
in  layers,  but  that  these  layers  could  not  be  distinguished  as  a  distinct 
membrane.  Leydig,  in  18-56,  denied  the  existence  of  a  cell  wall,  and 
believed  what  was  held  to  be  it  was  but  the  hardened  periphery  of 
protoplasm,  which,  together  with  the  nucleus,  constituted  the  cell. 
Schultze,  in  1861,  "defined  the  cell  Hii  protoplasm  enclosing  a.  nncXen^." 
"  The  cell,"  he  says  in  186.3,  "  leads  in  itself  an  independent  life,  of  which 
the  protoplasm  is  especially  the  seat,  although  to  the  nucleus  also  un- 
*  Tyson's  Cell  Doctrine,  p.  69. 


DEVELOPMENT    OF    THE    CELL    DOCTRINE.  41 

doubtedly  falls  a  most  important  though  not  yet  precisely  determined 
role.     Protoplasm  is  for  the  most  part  no  further  distinct  than  that  it 
will  not  commingle  with  the  surrounding  medium,  and  in  the  pecu- 
liarity that  with  the  nucleus  it  forms  a  unit.     Upon  the  surface  of  the 
protoplasm  there  may  form  a  membrane,  which,  although  derived  from 
it,  may  be  chemically  different,  and  the  assertion  that  it  is  the  beginning 
of  a  retrogression  may  be  defended."*     Brucke  had  previously  (1861) 
shown  that  the  nucleus  even  was  not  an  essential  part  of  the  cell,  and  there 
has  been  cited  in  evidence  the  non-nucleated  amoeba  and  protozoon,  and 
two  non-nucleated  monads  described  by  Cienkowsky.    We  come  now  to 
the  consideration  of  that  doctrine  which  seems  to  us  to  embody  the  great- 
est amount  of  truth,  and  to  be  capable  of  explaining  the  greatest  number 
of  the  phenomena  of  life  —  a  doctrine  that  has  been  slowly  evolved  by 
the  labor  of  scientists  everywhere:  many  of  the  ideas  entering  into  it 
had  been  suggested  by  other  investigators ;  but  Dr.  Lionel  Beale  — 
who,  more  than  any  other  investigator,  has  more  fully  elaborated,  and 
more  wisely  associated  the  facts  on  which  it  is  based,  whilst  adding 
largely  to  them  by  his  own  investigation  —  is  generally  recognized  as 
the  exponent  of  that  doctrine  of  cell  organization  and  growth  which 
claims  a  "vital"  influence  as  an  essential  factor  in  the  resolution  of 
the  problem  of  life  —  a  doctrine  to  which  we  give  our  most  unqualified 
adherence.     Dr.  Beale  makes  some  very  important  and  advantageous 
alterations  in  the  old  nomenclature;  he  describes  the  cell,  or,  as  he 
prefers  to  call  it,  "elementary  part,"  as  consisting  essentially  of  "ger- 
minal matter  "  and  "  formed  material."    "  Germinal  matter"  represents 
what  was  known  to  former  writers  as  "  cell  contents,"  "  protoplasm," 
"endoplast,"  and  "nucleus."     It  is  the  living,  growing  part  of  the 
cell  —  that  part  which  appropriates  the  pabulum  brought  to  it  by  the 
blood,  and  with  it  reconstructs  itself,  continually  repairing  the  waste 
resulting  from  disintegration  of  "formed  material,"  the  latter  cor- 
responding, to  the  "cell  wall,"  primordial  utricle,  "periplast,"  and 
"  intercellular  substance ;"  the  germinal  matter  is  centrally  situated, 
the  formed  material  superficially,  and  results,  Dr.  Beale  thinks,  from  the 
death  of  the  germinal  matter,  and  this  is  the  single  feature  of  his  doc- 
trine to  which  we  are  disposed  to  take  exception.     We  do  not  see  with 
what  propriety  the  formed  material  is  spoken  of  as  "  dead,"  whilst  still 
invested  with  the  properties  of  life,  contractility  in  muscle,  neurility 
in  nerve,  etc.,  as  has  been  well  objected  by  Dr.  Tyson,  though  Dr. 
Beale  himself  does  not  seem  to  look  upon  contractility  and  neurility 
as  vital  phenomena.     "I  might  go  farther  than  many  of  those  who 
adopt  the  physical  theory  of  life,  and  admit  that  not  only  muscular 
and  nervous  action,  but  that  the  production  of  many  of  the  compounds 
*  Schultze,  Protopl.  d.  Rhizopoden. 


42  DEVELOPMENT    OF    THE    CELL    DOCTRINE. 

found  in  the  secretions  and  in  the  blood  are  due  to  physical  and 
chemical  changes  alone."*  To  rae  the  function  of  the  different  struc- 
tures seems  quite  as  wonderful,  and  as  inexplicable  on  purely  physical 
laws  as  their  formation  ;  and  indeed  Dr.  Beale  seems  to  have  an  uneasy 
sensation  that  something  more  than  physical  law  is  involved  in  mus- 
cular contractility,  for  a  little  further  on  he  says:  "No  one  knows 
better  than  the  pliysicist,  that  the  force  of  muscular  contraction  very 
far  exceeds  that  which  can  be  obtained  from  any  known  arrangement 
containing  the  same  weight  of  matter."  f  Nor  do  any  of  the  phenom- 
ena of  life  seem  more  remarkable  to  me  than  sensibility,  and  the  power 
of  originating  sentient  motion,  which  latter  is  surely  quite  as  wonderful 
as  that  living  particles  should  move  from  a  centre  in  opposition  to  the 
general  law  of  all  purely  physical  motion,  not  to  mention  the  higher 
intellectual  acts  to  which  ther  application  of  the  term  nerve-function 
may  not  be  recognized  as  appropriate.  The  essential  features  of  this 
theory  are  that  all  structures  "spring  from  pre-existing  structures" 
which  are  capable  of  appropriating  to  themselves  things  differing  from 
themselves,  and  converting  them  into  structures  identical  with  them- 
selves, and  further,  that  they  are  capable  of  indefinite  multiplication. 
No  such  thing,  therefore,  as  spontaneous  generation  does  or  can  occur. 
Germinal  matter  is  of  "  granular  appearance,"  and  is  everywhere  the 
same;  the  germinal  matter  of  nerve  tissue  cannot  be  distinguished 
from  the  germinal  matter  of  a  leaf  or  of  the  lowest  fungus.  All  ger- 
minal matter  was  once  pabulum,  as  all  tissues  were  once  germinal 
matter.  The  formed  material,  or  cell  wall  when  it  exists,  is  of  vari- 
able thickness,  and  may  continue  to  increase  in  thickness  by  the 
formation  from  the  germinal  matter  of  new  material  on  its  inner  sur- 
face, or  it  may  become  thinner  by  the  rapid  accumulation  of  germinal 
matter  within,  and  its  consequent  distention;  or  both  ^ay  take  place 
at  the  same  time,  the  cell  wall  remaining  passive.  The  formed  mate- 
rial endowed  with  such  properties  as  contractility  in  muscle  is  yet 
incapable  of  reproducing  itself  by  the  assimilation  of  pabulum,  whilst 
the  germinal  matter  is  the  laboratory  where,  under  some  inexplicable 
guidance,  the  inert  elements  of  the  tissues,  brought  thither  by  the 
blood,  are  converted  into  living  matter. 

Situated  in  the  centre  of  the  elementary  part,  all  food  must  pass 
through  the  formed  material  to  reach  the  germinal  matter ;  hence  the 
growth  of  the  cell  will  be  more  or  less  rapid,  other  things  being  equal, 
according  to  the  thickness  of  the  formed  material,  the  most  superficial 
and  oldest  part  of  the  cell.  The  form  of  the  particles  of  germinal 
matter  is,  in  Dr.  Beale's  opinion,  spherical,  though  he  acknowledges 

*  Structure  and  Growth  of  Tissues,  p.  211. 
t  Ibid.  p.  213. 


DEVELOPMENT    OF    THE    CELL,    DOCTRINE.  43 

that  such  a  conclusion  is  purely  conjectural,  since  it  is  impossible  to 
see  thein  separately  or  even  to  conceive  a  particle  of  living  matter  not 
compound. 

The  nutritive  changes  in  the  tissues  depend  for  their  proper  activity 
on  the  two  opposite  processes  of  disintegration  and  renewal ;  as  new 
particles  are  constantly  being  added  by  the  assimilative  action  of  the 
germinal  matter,  so  waste  is  constantly  taking  place  by  destructive 
metamorphosis  of  the  formed  material,  and  in  the  maintenance  of  a 
perfect  equilibrium  between  these  processes  consists  the  health  of  the 
part;  but  if  the  blood  be  charged  with  some  poisonous  element  impair- 
ing the  nutritive  qualities  of  the  cell  food,  or  if  the  blood  be  deficient 
in  healthy  pabulum,  from  indigestion  or  improper  quality  of  ingesta, 
or  if  the  quantity  of  the  blood  circulating  through  the  part  prove 
inadequate  to  its  proper  support,  this  Equilibrium  is  destroyed  and 
disease  results.  "  A  change  of  this  sort  occurs  in  scarlet  fever.  The 
morbid  matter  circulating  in  the  blood  interferes  with  the  regular  pro- 
duction of  new  cuticle ;  for  a  time  none  is  formed,  but  by  and  by, 
when  the  violence  of  the  disease  abates,  and  the  poison  is  in  a  great 
measure  eliminated  from  the  blood,  the  formative  process  is  re-estab- 
lished. A  gap,  however,  exists,  as  it  were,  between  the  tissue  formed 
before  the  interference  of  the  disease,  and  that  produced  after  the 
natural  process  was  resumed.  In  point  of  age  they  are  separated  by 
an  interval,  so  that  as  the  new  cuticle  grows  up  from  below,  the  old  is 
separated  en  masse."  Though  the  germinal  matter  is  everywhere  the 
same  in  general  appearance,  and  grows  in  precisely  the  same  way,  yet 
the  structure  resulting  from  its  growth  is  very  different  according  to 
the  situation  from  which  it  is  derived  ;  the  germinal  matter  of  muscle 
will  form  nothing  but  muscle,  that  of  nerve  nothing  but  nerve;  it  is 
seen  therefore  to  possess  peculiar  endowments  according  to  the  locality 
in  which  it  originated,  though  all  these  structures  are  known  to  have 
had  a  common  origin  "from  a  single  mass  in  the  embryo."  Nor  is 
this  peculiar  endowment  lost  by  transplantation  ;  in  whatever  situation 
the  cell  may  subsequently  be  found,  if  it  grow  at  all,  it  does  so  in 
obedience  to  the  impulse  received  from  the  parent  cell,  refusing  to 
acknowledge  any  formative  control  from  the  structure  by  which  it 
may  be  invested.  The  germinal  matter  of  bone  will  produce  bone 
wherever  it  may  be  placed,  if  the  conditions  requisite  to  its  growth  and 
development  be  preserved.  Dr.  Beale  thinks  "bone  cancer"  is  an 
illustration  of  this  fact ;  and  that  it  is  due  to  the  escape  into  the  blood  of 
minute  particles  of  germinal  matter  from  bone,  Avhich  is  subsequently 
deposited  in  some  tissue  where  conditions  favorable  to  development 
exist,  and  thus  is  formed,  in  an  abnormal  situation,  an  osseous  growth. 
Virchow's  theory  that  all  pathological  growths  are  the  result  of  exces- 


44  DEVELOPMENT    OF    THE    CELL    DOOTRINE. 

sive  proliferation  of  the  connective  tissue  corpuscle  in  the  situation  in 
which  it  is  found,  fails  to  account  satisfactorily  for  such  phenomena  as 
these.  On  considering  the  changes  that  take  place  after  the  applica- 
tion of  a  blister,  we  shall  be  able  to  observe  the  formation  of  pus  globules 
and  the  development  of  cuticle, —  after  the  application  of  the  irritant,  a 
fluid  is  poured  out  between  the  layers  of  the  cuticle;  upon  the  deep 
surface  of  the  superficial  layer  are  seen  little  masses  of  germinal  matter 
enveloped  in  a  thick  layer  of  formed  material,  in  the  subjacent  fluid 
also  after  a  time  will  be  found  a  great  number  of  these  elementary 
parts,  with  however  a  comparatively  thin  layer  of  formed  material, 
rapidly  multiplying.  These  are  pus  corpuscles  which  are  observed  to 
have  the  power  of  appropriating  the  nutrient  material  of  the  blood  and 
the  debris  of  the  tissues,  and  of  converting  it  into  material  like  them- 
selves. This  takes  place  mucli  more  rapidly  than  in  the  normal  state. 
The  nutritive  material  is  furnished  in  greater  abundance  than  usual, 
and  if  it  were  not  so  converted,  it  would  undergo  decomposition,  and 
the  whole  of  the  surrounding  tissue  would  be  destroyed. 

Here  the  elementary  part  of  cuticle  is  formed  in  the  usual  way, 
but  too  rapidly  for  the  low  conversion  of  germinal  matter  into  the 
tissue  of  cuticle;  a  soft,  spongy  matter  resembling  cuticle  is  formed, 
which  cannot  undergo  further  formative  transformation,  but  becomes 
pus  instead.  In  the  process  of  healing,  the  reverse  of  this  takes  place : 
a  laver  of  formed  material  is  slowly  formed  on  the  surface  of  the  ele- 
mentary parts,  which  are  no  longer  produced  with  such  rapidity,  and 
is  gradually  converted  into  proper  cuticular  tissue.  The  relative  pro- 
portion of  germinal  matter  to  formed  material  is  much  greater  in  young 
tissue  than  in  old ;  in  youth  than  in  the  adult.  The  development  of 
tissue  takes  place  rapidly  in  the  embryo,  where  the  germinal  matter  is 
abundant,  in  old  age  it  progresses  slowly,  owing  to  the  proportionately 
small  quantity  of  germinal  matter  to  the  formed  material,  which  so 
envelops  it  as  to  obstruct  the  passage  of  nutrient  matter  to  it.  In  the 
fluids  of  the  body  we  find  germinal  matter  abundant  in  "the  white 
corpuscles  of  the  blood,  the  corpuscles  of  the  lymph  and  chyle,  and  the 
contents  of  the  closed  glands  are  to  be  regarded  as  masses  of  germinal 
matter  possessing  important  powers  of  growth."  *  In  certain  diseased 
conditions  the  white  blood  corpuscles  undergo  very  rapid  development, 
whilst  their  further  change  into  red  blood  corpuscles  takes  place  very 
slowly,  thus  destroying  the  balance  between  disintegration  and  repair: 
•'  Chyle  and  lymph  corpuscles,  certain  corpuscles  in  some  specimens  of 
mucus,  the  corpuscles  in  certain  glandular  organs,  white  blood  cor- 
puscles, and  pus  globules,"  bear  an  exceedingly  close  resemblance  to 
each  other  for  a  very  obvious  reason ;  they  are  composed  almost  en- 
*  Boale  On  the  Structure  and  Growth  of  Tissues,  p.  48. 


DEVELOPMENT    OF    THE    CELL    DOCTRINE.  45 

tirely  of  germinal  matter ;  and  we  have  seen  that  germinal  matter  is 
the  same  in  appearance  wherever  found,  though  possessed  of  very  dif- 
ferent powers,  according  to  its  origin.  The  white  blood  corpuscles  are 
purely  germinal  matter,  which  Dr.  Beale  thinks  would  undergo  de- 
velopment into  tissue,  if  it  were  not  for  the  constant  motion  to  which 
they  are  subjected,  and  that  when,  from  any  cause,  they  become  sta- 
tionary, they  undergo  rapid  conversion  into  some  simple  form  of  fibrous 
tissue ;  "  indeed,  there  is  reason  for  believing  that  fibrin  is  the  formed 
material  of  the  tvhite  blood  corpuscles.'"^  Secretion,  according  to  Dr. 
Beale,  is  the  resultant  of  the  disintegration  of  the  secretory  organ ; 
thus,  in  the  liver  this  process  is  described  as  a  transudation  from  the 
blood  of  the  material  of  which  the  bile  is  composed,  which  becomes 
converted  into  the  germinal  matter  of  the  liver  cell.  "  The  particles 
of  this  mass  are  constantly  growing  from  centre  to  circumference,  and 
when  they  have  reached  the  circumference  of  the  mass,  ^having  passed 
through  various  stages  of  their  existence,  they  become  bile."  The 
general  theory  of  development,  as  taught  by  Dr.  Beale,  is  briefl.y 
summed  up  by  himself  in  the  following  words:  "  1.  Matter  which  pos- 
sesses the  power  of  forming  itself  into,  or  of  altering  the  arrangement  and 
relation  of,  its  own  constituent  elements  so  as  to  form  matter  having  cer- 
tain peculiar  properties.  2.  Matter  or  tissue  ivhich  has  thus  resulted  or 
been  fanned.  The  latter  generally  forms  an  investment  around  and 
protects  the  former ;  but  in  certain  cases,  besides  this  investment  being 
formed,  some  of  the  living  particles  undergo  change,  and  become  re- 
solved into  a  peculiar  formed  matter,  of  which  very  little  remains,  is 
found  between  the  external  investment  and  Vna  peculiar  formed  matter 
within.  As  examples  of  this,  you  may  remember  I  adduced  the 
familiar  examples  of  the  fat  cell  and  the  starch  cell.  In  nutrition,  the 
pabulum  first  becomes  forming  matter,  and  in  this  new  state  passes 
through  certain  stages  of  existence,  and  at  last  becomes  formed.  The 
movement  of  the  particles  always  takes  place  in  one  constant  direction 
from  the  centre,  at  which  they  become  living.  The  pabulum  always 
passes  in  the  opposite  direction." 

*  Beale  On  the  Structure  and  Growth  of  Tissues,  p.  49. 


46   ANATOMY  AXD  PHYSIOLOGY  OF  THE  MOUTH. 


CHAPTER  II. 

ANATOMY  AND    PHYSIOLOGY    OF   THE    MOUTH. 

THE  mouth  signifies,  in  the  human  subject,  the  space  included  be- 
tween the  pahitine  arch  above,  the  mylohyoid  muscles  beneath,  the 
lips  in  front,  the  velum  palati  behind,  and  the  cheeks  on  either  side. 
The  teeth  and  closed  jaws  separate  the  inner  portion,  or  lingual  cavity, 
from  the  outer,  or  vestibular  space;  and  while  that  part  of  the  latter 
bounded  by  the  cheeks  ought  properly  to  bear  the  appellation  buccal, 
the  term  buccal  cavity  is  not  unfrequently  employed  with  a  significa- 
tion so  general  as  to  comprehend  the  whole  oral  cavity. 

In  the  mouth  are  the  tongue,  teeth,  and  the  alveolar  ridges  invested 
by  the  gums :  into  it  are  poured  the  secretion  of  the  parotid,  sub- 
maxillary and  sublingual  glands,  as  well  as  that  of  the  ordinary 
mucous  and  of  the  special  lingual  follicles ;  and  in  it  the  food  is  sub- 
jected to  the  processes  of  mastication  and  insalivation  previous  to 
deglutition. 

It  is  farther  concerned  in  the  prehension  of  aliment ;  and  besides 
containing  the  organs  of  taste,  is  employed  in  articulation,  expectora- 
tion, suction,  etc. 

The  parts  concurring  to  constitute  the  mouth  form  a  very  compli- 
cated piece  of  mechanism  ;  through  them  it  has  a  wide  range  of  sym- 
pathies, and  by  them  it  performs  a  great  variety  of  functions. 

The  anatomical  elements  composing  these  parts  consist  of  Bone- 
Ligament,  Muscle,  Gland,  Bloodvessel,  Nerve,  Areolar,  and  Adipose 
tissues,  and  Mucous  membrane. 

These  different  elements  combine  together  and  form  the  various 
organs  which  constitute  the  mouth. 

These  organs  I  shall  consider  in  their  physiological  order :  thus 
combining  their  anatomy  and  physiology,  studying  at  the  same  time 
both  their  healthy  structure  and  function. 


OSTEOLOGY.  47 


CHAPTER  III. 

OSTEOLOGY. 

T)  ONE  is  one  of  the  hardest  substances  in  the  body.  It  is  composed 
JJ  of  animal  or  organic  matter  in  intimate  association  with  earthy, 
or  inorganic  matter.  From  the  organic  matter  the  bone  derives  the 
properties  of  toughness  and  elasticity ;  and  from  the  earthy  material, 
hardness  and  solidity.  The  mineral  matter  may  be  dissolved  out  by 
a  dilute  solution  of  nitric  or  muriatic  acids,  whilst  the  animal  matter 
remains  unaffected,  retaining  its  form,  though  loosing  its  hardness,  so 
that  the  long  bones,  so  great  is  their  flexibility,  may  be  tied  into  a 
knot;  on  the  other  hand,  by  subjecting  them  to  a  high  heat  in  an  open 
fire,  Avhilst  exposed  to  the  air,  the  animal  matter  may  be  consumed, 
leaving  the  mineral  to  preserve  the  form  of  the  bone,  but  so  insecurely 
that  it  will  crumble  to  ashes  in  the  grasp  of  the  hand. 

The  composition  of  bone,  according  to  Berzelius,  is  about  one-third 
animal  and  two-thirds  mineral  matter : 

Animal  Matter,             Gelatin  and  Bloodvessels,       .         .         .         .  33-30 

"]       Phosphate  of  Lime,.         .....  51-04 

Inorganic                 I       Carbonate  of  Lime,        .....  11-30 

or                      [      Fluoride  of  Calcium,         .....  200 

Earthy  Matter.                Phosphate  of  Magnesia,        .         .         .          .  116 

Soda  and  Chloride  of  Sodium,           .         .         .  1-20 

The  proportion  of  earthy  and  animal  matter  is  generally  thought 
to  vary  with  varying  age.  According  to  Shreger,  this  difference  is  as 
follows : 


CHILD. 

ADULT. 

OLD  AGE 

Animal  Matter,    . 

.     47-20 

20-18 

12-2 

Earthy  Matter, 

48-48     . 

.     74-84    . 

.     84-1 

To  this  supposed  difference  has  commonly  been  ascribed  the  greater 
brittleuess  of  bones  in  aged  people ;  but  recent  analyses  tend  to  show 
that  bone  is  at  all  periods  of  individual  life  chemically  the  same,  and 
if  so,  the  inference  growing  out  of  the  error  of  former  analyses  is  false- 

The  development  of  bone  takes  place  in  a  manner  somewhat  differ- 
ent from  that  of  most  other  tissues,  since  we  have,  in  addition  to  the 
germinal  matter  and  formed  material,  a  deposit  of  earthy  matter  in 
the  latter.  The  formation  of  the  animal  matter  is  avital  phenomenon, 
the  deposit  of  earthy  matter  a  purely  physical  one. 

The  "cell"  or  "elementary  part"  of  bone  consists  of  a  soft  central 


48  OSTEOLOGY. 

mass  of  germinal  matter,  surrounded  by  a  thin  layer  of  soft  formed 
material  with  which  it  is  continuous,  and  which  "  passes  uninterrupt- 
edly into  the  hard  calcified  formed  material."  This  hard  formed  ma- 
terial is  everywhere  perforated  by  little  channels  called  canaliculi, 
along  which  the  nutrient  nuiterial  is  conveyed  to  the  germinal  matter. 
These  canaliculi  are  formed  in  a  manner  corresponding  to  the  deposi- 
tion of  the  mineral  matter,  that  is,  from  without  inward,  commencing 
at  a  point  most  distant  from  the  germinal  matter.  In  the  dried  bone 
these  canals  are  seen  to  communicate  with  little  vacant  spaces  called 
lacunae,  occupied  in  the  fresh  state  with  germinal  matter,  seeming  to 
associate  them  one  with  another.  In  this  manner,  each  lacuna  com- 
municates freely  with  adjacent  lacunce. 

The  only  part  of  the  bone,  in  Dr.  Beale's  opinion,  which  can  be  said 
to  be  living,  is  the  "  nucleus"  or  "  bone  cell  "  in  the  space  or  lacuna, 
constituting  perhaps  one-twelfth  part  of  the  bone ;  all  the  rest  being 
as  dead  in  the  living  body  as  when  removed  from  it.  "  It  (the  germi- 
nal matter)  alone  can  grow  and  give  rise  to  the  formation  of  matrix. 
Bone  cannot  produce  hone,  but  the  germinal  matter  of  bone  may  become 
converted  into  new  hone  tissue."  Virchow  is  of  the  opinion  that  the 
matrix  is  true  intercellular  substance  into  which  proceed  stellate  pro- 
cesses from  the  cells  occupying  the  lacunse,  thus  giving  rise  to  the 
canaliculi ;  an  opinion  directly  opposite  to  that  of  Dr.  Beale,  that  the 
canaliculi  begin  in  the  matrix  (which  is  not  formed  independently  of 
the  cell,  but  consists  simply  of  the  formed  material,  or  cell  wall,  in 
which  mineral  matter  has  been  deposited,)  and  extend  to  the  germinal 
matter  occupying  the  lacuna!  space.  This  germinal  matter  is  always 
present  in  the  lacuna  ;  on  it  depends  the  circulation  of  the  calcareous 
matter  held  in  solution  by  the  blood  ;  without  it  bone  tissue  cannot  be 
formed,  and  on  its  presence  the  life  of  the  bone  depends.  The  canaliculi, 
then,  are  the  "  altered  spaces  or  ducts  which  are  left  between  the  calcare- 
ous globules  originally  deposited,  and  through  them  pass  fluids  to  and 
from  the  germinal  matter."  (Beale  On  the  Structure  and  Growth 
of  Tissues,  128.)  Originally  triangular  in  form,  they  finally  become  so 
altered  by  the  filling  up  of  the  angles  as  to  exhibit  a  circular  ajipearance 
on  ti'ansverse  section.  The  osseous  tissue  with  its  canaliculi  and  germinal 
matter  always  bears  a  fixed  and  definite  relation  to  the  vessels.  It 
may  exist  as  solid  cylindrical  processes  covered  with  a  vascular  mem- 
brane, or  as  thin  laminae  also  covered  with  a  vascular  membrane,  or 
as  concentric  laminae  arranged  round  a  central  opening,  a  "  Haversian 
canal."  Each  Haversian  canal  has  a  diameter  of  about  one-five- 
hundredth  of  an  inch;  though  they  are  of  very  different  sizes,  varying 
from  one-fifteen-hundredth  to  one-two-hundredth  of  an  inch  in  diameter. 

The  elementary  parts  of  bone  are  so  arranged  as  to  form  either  the 


BONES  OF  THE  HEAD  AND  FACE.         49 

loose  and  spongy  or  cancellated  bone  tissue,  or  the  more  solid  and  com- 
pact or  laminated  tissue,  as  in  the  shaft  of  a  long  bone ;  and  between 
these,  in  health,  a  transitional  stage  may  always  be  observed,  while  in 
disease  the  compact  tissue  may  undergo  such  modification  as  to  resem- 
ble the  cancellated.  There  are  also  "  large  spaces  like  cancelli "  in 
the  compact  tissue  called  the  "  Haversian  spaces,"  which  are  merely 
the  canals  enlarged  by  erosion  taking  place  from  within  outward. 
The  canals  and  spaces  which  finally  form  the  fat  cells  may  also  undergo 
conversion  into  bone  tissue,  and  are  originally  derived  from  the  same 
elementary  parts  as  those  from  which  bone  is  formed. 


CHAPTER  IV. 

BONES    OF    THE    HEAD    AND    FACE. 

THE  osseous  structures  in  which  the  student  of  dentistry  is  especially 
interested,  and  to  which  we  would  direct  attention,  are : 

1.  The  superior  maxillary  or  upper  jaw  bones. 

2.  The  inferior  maxillary  or  lower  jaw  bones. 

3.  The  palate  bone. 

THE   SUPERIOR   MAXILLARY   BONES. 

The  Superior  Maxillary  Bones,  two  in  number,  are  in  pairs  and 
united  on  the  median  line  of  the  face.  They  occupy  the  anterior 
upper  part  of  the  face,  are  of  very  irregular  form,  and  consist  of  a 
body  and  processes.  They  are  the  largest  bones  of  the  face  except  the 
inferior  maxilla,  and  enter  into  the  formation  of  three  cavities,  the 
orbit,  the  mouth,  and  the  nares ;  they  also  enter  into  the  formation  of 
the  zygomatic  and  splieno-maxillary  fossse,  and  the  spheno-maxillary 
and  pterygo-maxillary  fissures. 

The  body  is  the  central  part  of  the  bone,  and  has  four  surfaces ; 
namely,  the  external  or  facial,  the  posterior  or  pterygoid,  the  superior 
or  orbital,  and  the  internal  or  palatine. 

The  External  Surface  is  irregularly  convex,  and  has  a  depression 
about  its  centre  just  above  the  canine  and  first  bicuspid  teeth,  called 
the  canine  fossa :  immediately  above  which  is  the  infra-orbital  foramen 
for  transmitting  an  artery  and  nerve  of  same  name ;  its  upper  and 
inner  edge  forms  part  of  the  lower  margin  of  .the  orbit,  to  which  is 
attached  the  levator  labii  superioris  proprius  muscle. 
4 


50 


BONES  OF  THE  HEAD  AND  FACE. 


The  Posterior  Surface  has  a  bul<iing,  called  tuberosity,  which  is  con- 
nected with  the  palate  bones,  and  bounds  the  antrum  behind  ;  it  is 
perforated  by  three  or  four  small  holes,  —  the  posterior  dental  canals 
which  transmit   nerves   and  bloodvessels   to   the  molar   teeth.     This 


OUTER 


Fig.  1. 
SURFACE 


TENDO  OCULI- 


»:  HASAll  ,  < 
:.";S  /'*    LACHRYMAL    TUBEnCLC 

4:      \- 


INCISIVE  FOSSA 


POSTIRIOR  OCMTAl 

CAAfALS 


"l-joR'J  MAxiLLAny  ruBcnosiry 


"^WA/e.    Bicuspfos. 


surface  presents  also  on  its  nasal  face  a  groove  which  becomes  by 
articulation  Avith  the  palate  bone  the  posterior  palatine  canal. 

The  Internal  Surface  extends  from  the  alveolar  processes  in  front  to 
the  horizontal  plate  of  the  palate  bones  behind,  called  the  palatine 
processes,  which  are  rough  below,  forming  the  roof  of  the  mouth,  and 
smooth  above,  making  the  floor  of  the  nostrils.  They  are  united  along 
the  median  line,  at  the  anterior  part  of  which  is  the  foramen  incisivum, 
having  two  openings  in  the  nares  above,  while  there  is  but  one  in  the 
mouth  below.  The  body  of  the  superior  maxilla  is  occupied  by  a 
large  and  very  important  cavity  called  the  Antrum  Hlghmorianum,  or 
Maxillary  Sinus.  This  cavity  is  somewhat  triangular  in  shape,  with 
its  base  generally  looking  to  the  nose,  and  its  apex  to  the  malar  pro- 
cess. Its  upper  wall  is  formed  by  the  floor  of  the  orbit,  its  lower  by 
the  alveoli  of  the  molar  teeth,  which  sometimes  perforate  this  cavity. 
The  canine  fossa  bounds  it  in  front,  while  the  tuberosity  closes  it 


BONES  OF  THE  HEAD  AND  FACE. 


51 


behind.  But  the  shape  of  this  cavity  is  exceedingly  variable.  In  ex- 
amining a  collection  of  nearly  one  hundred  maxillae  in  the  Museum 
of  the  Baltimore  Dental  College,  no  two  sinuses  were  found  to  be 
shaped  alike ;  and  this  difference  is  as  marked  between  the  right  and 
the  left  in  the  same,  as  in  different  subjects.  The  floor  of  some  is 
nearly  flat,  but  in  the  majority  of  cases  it  is  very  uneven ;  sometimes 
crossed  by  a  single  septum,  varying  from  one-eighth  to  half  an  inch  in 
height ;  at  other  times  there  are  found  three  or  four  septa,  dividing  the 
lower  part  of  the  cavity  into  as  many  separate  compartments,  with  the 
bottom  or  floor  of  no  two  on  a  level  with  each  other.  Some  are  per- 
forated by  the  roots  of  one  or  more  teeth ;  at  other  times  the  roots  of 
several  teeth  extend  considerably  above  the  level  of  the  floor  of  the 
antrum,  covered  by  a  lamina  of  bone  scarcely  thicker  than  bank-note 
paper.  In  other  cases,  the  floor  of  the  antrum  is  half  an  inch  above 
the  extremities  of  the  roots  of  the  teeth.  This  cavity  also  varies  as 
much  in  size  as  it  does  in  shape. 


BONES  P/\RTIALLY  CLOS\NC   ORIFICE  OF 
iAIMTRUM    MARKED   IN    OUTLINE 


ANTER.  NASAL 
SPINE 


BRISTLE  PASSED 
THROUGH  ANTE. 
PAL  AT.  CANAL 


The  opening  of  the  antrum  is,  on  its  nasal  portion  or  base,  into  the 
middle  meatus  of  the  nose  ;  in  the  skeleton  it  is  large,  while  in  the 
natural  state  it  is  much  contracted  by  the  ethmoid  bone  above,  the 
inferior  turbinated  bone  below,  the  palate  bone  behind,  and  by  the 


52 


BONES  OF  THE  HEAD  AND  FACE. 


mucous  membrane  which  passes  through  the  opening  and  lines  the  in- 
terior of  the  antrum.  A  deep  groove  lies  in  front  of  the  opening  in 
the  antrum,  which  is  converted  into  a  canal  for  the  nasal  duct  by  the 
lachrymal  and  inferior  turbinated  bones. 

Tiie  Malar  Process  is  a  rough,  triangular  process,  marking  the 
boundary  between  the  external  and  internal  surfaces.  It  presents  on 
its  upper  margin  a  roughened  surface  for  articulation  with  the  malar 
bone. 

The  Nasal  Process  forms  the  lateral  boundary  of  the  nose.  It  is  a 
thick,  triangular  prominence  articulating  at  its  upper  extremity  by  a 
serrated  edge  with  the  frontal  bone,  and  by  an  uneven  surface  with 
the  ethmoid  bone ;  a  little  lower  on  its  internal  surface  it  offers  a 
transverse  ridge,  the  superior  turbinated  crest,  for  articulation  with 
the  middle  turbinated  bone ;  below  this  is  the  inferior  turbinated 
crest  to  which  is  attached  the  inferior  turbinated  bone ;  and  lying 
between  these  crests  is  a  smooth  concave  space,  forming  part  of 
the  middle  meatus,  while  beneath  the  inferior  crest  is  a  like  space 
which  forms  part  of  the  inferior  meatus.  By  its  anterior  border  it  is  ' 
articulated  with  the  nasal  bone,  and  by  its  posterior  with  the  lachrymal 
bone,  forming  with  it  the  canal  for  the  nasal  duct,  whilst  at  the  junc- 
tion of  the  anterior  lip  of  the  nasal  groove  with  the  orbital  surface  is 
placed  the  lachrymal  tubercle,  serving  as  a  guide  to  the  duct  in  all 
operations  for  fistula  lachrymalis. 

The  Alveolar  Process  is  formed  on  the  lower  edge  of  the  external 
sui'face ;  it  is  broader  behind  than  in  front,  and  is  perforated  with  ex- 
cavations corresponding  in  number  with  the  teeth,  those  depressions 
which  receive  teeth  of  more  than  one  fang  are  sub-divided  by  bony 
septa  into  compartments  of  a  sufficient  number  to  receive  these  fangs. 

The  bottom  of  each  of  these 
cavities  is  perforated  by  a  small 
foramen,  for  the  passage  of  nerves 
and  bloodvessels  which  supply 
the  teeth.     The  alveolar  border 
externally  presents  a  fluted  ap- 
pearance ;   the  projections  cor- 
respond with  the  alveolar  cavi- 
ties, and    the  depressions   with 
the   septa    which    divide   them 
from  one  another. 
The  Palate  Process  forms  the  roof  of  the  mouth  and  part  of  the  floor 
of  the  nose ;  it  is  thick  and  strong,  and  presents  in  front  the  orifice  of 
the  anterior  palatine  canal  through  which  passes  the  anterior  palatine 


BONES  OF  THE  HEAD  AND  FACE.         53 

vessels,  whilst  the  inferior  naso-palatine  nerves  pass  along  the  inter- 
maxillary suture.  The  inferior  surface  at  the  back  part  has  a  deep 
groove,  sometimes  a  canal,  for  the  passage  of  the  posterior  palatine 
vessels,  and  a  nerve  of  large  size ;  it  is  also  perforated  with  numerous 
foramina  for  the  passage  of  nutrient  vessels.  The  outer  border  is 
closely  attached  to  the  rest  of  the  bone.  The  inner  border,  thicker  in 
front  than  behind,  presents  a  ridge  which,  together  with  a  similar  ridge 
on  the  opposite  bone,  forms  a  groove  in  which  the  vomer  is  received. 
The  anterior  margin  is  prolonged  into  a  sharp  process,  the  nasal  spine. 
By  its  posterior  border  it  articulates  with  the  horizontal  plate  of  the 
palate  bone. 

The  structure  of  the  upper  jaw,  with  its  alveolar  and  numerous 
other  processes,  is  thick  and  cellular ;  the  cancellated  structure  being 
invested  with  a  thin  layer  of  compact  bone. 

It  is  articulated  with  two  bones  of  the  cranium,  the  frontal  and 
ethmoid,  and  seven  of  the  face,  namely :  the  nasal,  malar,  lachrymal, 
palate,  inferior  turbinated,  vomer,  and  to  its  fellow,  by  sutures  ;  also 
to  the  teeth  by  the  articulation  termed  gomphosis. 

Its  development  commences  at  so  early  a  period  of  intra-uterine  life, 
and  ossification  proceeds  so  rapidly,  that  the  number  of  ossific  centres 
is  uncertain  :  some  give  a  centre  for  the  body  and  each  process,  others 
think  that  most  probably  there  are  but  four  centres  in  all.  It  may  be 
seen  as  early  as  the  thirty-fifth  or  fortieth  day  after  conception  ;  and 
although  at  birth  it  has  acquired  but  little  height,  it  has  increased  con- 
siderably in  breadth.  But,  at  this  period,  the  alveolar  border,  which 
constitutes  the  largest  portion  of  the  bone,  is  almost  in  contact  with 
\  he  orbit.  The  antrum  is  still  scarcely  perceptible,  but  as  the  vertical 
dimensions  of  the  bone  are  increased,  it  is  gradually  developed.  With 
l,he  loss  of  the  teeth,  the  alveolar  border  nearly  disappears,  so  that  the 
Tault  of  the  palate  loses  its  arched  form,  and  sometimes  becomes 
almost  flat. 

The  Upper  or  Orbital  Surface  is  triangular  in  shape,  with  its  base  in 
front  forming  the  anterior,  lower,  and  internal  edge  of  the  orbit ;  while 
its  apex  extends  back  to  the  bottom,  forming  the  floor  of  the  orbit  and 
roof  of  the  antrum  ;  its  internal  edge  is  united  to  the  lachrymal, 
ethmoid,  and  palate  bones ;  its  external  edge  assists  in  forming  the 
spheno-maxillary  fissure,  and  along  its  central  surface  is  seen  a  canal 
running  from  behind,  forward  and  inward,—  the  infra-orbital  canal. 
This  canal  divides  into  two  :  the  smaller  is  the  anterior  dental,  which 
descends  to  the  anterior  alveoli  along  the  front  wall  of  the  antrum ; 
the  other  is  the  proper  continuation  of  the  canal,  and  ends  at  the  infra- 
orbital foramen. 


54 


BONES    OF    THE    HEAD    AND    FACE. 


THE   INFERIOR   MAXILLARY    BONE. 
Fig.  4. 


^aiD, 


ANGLE 


The  Inferior  Maxillary  Bone  (Fig.  4)  is  the  largest  bone  of  the  face  ; 
aud  though  single  in  the  adult,  it  consists  of  two  symmetrical  pieces  in' 
the  foetus. 

It  occupies  the  lower  part  of  the  face,  has  a  parabolic  form,  and  ex- 
tends backward  to  the  base  of  the  skull. 

It  is  divided  into  a  body  and  extremities. 

The  body  is  the  middle  and  horizontal  portion  ;  this  is  divided  along 
its  centre  by  a  ridge  called  the  symphysis,  which  is  the  place  of  separa- 
tion in  the  infant  state ;  the  middle  portion  projects  at  its  inferior  part 
into  an  eminence  called  the  mental  process  or  chin ;  on  each  side  of 
which  is  a  depression  for  the  muscles  of  the  lower  lip;  and  externally 
to  these  depressions  are  two  foramina,  called  anterior  mental,  for  trans- 
mitting an  artery  aud  nerve  of  the  same  name. 

The  horizontal  portions  extend  backward  and  outward ;  and  on  the 
outward  surface  have  an  oblique  line  for  the  attachment  of  muscles. 

On  the  inner  surface  of  the  middle  part  behind  the  chin,  along  the 
line  of  the  symphysis,  there  is  a  chain  of  eminences  called  genial  tuber- 
cles;  to  the  superior  of  which  the  frsenum  linguse  is  attached,  to  the 
middle  the  genio-hyo-glossi,  aud  to  the  inferior  the  genio-hyoid  mus- 
cles ;  on  each  side  of  these  eminences  are  depressions  for  the  sublingual 
glands ;  and  beyond  these  depressions  there  runs  an  oblique  ridge 
upward  and  outward,  to  the  anterior  part  of  which  is  attached  the 
mylo-hyoid  muscle,  aud  to  the  posterior  part,  the  superior  constrictor 


BONES  OF  THE  HEAD  AND  FACE. 


55 


of  the  pharynx ;  this  latter  muscle  is  consequently  involved  more  or 
less  in  the  extraction  of  the  last  molar  tooth.  Below  this  line  there  is 
a  groove  for  the  mylo-hyoid  nerve,  and  a  depression,  the  submaxillary 
fossa,  for  the  reception  of  the  submaxillary  gland. 


Fig.  5. 


^^■^JII5^^^ 


The  alveolar  border,  in  the  foetus,  constitutes  nearly  the  whole  body 
of  the  bone.  After  the  loss  of  the  teeth,  this  part  of  the  inferior  max- 
illary is  gradually  wasted.  The  alveolar  border,  in  the  lower  jaw, 
describes  a  rather  smaller  arch  than  it  does  in  the  upper,  and  both  its 
anterior  walls  are  thinner  than  the  posterior.  Passing  over  the  infe- 
rior border,  near  the  junction  of  the  body  with  the  ramus,  is  a  groove 
for*the  facial  artery. 

The  extremities  of  the  body  have  two  large  processes  rising  up  at  an 
obtuse  angle,  named  the  rami  of  the  lower  jaw.  These  processes  are 
flat  and  broad  on  their  surfaces ;  the  outer  one  is  covered  by  the  mas- 
seter  muscle ;  the  inner  one  has  a  deep  groove  which  leads  to  a  large 
hole,  the  posterior  dental  or  maxillary  foramen,  for  transmitting  the 
inferior  dental  nerves  and  vessels  to  the  dental  canal  running  along 
the  roots  of  the  teeth.  This  foramen  is  protected  by  a  spine  to  which 
the  spheno-maxillary  ligament  is  attached. 

The  ramus  has  a  projection  at  its  lower  part,  which  is  the  angle  of 
the  lower  jaw;  its  upper  ridge  is  curved,  having  a  process  at  each 
end  —  the  anterior  one  is  the  coronoid  process;  this  is  triangular,  and 


56         BONES  OF  THE  HEAD  AND  FACE. 

has  the  temporal  muscle  inserted  into  it ;  the  posterior  is  the  condyloid, 
and  articulates  with  the  temporal  bone.  This  process  has  a  neck 
■which  receives  the  insertion  of  the  external  pterygoid  muscle. 

The  Coronoid  Process  is  thin,  flat,  and  triangular.  To  its  external  sur- 
face is  attached  the  temporal  and  masseter  muscles.  On  its  internal  sur- 
face is  a  longitudinal  ridge  extending  to  the  posterior  part  of  the 
alveolar  process,  and  to  which  is  attached  the  temporal  muscle  above 
and  the  buccinator  muscle  below.  In  front  of  this  ridge  is  a  deep 
groove,  to  which  the  temporal  and  buccinator  muscles  are  in  part 
attached. 

The  Condyloid  Process  consists  of  two  portions  —  a  condyle  and  a 
neck.  The  condyle  is  of  an  oval  form,  convex  both  laterally  and  from 
before  backward.  The  neck  of  the  condyle,  flattened  from  before 
backward,  convex  on  its  posterior  surface,  presents  anteriorly  a  de- 
pression, the  pterygoid  fossa,  for  the  attachment  of  the  external  ptery- 
goid muscle.  Between  these  two  processes  is  the  sigmoid  notch,  a 
semilunar  depression  over  which  passes  the  masseteric  artery  and  nerve. 

The  structure  of  the  inferior  maxilla  is  compact  externally,  cellular 
within,  and  is  traversed  in  the  greater  part  of  its  extent  by  the  inferior 
dental  canal. 

The  lower  jaw  is  developed  from  two  centres  of  ossification,  which 
meet  at  the  symphysis.  It  articulates  on  each  side  by  one  of  its  con- 
dyles with  the  glenoid  cavity  of  the  temporal  bone,  situated  at  the  base 
of  the  zygomatic  process.  This  cavity  is  divided  into  two  portions  — 
an  anterior  and  a  posterior.  The  former  constitutes  the  articular  por- 
tion, the  latter  lodges  a  process  of  the  parotid  gland.  The  two  are 
separated  by  the  fissure  of  Glasserius,  which  transmits  the  chorda 
tympani  nerve,  the  laxator  tympani  muscle,  and  the  anterior  tympanic 
artery.  It  also  gives  lodgment  to  the  long  process,  processus  gracilis, 
of  the  malleus. 

Between  this  cavity  and  the  condyle  there  is  interposed  an  iirter- 
articular  cartilage,  so  moulded  as  to  fit  the  two  articular  surfaces. 
The  circumference  of  this  being  free,  except  where  it  adheres  to  the 
external  lateral  ligament,  aflbrds  attachment  to  a  few  fibres  of  the  ex- 
ternal pterygoid  muscle,  and  facilitates  the  movements  of  the  joint. 

The  union  of  this  articulation  is  maintained  by  the  external  lateral, 
the  spheno-maxillary,  and  the  styio-maxillary  ligaments. 

THE   PALATE   BONES. 

The  Palate  Bones,  two  in  number,  are  situated  at  the  back  part  of 
the  superior  maxillary  bone,  between  its  tuberosities  and  the  pterygoid 
processes  of  the  sphenoid  bone. 


BONES  OF  THE  HEAD  AND  FACE.  67 

The  palate  bone  is  divided  into  three  plates :  the  horizontal  or  pala- 
tine, the  vertical  or  nasal,  and  the  orbital. 

The  palate  plate  is  broad  and  on  the  same  line  with  the  palate  pro- 
cesses of  the  superior  maxillary  bone ;  its  upper  surface  is  smooth  and 
forms  the  posterior  floor  of  the  nostrils,  the  lower  surface  is  rough  and 
forms  the  posterior  part  of  the  roof  of  the  mouth ;  its  anterior  edge  is 
connected  with  the  palate  process  of  the  upper  jaw,  and  its  posterior  is 
thin  and  crescentric,  to  which  is  attached  the  velum-pendulum  palati 
or  soft  palate ;  at  the  posterior  point  of  the  suture,  uniting  the  two 
palate  bones,  there  projects  backward  a  process  called  the  posterior 
nasal  spine,  which  gives  origin  to  the  azygos-uvulse  muscle.  The  ver- 
tical plate  ascends,  helps  to  bound  the  nasal  cavity,  diminishes  the 
opening  into  the  antrum  by  projecting  forward,  and  by  its  external 
posterior  part,  in  conjunction  with  the  pterygoid  processes  of  the 
sphenoid  bone,  forms  the  'posterior  palatine  canal;  the  lower  orifice  of 
which  is  seen  on  the  margin  of  the  palate  plate,  and  is  called  the  'pos- 
terior pialatine  foramen,  transmitting  the  palatine  nerve  and  artery  to 
the  soft  palate ;  behind  this  foramen  is  often  seen  a  smaller  one,  pass- 
ing through  the  base  of  the  pterygoid  process  of  this  bone,  and  sending 
a  filament  of  the  same  nerve  to  the  palate. 

Fig.  6. 


SUPERIOR  ME  A  TUS. 
SPHCna     PALA  TINE  J^OKAMEN 


MAXILLARY 
-PROCESS 


HORIZONTAL      PLATE 

The  upper  end  of  the  vertical  or  nasal  plate  has  two  processes  —  the 
one  is  seen  at  the  back  of  the  orbit,  called  the  orbital  process ;  the 
other  is  posterior,  and  fits  against  the  under  surface  of  the  body  of  the 
sphenoid  bone.     Between  these  two  processes  is  a  foramen,  the  spheno- 


58 


MUSCLES. 


palatine,  which  trausraits  to  the  nose  a  nerve  and  artery  of  the  same 
name. 

The  palate  bone  articulates  with  six  others,  namely :  the  superior 
maxillary,  inferior  turbinated,  vomer,  sphenoid,  ethmoid,  and  opposite 
palate. 

'■  The  structure  of  this  bone  is 

very  thin,  and  consists  almost 
entirely  of  compact  tissue.  Its 
development,  it  is  said,  takes 
place  by  a  single  point  of  ossi- 
fication at  the  union  of  the 
vertical,  horizontal,  and  pyra- 
.  midal  portions. 

The  bones  of  the  head  are 
twenty -two  in  number,  of  which 
eight  compose  the  cranium  and 
fourteen  the  face.  Those  of 
the  cranium  are  one  frontal, 
two  parietal,  two  temporal,  one 
occipital,  one  sphenoid,  and  one 
ethmoid.  Those  of  the  face 
are  six  pairs  and  two  single 
bones ;  the  pairs  are  the  two  malar,  two  superior  maxillary,  two  lach- 
rymal, two  nasal,  two  palatine,  and  two  inferior  turbinated.  The 
vomer  and  inferior  maxillary  are  the  two  single  bones. 


SPHENO.PALA  TIHE  rORA. 


SPHENOIDAL    PROCESS 

-f—/iflTICULAP  PORT. 

\  cxT.sunr. 

NON  AKTICUL/IR  POfir. 


POST. 
NASAL    SP/A/E 


''"aepo. 


AZYCOS    1. 

RIZONTAL 
PLATE 


CHAPTER  V. 


MUSCLES. 

MUSCLES  are  the  fleshy  parts  of  the  body.     They  are  the  active 
organs  of  locomotion,  and  are  composed  of  fibres  bound  together 
in  bundles,  or  fasciculi,  by  delicate  areolar  tissue. 

The  muscular  fibres  of  which  each  muscle  is  compounded  are  called 
ultimate  fibres.  Of  these  anatomists  recognize  two  kinds  —  volun- 
tary or  animal  fibres,  and  involuntary  or  organic  fibres.  The  former 
are  generally  under  the  influence  of  the  will,  are  of  uniform  size, 
and  present  transverse  markings.  They  compose  the  muscles  of 
the  trunk  and  limbs  as  well  as  those  of  the  heart,  urethra,  internal 
ear,  and,  in  part,  those  of  the  oesophagus, — though  these  latter  are  not 
subject  to  the  will. 


MUSCLES.  59 

The  involuntary  fibres  are  not  under  volitional  control,  are  not 
striped,  are  of  smaller  size  and  homogeneous  structure.  They  are 
found  in  the  digestive  canal,  uterus,  and  bladder.  The  voluntary 
muscles  terminate  in  fibrous  tissue,  which  is  sometimes  gathered  to- 
gether in  bundles  to  form  tendon,  or  is  spread  out  in  a  membranous 
form,  and  is  then  called  aponeurosis.  By  one  or  the  uther  of  these 
terminal  forms  almost  all  muscles  are  attached  to  those  parts  which 
it  is  their  ofiice  to  move. 

The  involuntary  muscles  are  generally  found  interlacing  freely  around 
a  cavity,  which,  by  their  contraction,  they  constrict,  expelling  its  con- 
tents. Each  muscle  is  closely  though  loosely  invested  by  a  sheath  of 
cellular  tissue,  which  also  sends  prolongations  into  the  body  of  the 
muscle,  investing  each  fibre  and  binding  them  together.  Muscles  are 
variously  named,  according  to  their  form,  long,  broad,  short,  etc. 
These  names  sufiiciently  explain  themselves.  Other  names  are  given 
them,  depending  on  the  arrangement  of  their  fibres,  their  situation, 
number  of  divisions,  office,  etc. ;  for  fuller  explanation,  students  are 
referred  to  more  exclusively  anatomical  works. 

The  Fascia,  which  everywhere  invests  the  more  delicate  organs,  is 
of  two  kinds  —  superficial  or  fibro-areolar,  and  deep  or  aponeurotic. 
The  superficial  facia  lies  just  beneath  the  skin,  and  covers  nearly  the 
entire  surface  of  the  body.  It  serves  to  connect  the  skin  with  the 
deep  facia,  and  furnishes  a  nidus  for  nerves  and  bloodvessels  passing 
to  the  skin. 

The  deep  facia  is  composed  of  fibres  arranged  in  a  reticulated  man- 
ner, forming  a  dense,  inelastic  membrane,  which  invests  each  muscle  in 
a  separate  sheath.  Sheaths  are  also  formed  from  it  for  the  vessels  and 
nerves;  and  it  serves  also  as  points  of  attachment  for  the  muscles. 

Each  striped  muscular  fibre  is  composed  of  two  parts  —  a  proper 
substance  called  the  sarcous  element,  in  which  the  contractile  property 
resides,  and  a  sheath  or  sarcolemma,  a  transparent,  structureless  mem- 
brane, in  which  is  contained  the  contractile  substance.  These  element- 
ary fibres  are  connected  by  areolar  tissue,  with  which  a  little  fat  is 
often  associated.  Lying  between  these  fibres  are  bloodvessels,  nerves, 
and  lymphatics. 

The  sarcous  element  is  a  soft,  granular  material,  on  the  varying  rela- 
tions of  which  granules  to  each  other  depend  the  alterations  in  ap- 
pearance of  the  strise.  If  they  approach  each  other  more  closely  in 
the  direction  of  the  length  of  the  fibre  than  in  its  width,  it  will  appear 
fibrillated ;  if  the  reverse,  it  will  present  the  appearance  of  discs. 

Muscles,  like  all  other  tissues,  are  developed  from  germinal  matter 
which  has  undergone  special  metamorphosis,  under  the  impulse  of  the 
parent  cell,  to  construct  this  tissue.     "  Germinal  matter  "  and  "  formed 


60 


MUSCLES. 


material  "constitute  the  "elementary  part," — according  to  Mr.  Beale, 
—  or  the  muscular  cell  of  other  writers  from  which  the  muscular  fibre 
is  formed.  In  the  formed  material,  which  is  the  constructed  muscle, 
resides  the  power  of  contraction.  The  germinal  matter  or  constructive 
part  does  not  possess  this  property. 

Following  the  arrangement  of  Mr.  Gray,  we  shall  divide  the  muscles, 
which  it  is  our  purpose  to  describe,  into  certain  groups,  as  follows : 


1.    Nasal  Group. 
Pyramidalis  Nasi. 

Leyator  Labii  Superioris  Alaeque  Nasi. 
Levator  Proprius  Alae  Nasi  Posterior. 
Levator  Proprius  Alte  Nasi  Anterior. 
Compressor  Naris. 
Compressor  Narium  Minor. 
Depressor  Alte  Nasi. 

2.   SiPERioR  Maxillary  Group. 
Levator  Labii  Superioris  Proprius. 
Levator  Anguli  Oris. 
Zygomaticus  Major. 
Zygomaticus  Minor. 

8.    Inferior  Maxillary  Group. 
Levator  Labii  Inferioris. 
Depressor  Labii  Inferioris. 
Depressor  Anguli  Oris. 

4.  Temporo-Maxillary  Group. 
Masseter. 
Temporal. 


Pterygo-Maxillary  Group 

Pterygoidcus  Esternus. 
Pterygoidcus  Internua. 

6.  Lingual  Group. 
Genio-hyo-glossus. 
Hyo-glossus. 
Lingualis. 

Stylo-glossus. 
Palato-glossus. 

7.  Pharyngeal  Group. 
Constrictor  Infei'ior. 
Constrictor  Medius. 
Constrictor  Superior. 
Stylo-pharyngeus. 
Palato-pharyugeus. 

8.  Palatal  Group. 
Levator  Palati. 
Tensor  Palati. 
Azygos  Uvulae. 
Palato-glossus. 
Palato-pharyngeus. 


1.  Nasal  Group. 

Pyramidalis  Nasi. 

Levator  Labii  Superioris  Alaeque  Nasi. 

Levator  Proprius  Alae  Nasi  Posterior. 

Levator  Proprius  Alae  Nasi  Anterior. 

Compressor  Naris. 

Compressor  Narium  Minor. 

Depressor  Alae  Nasi. 

The  Pyramidalis  Nasi  is  a  triangular,  muscular  slip  extended  from 
the  occipito  frontalis.  It  lies  along  the  side  of  the  nose,  and  blends  by 
a  tendinous  expansion  with  the  compressor  naris. 

The  Levator  Labii  Superioris  Alceque  Nasi  is  also  a  triangular 
muscle,  arising  from  the  nasal  process  of  the  superior  maxilla,  its 
upper  part.  Passing  down  behind  the  muscle  just  described,  it  divides 
into  two  muscular  slips,  one  of  which  is  inserted  into  the  cartilage  of 


MUSCLES.  61 

the  ala  of  the  nose,  the  other  is  continued  to  the  angle  of  the  mouth, 
where  it  blends  with  the  orbicularis  oris  and  levator  labii  proprius. 

Beneath  this  muscle  is  a  small  muscular  slip  extending  from  the 
origin  of  the  compressor  naris  to  the  nasal  process,  about  an  inch  above 
it.     It  is  called  the  "Musculus  Anomalus,"  or  the  "  Rhomboideus." 

The  Levator  Proprius  Aloe,  Nasi  Posterior,  or  Dilator  K'aris  Poste- 
rior, extends  from  the  nasal  notch  to  the  margin  of  the  nostril. 

The  Levator  Proprius  Alee  Naris  Anterior,  or  the  Dilator  Naris 
Anterior,  is  situated  a  little  in  front  of  the  last  described  muscle,  and 
arises  from  the  cartilage  of  the  wing  of  the  nose,  and  is  inserted  into 
the  integument  near  its  margin. 

The  Compressor  Naris,  triangular  in  form,  arises  from  the  superior 
maxilla,  a  little  above  and  external  to  the  incisive  fossa,  and  is  attached 
to  the  fibro-cartilage  of  the  nose  joining  at  the  median  line  with  its 
fellow  of  the  opposite  side. 

The  Compressor  Narium  Minor  extends  from  the  alar  cartilage  to 
the  integument  of  the  end  of  the  nose. 

The  Deptressor  Alee  Nasi  arises  from  the  incisive  fossa  of  the  supe- 
rior maxilla,  and  dividing  into  two  sets  of  fibres,  ascending  and  descend- 
ing, is  inserted  into  the  septum  and  posterior  portion  of  nasal  cartilage, 
and  by  some  fibres  of  the  latter  into  the  back  part  of  the  orbicularis  oris. 

The  facial  nerve  supplies  all  the  muscles  of  this  group. 

Their  respective  actions  are  sufficiently  explained  by  their  names, 
except  the  pyramidalis,  which  draws  down  the  inner  angle  of  the  eye- 
brow, and  perhaps  aids  in  dilating  the  nostril ;  and  the  compressores 
nasi,  whose  action  is  directly  opposite  to  that  implied  by  their  names. 

The  contraction  of  the  levator  labii  superioris  alseque  nasi  gives 
to  the  face  the  expression  of  contempt. 

2.  Superior  Maxillary  Group. 

Levator  Labii  Superioris  Proprius. 
Levator  Anguli  Oris. 
Zygomaticus  jNLijor. 
Zygomaticus  Minor. 

The  Levator  Labii  Superioris  Proprius  arises  from  the  lower  margin 
of  the  orbit,  some  of  its  fibres  from  the  superior  maxillary,  others  from 
the  malar  bone  ;  they  pass  down  to  be  inserted  in  the  fleshy  part  of  the 
upper  lip. 

The  Levator  Anguli  Oris  arises  from  the  canine  fossa  just  below  the 
infra-orbital  foramen,  and  descends  to  the  angle  of  the  mouth,  where 
it  blends  with  the  orbicularis  oris,  the  zygomatici,  and  the  depressor 
anguli  oris  muscles. 

The  Zygomaticus   Major  is  a  delicate  fasciculus,  arising  from  the 


62  MUSCLES. 

malar  bone  and  finding  attachment  to  the  orbicularis  and  depressor  an- 
guli  oris  at  the  angle  of  the  mouth. 

The  Zi/gomaticus  Minor  arises  from  the  malar  bone  just  behind  the 
maxillary  suture,  and  pa.?ses  downward  and  inward  to  be  inserted  in 
the  outer  margin  of  the  levator  labii  superioris,  with  which  it  is  con- 
tinuous. 

Tiiese  muscles  are  also  supplied  by  the  facial  nerve. 

The  action  of  the  levator  muscles  is  described  in  their  names.  The 
zygoraatici  draw  the  lip  upward  and  outward,  as  in  laughing. 

3.  Inferior  Maxillary  Group. 

Levator  Labii  Inferioris,  (Levator  Menti.) 

Depressor  Labii  Inferioris,  (Quadratus  Menti.) 

Depressor  Anguli  Oris,  (Triangularis  Menti. ) 

The  Levator  Labii  Inferioris  arises  from  the  incisive  fossa  just  exter- 
nal to  the  symphysis  of  the  chin  :  it  is  a  small  conoidal  fasciculus,  and 
is  inserted  into  the  integument  of  the  chin. 

The  Depressor  Labii  Inferioris  is  a  quadrilateral  muscle  arising  from 
the  oblique  line  of  the  inferior  maxilla,  between  the  incisive  fossa  and 
mental  foramen,  and  is  attached  to  the  integument  of  the  lower  lip, 
blending  with  the  orbicularis  oris  and  with  its  fellow  of  the  opposite 
side. 

The  Depressor  Anguli  Oris,  situated  externally  to  the  last  mentioned 
muscle,  also  arises  from  the  external  oblique  line  of  the  lower  jaw,  and 
is  attached  at  the  angle  of  the  mouth  to  the  orbicularis,  levator 
anguli,  and  zygomaticus  major  muscles. 

The  facial  nerve  supplies  this  group. 

Their  action  is  indicated  by  their  names. 

4.  Temporo-Maxillary  Group. 

Temporal. 
Masseter. 

The  Temporal  Muscle  (Fig.  8)  is  seen  on  the  side  of  the  head.  It  has 
its  origin  from  the  semi-circular  ridge  commencing  at  the  external  angu- 
lar process  of  the  os-frontis,  and  extending  along  this  and  the  parietal 
bone ;  also  from  the  surfaces  below  this  ridge  formed  by  the  frontal 
and  squamous  portion  of  the  temporal  and  sphenoid  bones ;  likewise 
from  the  under  surface  of  the  temporal  aponeurosis,  and  from  a  fascia 
covering  this  muscle ;  and  its  fibres  are  inserted,  after  they  have  con- 
verged and  passed  under  the  zygoma,  into  the  coronoid  process  of  the 
lower  jaw,  surrounding  it  on  every  side  by  a  dense  strong  tendon. 

The  Masseter  Muscle  (Fig.  9j  is  seen  at  the  side  and  back  part  of 
the  face  in  front  of  the  meatus  externus,  and  lies  directly  under  the 


MUSCLES, 


63 


skin.  It  arises  by  two  portions  :  the  one  anterior  and  tendinous,  from 
tlie  superior  maxilla  where  it  joins  the  malar  bone ;  the  other  portion, 
mostly  fleshy,  from  the  inferior  edge  of  the  malar  bone  and  the  zygo- 
matic arch  as  far  back  as  the  glenoid  cavity,  and  is  inserted,  tendinous 
and  fleshy,  into  the  external  side  of  the  ramus  of  the  jaw  and  its  angle 
as  far  up  as  the  coronoid  process. 

The  inferior  maxillary  nerve  supplies  both  these  muscles. 

The  ofiice  of  the  temporal  muscle  is  to  bring  the  two  jaws  together, 
as  in  the  cutting  and  rending  of  the  food. 

The  use  of  the  masseter  muscle,  when  both  portions  act  together,  is 
to  close  the  jaws ;  if  the  anterior  acts  alone,  the  jaw  is  brought  for- 
ward, if  the  posterior,  it  is  drawn  backward. 

Fig.  8. 


The  use  of  the  pterygoid  muscle  is  to  aid  the  temporal  and  masseter 
muscles  in  the  trituration  of  the  food.  The  external  pterygoids  carry 
the  lower  jaw  directly  forward  when  acting  together,  to  one  or  the 
other  side  when  acting  separately  The  internal  pterygoid  aids  the 
masseter  and  temporal  in  bringing  the  lower  jaw  firmly  up  against  the 
superior  maxilla,  and  also  assists  in  carrying  the  low^er  jaw  forward. 

The  inferior  maxillary  nerve  supplies  these  muscles,  which  form  the 
pterygo-maxillary  group,  and  which  come  next  in  order  of  description. 


64 


MUSCLES, 


5.  Pterygo-Maxillary  Group. 

Ptervgoideus  Externus. 
Pterygoideus  Internus. 

Pterygoklens  Externus  (Fig.  10)  arises  from  the  outer  surface  of  the 
external  plate  of  the  pterygoid  process  of  the  sphenoid  bone,  from  the 
tuberosity  of  the  superior  maxilla,  and  from  the  ridge  on  the  sphenoid 

Fig.  9. 


LEVATOR  niENTI 


bone  separating  the  zygomatic  from  the  pterygoid  fossa,  and  is  inserted 
into  the  inner  side  of  the  neck  of  the  lower  jaw,  and  capsular  ligament 
of  the  articulation. 

Pterygoideus  Internum  arises,  tendinous  and  fleshy,  from  the  inner 
surface  of  the  pterygoid  plate,  fills  the  greater  part  of  the  pterygoid 


MUSCLES, 


65 


fossa,  and  is  inserted,  tendinous  and  fleshy,  into  the  inner  face  of  the 
angle  of  the  inferior  maxilla  and  the  rough  surface  above  the  angle. 

The  external  one  is  triangular,  having  its  base  at  the  pterygoid  pro- 
cess and  running  outward  and  backward  to  the  neck  of  the  condyle. 
The  internal  is  strong  and  thick,  placed  on  the  inside  of  the  ramus  of 
the  jaw,  and  running  downward  and  backward  to  the  angle. 

Fig.  10. 


6.  Lingual  Group. 

Genio-hyo-glossus. 
Hyo-glossus. 
•  Lingualis. 

Stylo-glossus. 
Palato-glossus. 

The  Genio-hyo-giossiis  is  attached,  as  its  name  implies,  to  the  chin, 
hyoid  bone,  and  tongue.  It  is  a  triangular,  fan-like  muscle,  arising  by 
its  apex  from  the  superior  genial  tubercle,  and  has  its  inferior  fibres 
running  parallel  with  the  genio-hyoid  to  be  inserted  into  the  hyoid 
bone,  while  its  middle  and  anterior  fibres  are  inserted  into  the  under 
surface  of  the  tongue  its  whole  length. 

The  Hyo-glossus,  a  thin,  broad,  quadrilateral  muscle,  has  its  origin 
from  the  body,  cornu,  and  appendix,  of  the  os-hyoides,  and  is  inserted 
into  the  side  of  the  tongue,  forming  the  greater  part  of  its  bulk. 

The  Lingualis  has  its  origin  on  the  under  surface  of  the  tongue,  ex- 
tending from  its  base  and  the  hyoid  bone  to  the  apex,  and  so  inter- 
5 


66 


MUSCLES. 


mingling  with  the  other  muscles  as  to  be  considered  rather  a  part  of 
them  than  a  distinct  muscle. 

The  Sttjh-glossus  arises  from  the  point  of  the  styloid  process  and 
stylo-maxillary  ligament.  It  is  inserted  into  the  side  of  the  tongue 
near  its  root,  its  fibres  running  to  the  tip. 

Fig.  11. 


The  Palato-glossus  is  more  directly  associated  with  the  soft  palate, 
and  will  consequently  be  described  with  the  palatal  group. 


7.  Pharyngeal  Group. 

Constrictor  Inferior. 

Constrictor  Medius. 
Constrictor  Superior. 
Stylo-pharyngeus. 
Palat  o-pharyngeus. 

The  Inferior  Constrictor  of  the  pharynx  (Fig.  12)  arises  from  the 
side  of  the  thyroid  cartilage  and  its  inferior  cornu,  and  from  the  side 
of  the  cricoid  cartilage,  and  is  inserted  with  its  fellow  into  the  middle 


MUSCLES. 


67 


line  on  the  back  of  the  pharynx.     This  is  the  largest  of  the  constrictor 
muscles,  and  overlaps  the  middle  constrictor. 

The  Middle  Constrictor  of  the  pharynx  (Fig.  12)  arises  from  the 
appendix  and  both  cornua  of  the  os-hyoides,  and  from  the  thyro-hyoid 
ligament;  its  fibres  ascend,  run  transversely  and  descend,  giving  a  tri- 
angular appearance ;  the  upper  ones  overlap  the  superior  constrictor, 
while  the  lower  are  beneath  the  inferior ;  the  whole  pass  back  to  be 
inserted  into  the  middle  ten- 
dinous line  of  the  pharynx.  ^^^-  ^-• 

The  Superior  Constrictor  (Fig. 
12)  arises  from  the  cuneiform 
process  of  the  occipital  bone, 
from  the  lower  part  of  the 
internal  pterygoid  plate  of  the 
sphenoid  bone,  from  the  pterygo- 
maxillary  ligament,  and  from 
the  posterior  third  of  the  mylo- 
hyoid ridge  of  the  lower  jaw, 
near  the  root  of  the  last  molar 
tooth.  It  is  inserted  with  its 
fellow  into  the  middle  tendinous 
line  at  the  back  of  the  pharynx. 

The  Stylo-pharyngeus  arises 
from  the  root  of  the  styloid  pro- 
cess, and  is  inserted  into  the  side 
of  the  pharynx  and  corner  of 
the  os-hyoides  and  thyroid  car- 
tilage. It  is  a  long  and  narrow 
muscle,  and  passes  to  the  pha- 
rynx between  the  upper  and 
middle  constrictors. 

The  Palato-pharyngeus,  which 
forms  the  posterior  pillar  of  the 
soft  palate,  is  a  long,  fleshy  muscle,  wider  at  either  extremity  than  in  the 
middle,  and  arises  from  the  soft  palate  by  a  divided  fasciculus,  between 
which  points  of  attachment  lies  the  levator-palati.  It  passes  behind 
the  tonsil,  downward  and  outward,  to  be  inserted  into  the  posterior 
part  of  the  thyroid  cartilage,  together  with  the  stylo-pharyngeus. 

The  muscles  of  this  group  are  supplied  with  nerves  from  the  pharyn- 
geal plexus  and  glosso-pharyngeal  nerve ;  an  additional  branch  from 
the  external  laryngeal  nerve  being  sent  to  the  inferior  constrictor; 
the  palato-pharyngeus  receives  a  branch  from  Meckle's  ganglion. 

These  muscles  are  exercised  in  the  act  of  deglutition,  and  also  exert 
an  influence  in  modulating  the  voice. 


68 


MUSCLES. 


8.  Palatal  Group. 

The  Levator  Palali. 

Tlie  Tensor,  or  Circuniflexus  Palati. 

Constrictor  Isthmi-faucium,  or  Palato-glossus. 

Palato  pharyngeus. 

Azygos-uvuUc. 

The  Levator  Palati  (Fig.  13)  arises  from  the  point  of  the  petrous 
portion  of  the  temporal  bone  and  adjoining  portion  of  the  Eustachian 
tube,  descends  and  is  inserted  into  the  soft  palate. 

The  Temor,  or  Circumjiexus  Palati,  arises  from  the  base  of  the 
pterygoid  process  of  the  sphenoid  bone  and  from  the  Eustachian  tube;  it 

Fig.  13. 


descends  in  contact  with  the  internal  pterygoid  muscle  to  the  hamulus, 
round  which  it  winds,  and  is  inserted  into  the  soft  palate,  where  it  ex- 
pands and  joins  its  fellow. 

The  Constrictor  Isthmi-faucium,  or  Palato-glossus,  occupies  the  ante- 


MUSCLES.  69 

rior  lateral  half  arches  of  the  palate;  it  arises  from  the  side  of  the 
tongue  near  its  root,  and  is  inserted  into  the  velum  near  the  uvula. 

The  Palato-pharyngeus  has  already  been  described  with  the  muscles 
of  the  pharyngeal  group. 

The  Azygos-uvulce  arises  from  the  posterior  spine  of  the  palate  bones 
at  the  termination  of  the  palate  suture,  runs  along  the  central  line  of  the 
soft  palate,  and  ends  in  the  point  of  the  uvula.  It  raises  and  shortens 
the  uvula. 

It  is  thus  seen  that  the  various  muscles  of  the  soft  palate  are  all 
concerned,  more  or  less,  in  conducting  the  food  into  the  pharyngeal 
cavity.  The  elevators  raise  the  palate,  and  at  the  same  time  protect 
the  posterior  nares  from  regurgitation  of  the  food;  while  the  tensor 
puts  it  on  the  stretch,  and  after  it  has  passed  the  velum,  the  con- 
strictor isthmi-faucium  and  palato-pharyngeus  draw  the  palate  down, 
and  thus  close  the  opening  into  the  mouth ;  after  which  the  food,  as 
already  mentioned,  is  grasped  by  the  constri<3tor  muscles  of  the 
pharynx,  and  conveyed  into  the  cesophagus. 

The  Soft  Palate  is  a  movable  curtain,  composed  of  mucous  mem- 
brane, inclosing  several  muscles.  It  is  situated  at  the  back  part  of  the 
mouth  between  this  cavity  and  the  pharynx,  is  connected  above  to  the 
posterior  edge  of  the  hard  palate,  and  laterally  to  the  side  of  the 
tongue  and  pharynx. 

By  this  arrangement,  the  soft  palate  has  the  appearance  of  a  lunated 
or  arched  veil  between  the  cavity  of  the  mouth  and  the  pharynx. 

In  the  centre  of  this  arch  an  oblong  body  is  suspended,  called  the 
uvula,  which  divides  the  soft  palate  into  lateral  half  arches,  that  pass 
on  either  side  from  the  uvula  to  the  root  of  the  tongue. 

There  is  also  seen  passing  from  the  uvula  on  each  side  to  the 
pharynx,  two  other  arches,  which,  from  being  behind  the  first,  are 
called  the  posterior  arches  or  pillars. 

Between  the  anterior  and  posterior  pillars,  on  either  side,  is  a  trian- 
gular interval  containing  the  tonsil  glands. 

The  Fauces  are  the  straits  or  passage  leading  from  the  mouth  to  the 
pharynx;  and  the  space  included  between  the  soft  palate  above,  the 
half  arches  or  tonsils  on  either  side,  and  the  root  of  the  tongue  below, 
is  called  the  isthmus  of  the  fauces. 

The  Tonsils  are  two  bodies,  each  about  the  size  of  an  almond,  seen 
at  the  root  of  the  tongue  on  its  sides,  occupying  the  cavity  between 
the  anterior  and  posterior  half  arches.  They  consist  of  a  group  of 
compound  follicular  glands,  forming  somewhat  oval  bodies,  whose  en- 
largement constitutes  an  obstacle  to  deglutition,  and  by  their  locality 
near  the  mouths  of  the  Eustachian  tubes,  frequently  cause  obstruction 
and  deafness. 


70 


BLOODVESSELS    OF    THE    MOUTH. 


CHAPTER  VI. 

BLOODVESSELS   OF   THE   MOUTH. 

THE  arteries  that  supply  the  mouth  come  from  the  external  carotid. 
This  is  a  division  of  the  common  carotid  which  arises  on  the  rignt 
side  from  the  arteria  innominata,  and  on  the  left  from  the  arch  of  the 

Fig.  14. 


INCISTUS 


aorta ;  after  passing  up  the  neck  on  either  side  along  the  course  of  the 
sterno-cleido-mastoid  muscles,  it  divides  on  a  level  with  the  top  of  the 
thyroid  cartilage  into  its  two  great  branches — the  external  and  in- 
ternal carotid  arteries. 

The  Internal  Carotid  Artery  has  a  tortuous  course ;  is  first  to  the 
outside  and  behind  the  external  carotid ;  then  ascends  in  front  of  the 
vertebral  column  by  the  side  of  the  pharynx  and  behind  the  digastric 
and  styloid  muscles  to  the  carotid  foramen  in  the  petrous  portion  of 
the  temporal  bone;  thence  it  traverses  the  canal  in  this  bone  and 


BLOODVESSELS    OF    THE    MOUTH.  71 

enters  the  brain,  supplying  it  with  most  of  its  vessels,  not  giving  any 
to  the  mouth. 

The  External  Carotid  extends  from  the  top  of  the  larynx  to  the 
neck  of  the  condyle  of  the  lower  jaw ;  at  first  anterior  and  on  the 
inside  of  the  internal  carotid,  it  soon  gets  to  the  outside,  then  passes 
under  the  digastric  and  stylo-hyoid  muscles  and  lingual  nerve,  becomes 
imbedded  in  the  parotid  gland,  and  terminates  between  the  neck  of 
the  inferior  maxilla  and  the  auditory  meatus  in  the  temjDoral  and  in- 
ternal maxillary  arteries. 

The  branches  of  the  external  carotid  with  which  we  have  to  do 
are  the 

Lingual. 

Facial. 

Ascending  Pharyngeal. 

Temporal. 

Internal  Maxillary. 
The  Lingual  Artery  arises  from  the  external  carotid,  between  the 
superior  thyroid  and  facial ;  passing  obliquely  up  to  the  great  corner 
of  the  hyoid  bone,  it  runs  parallel  with,  and  ascending  perpendicularly 
to  the  base  of  the  tongue,  continues  its  course  to  the  tip  of  that  organ, 
under  the  name  of  the  ranine  artery.  This  part  of  the  artery  lies  just 
beneath  the  mucous  membrane,  and  is  in  danger  of  being  wounded  in 
division  of  the  freenum  in  children.  This  accident  may  be  avoided  by 
using  blunt-pointed  scissors,  and  directing  the  points  downward  and 
backward. 

The  hypo-glossal  nerve  accompanies  this  artery. 
The  branches  of  the  lingual  artery  with  which  we  are  concerned 
are  the 

Dorsalis  Linguae. 

Sublingual. 

Ranine. 
The  Dorsalis  Linguce  arises  from  the  lingual  artery,  beneath  the  hyo- 
glossus  muscle,  and  is  distributed  to  the  tonsil,  epiglottis,  soft  palate, 
and  mucous  membrane  of  the  tongue. 

The  Sublingual  arises  from  the  lingual  at  the  point  of  bifurcation, 
near  the  anterior  margin  of  the  hyo-glossus  muscle,  and  passes  forward 
to  be  distributed  to  the  sublingual  gland,  to  the  mucous  membrane  of 
the  mouth  and  gums,  and  to  the  neighboring  muscles. 

The  Ranine  may  be  considered  the  continuation  of  the  lingual.  It 
passes  along  the  inferior  surface  of  the  tongue  just  beneath  its  mucous 
membrane.  At  the  tip  of  the  tongue  it  anastomoses  with  its  fellow  of 
the  opposite  side.     It  is  accompanied  by  the  gustatory  nerve. 


72  BLOODVESSELS    OF    THE    MOUTH. 

The  Facial  Artery  is  the  third  branch  of  the  external  carotid.  It 
ascends  to  the  submaxillary  gland,  behind  which  it  passes  on  the  body 
of  the  lower  jtiw  —  thence  it  goes  in  front  of  the  masseter  muscle  to  the 
angles  of  the  mouth,  and  finally  terminates  at  the  side  of  the  nose  by 
anastomosing  with  the  ophthalmic  arteries. 

In  its  course  it  gives  off  the  submental,  inferior  labial,  superior  and 
inferior  coronary  arteries,  which  mainly  supply  the  elevators,  depres- 
sors, and  circular  muscles  of  the  mouth.  The  branches  of  the  facial 
artery  are  divided  into  two  sets : 

Cervical  Branches.  Facial  Branches. 

Inferior  or  Ascending  Palatine.  Muscular. 

Tonsillitic.  Inferior  Labial. 

Submaxillary.  Infei'ior  Coronary. 

Submental.  Superior  Coronary. 

Lateralis  Nasi. 

Angular. 

The  Inferior  Palatine  passes  up  between  the  stylo-glossus  and  stylo- 
pharyngeus  muscles,  which  it  supplies,  to  give  branches  to  the  tonsil, 
Eustachian  tube,  soft  palate,  and  palatine  glands,  anastomosing  with 
the  tonsillitic  artery,  and  with  a  branch  of  the  internal  maxillary. 

The  Tonsillitic  Artery  is  distributed  to  the  tonsil  and  root  of  the 
tongue. 

The  Submaxillary  supplies  the  submaxillary  gland,  together  with 
the  neighboring  lymphatic  glands,  muscles,  and  integument. 

The  Stihmental  is  the  largest  of  the  cervical  branches  of  the  facial 
artery  ;  it  is  given  off  from  it  just  as  it  emerges  from  the  submaxillary 
gland,  and  passing  along  the  lower  border  of  the  inferior  maxilla  is  dis- 
tributed to  the  muscles  attached  to  the  jaw,  and  terminates  in  a  super- 
ficial and  deep  branch  ;  the  former  of  which  is  distributed  to  the 
depressor  labii  inferioris  and  integument,  anastomosing  with  the  in- 
ferior labial ;  the  latter  is  also  distributed  to  the  lip,  and  anastomoses 
with  the  inferior  labial  and  mental  arteries. 

The  Facial  branches  are  distributed  to  the  muscles  of  the  face.  The 
muscular  to  the  pterygoid,  masseter  and  buccinator  muscles.  The 
superior  coronary  to  the  upper  lip,  giving  branches  to  the  septum  and 
ala  nasi.  The  inferior  coronary  passes  to  the  lower  lip,  and  anasto- 
moses with  its  fellow  of  the  opposite  side.  The  lateralis  nasi  sup- 
plies the  Aving  and  back  of  the  nose.  The  angular  is  the  terminal 
branch  of  the  facial.  It  supplies  the  cheek,  lachrymal  sac,  and  orbic- 
ularis palpebrarum  muscle,  and  terminates  by  anastomosing  with  the 
ophthalmic  by  its  nasal  branch. 

The  Ascending  Pharyngeal,  the  smallest  of  the  external  carotid 
branches,  is  given  off  from  the  posterior  part  of  the  external  carotid, 


BLOODVESSELS    OF    THE    MOUTH.  73 

passes  up  beneath  its  other  branches  and  the  stylo-pharyngeus  muscle 
to  the  base  of  the  skull ;  it  has  three  sets  of  branches  —  the  external, 
meningeal,  and  pharyngeal.  To  the  latter  only  do  I  wish  to  direct 
attention. 

The  Pharyngeal  branches  are  three  or  four  in  number,  two  of  which 
are  distributed  to  the  middle  and  inferior  constrictors  and  to  the  stylo- 
pharyngeus,  and  their  mucous  membrane.  The  largest  branch  sup- 
plies the  tonsil.  Eustachian  tube,  and  soft  palate,  substituting  the 
palatine  branch  of  the  facial  when  it  is  absent  or  of  small  size. 

The  Temporal  Artery  gives  off  a  transverse  facial  branch  just  before 
it  emerges  from  the  parotid  gland  which  is  distributed  to  that  gland, 
the  masseter  muscle  and  the  integument,  terminating  by  anastomosis 
with  the  facial  and  infra-orbital  arteries. 

The  Internal  Maxillary  Artery  commences  in  the  substance  of  the 
parotid  gland ;  then  goes  horizontally  behind  the  neck  of  the  condyle 
of  the  lower  jaw  to  the  pterygoid  muscles,  between  which  it  passes,  and 
then  proceeds  forward  to  the  tuberosity  of  the  superior  maxillary 
bone;  from  thence  it  takes  a  vertical  direction  upward  between  the 
temporal  and  external  pterygoid  muscles  to  the  zygomatic  fossa,  where 
it  again  becomes  horizontal,  and,  finally,  ends  in  the  spheno-maxillary 
fossa  by  dividing  into  several  branches. 

The  branches  of  this  artery  which  we  shall  describe  are  the — 

Inferior  Dental.  Alveolar. 

Infra-orbital.  Descending  Palatine. 

The  Inferior  Dental  Artery  enters  the  inferior  dental  foramen  of  the 
lower  jaw,  passes  along  the  dental  canal  beneath  the  roots  of  the  teeth ; 
sending  up,  in  its  course,  a  twig  through  the  aperture  of  each  to  the 
pulps  of  the  teeth,  and,  finally,  escapes  at  the  mental  foramen  on  the 
chin ;  a  branch  of  it,  however,  continues  forward  to  supply  the  incisors. 
After  emerging  from  the  mental  foramen,  it  supplies  the  muscles  and 
integument  of  the  chin  and  anastomoses  with  the  inferior  labial,  sub- 
mental, and  inferior  coronary  arteries.  Before  entering  the  dental 
foramen  a  large  branch,  the  mylo-hyoid,  which  lies  in  a  groove  of  the 
same  name  on  the  inner  surface  of  the  maxillary  bone  and  is  lost  on 
the  under  surface  of  the  mylo-hyoid  muscle,  is  given  off. 

The  Alveolar  is  given  off  from  the  internal  maxillary  by  a  trunk 
common  to  it  and  the  infra-orbital,  just  before  it  enters  the  spheno- 
maxillary fossa.  At  the  tuberosity  of  the  superior  maxillary  bone  it 
divides  into  num.erous  branches,^ome  of  which  passing  into  the  alveo- 
lar foramina  supply  the  bicuspid  and  molar  teeth  ;  others  pierce  the 
bone  to  supply  the  antrum,  whilst  some  are  distributed  to  the  gums. 

The  Infra-orbital  Artery  enters  the  infra-orbital  canal,  traverses  its 


74  BLOODVESSELS    OF    THE     MOUTH. 

whole  extent,  and  comes  out  at  the  foramen  of  the  same  name,  upon 
the  face ;  just  before  it  emerges  it  sends  through  the  anterior  dental 
canal  a  twig  for  the  incisors  and  cuspids,  having  previously  given 
branches  to  the  inferior  rectus  and  inferior  oblique  muscles,  and  to  the 
lachrymal  gland,  also  other  branches  to  the  lining  membrane  of  the 
antrum.  After  escaping  from  the  orbit,  it  supplies  the  lachrymal  sac 
and  neighboring  tissues  and  anastomoses  Avith  the  facial,  nasal  branch 
of  the  ophthalmic,  and  with  the  transverse  facial  and  buccal  branches. 

The  Descending  Palatine  passes  along  the  posterior  palatine  canal, 
accompanied  by  palatine  branches  of  Meckel's  ganglion,  emerging 
thence  it  runs  along  a  groove  on  the  inner  border  of  the  alveoli,  and  is 
distributed  to  the  mucous  membrane  of  the  hard  palate,  to  the  gums 
and  the  palatine  glands.  In  the  posterior  palatine  canal  it  gives  off 
branches,  which  pass  along  the  accessory  palatine  canal  to  be  dis- 
tributed to  the  soft  palate.  In  front  it  terminates  in  a  small  branch 
which  enters  the  anterior  palatine  canal,  through  which  it  passes  to 
reach  the  septum  naris,  where  it  unites  with  a  branch  of  the  spheno- 
palatine. 

The  Vein-i  correspond  so  nearly,  both  in  name  and  course,  with  the 
arteries,  that  a  description  of  them  would  be  only  a  repetition  of  what 
has  been  said  ;  suffice  it,  therefore,  to  observe,  that  there  are  two  com- 
panion veins  with  every  considerable  artery,  and  that  the  venous 
branches  are  mostly  collected  at  the  angle  of  the  jaw  into  a  common 
trunk  called  the  external  jugular  vein,  which  passes  down  the  neck  in 
the  course  of  the  fibres  of  the  platysma  muscle,  and  terminates  in  the 
subclavian  vein  at  the  posterior  edge  of  the  sterno-mastoid  muscle. 

The  office  of  the  veins  is  to  return  the  blood  to  the  heart. 


THE  NERVES  OF  THE  MOUTH. 


75 


CHAPTER  VII. 

THE  NERVES  OF  THE  MOUTH. 

THE  nerves  supplying  the  mouth  belong  to  the  fifth  pair,  and  the 
portio  dura  of  the  seventh  or  facial  nerve. 

Fig.  15. 


fffMSCHV  ROOT 

/MOTOR    R007 


AUmcULOTCMPaRM  A/ 


The  Fifth  (Trigemini)  is  the  largest  of  the  cranial  nerves,  and  gives 
sensibility  to  all  the  organs  concerned  in  the  primary  stages  of  diges- 
tion. 

This  nerve  will  also  be  found  to  be  a  compound  nerve,  having  motor 
filaments  as  well  as  sensitive,  and  thereby  giving  motion  as  well  as 
sensation.     It  is  also  a  nerve  of  special  sense. 

It  is  first  seen  at  the  side  of  the  pons  Varolii  near  its  junction  with 
the  crura-cerebelli,  but  its  origin  is  much  deeper  and  further  back.     It 


76  THE  NERVES  OF  THE  MOUTH. 

arises  by  two  unequal  roots,  one  of  which  may  be  traced  through  the 
pons  Varolii  iuto  the  lateral  tract  bchiiid  the  olivary  body  ;  the  smaller, 
or  motor  root,  is  lost  in  the  medulla  oblongata.  From  its  origins  this 
nerve  has  been  called  a  cranial-spinal  nerve. 

These  two  fasciculi,  the  one  anterior  and  the  other  posterior,  consti- 
tute the  fifth  nerve,  which  consists  of  eighty  or  one  hundred  filaments 
that  pass  forward  and  outward,  in  a  canal  formed  of  dura  mater,  to  a 
depression  on  the  anterior  surface  of  the  petrous  bone. 

At  this  point  it  spreads  into  a  ganglion,  called  the  Casserian  gang- 
lion, on  tlie  under  surface  of  which  is  seen  the  anterior  root ;  but  it  has 
no  intimate  connection  with  the  ganglion,  and  can  be  traced  on,  as  will 
be  presently  shown,  to  the  inferior  maxillary  nerve. 

The  Casserian  ganglion  receives  filaments  from  the  carotid  plexus 
of  the  sympathetic,  and  gives  ofi"  several  minute  branches  to  the  dura 
mater  and  tentorium  cerebelli.  Three  large  branches  are  given  off 
from  its  anterior  border,  the  ophthalmic  and  superior,  and  inferior 
maxillary.  The  ophthalmic  and  superior  maxillary  are  exclusively 
nerves  of  sensation,  their  fibres  being  derived  entirely  from  the  poste- 
rior or  sensory  root,  whilst  the  inferior  maxillary  receives  fibres  from 
both  roots,  and  is  consequently  more  variously  endowed. 

The  Ophilicdmic  Nerve  is  a  short  trunk,  that  enters  the  orbit  through 
the  foramen  lacerum  superius.  It  supplies  the  eye-ball,  the  mucous 
membrane  of  the  eye  and  nose,  and  the  lachrymal  gland,  also  the 
muscles  and  integument  of  the  eye-brow  and  forehead.  It  is  a  sensi- 
tive nerve ;  is  the  first  given  off"  from  the  Casserian  ganglion,  and  is 
the  smallest  of  the  three  branches.  It  receives  a  few  filaments  from 
the  cavernous  plexus  of  the  sympathetic,  and  divides  into  three  prin- 
cipal branches. 

1.  The  Frontal, 

2.  The  Lachrymal,  and 

3.  The  Nasal.' 

The  Frontal,  which  is  the  largest  branch  of  the  ophthalmic,  passes 
along  the  roof  of  the  orbit  to  the  supra-orbital  foramen,  through  which 
it  passes,  and  is  then  called  the  supra-orbital  nerve,  and  is  spent  on  the 
muscles  and  integuments  of  the  forehead.  It  gives  ofi*  several  branches 
in  its  course. 

The  Lachrymal,  the  smallest  branch  of  the  ophthalmic,  generally 
arises  by  two  branches,  one  from  the  fourth  and  the  other  from  the 
ophthalmic.  It  enters  the  orbit  through  the  sphenoidal  fissure,  receives 
a  communicating  branch  from  the  superior  maxillary,  and  is  finally 
distributed  to  the  lachrymal  gland,  taking  the  outward  direction,  and 
sending  branches  in  its  course  to  the  upper  eyelid,  conjunctiva,  and 
other  parts,  receiving  on  the  eyelid  branches  from  the  facial. 


THE  NERVES  OF  THE  MOUTH.  77 

The  Nasal  takes  its  direction  along  the  inner  side  of  the  orbit  to  the 
anterior  ethmoidal  foramen,  through  which  it  passes  into  the  cranium, 
on  the  upper  surface  of  the  cribriform  plate  of  the  ethmoidal  bone ; 
descends  by  the  side  of  the  crista-galli  through  a  slit-like  opening  into 
the  nose,  and  there  terminates  by  filaments  which  are  spent  upon  the 
septum,  mucous  membrane,  anterior  nares,  &c.  It  sends  off  several 
branches  in  its  course ;  one  in  particular  to  the  lenticular  ganglion  at 
the  bottom  of  the  eye,  others  to  the  caruncula  lachrymalis,  lachrymal 
sac,  conjunctiva,  &c. ;  but  as  these  do  not  belong  to  the  mouth  and 
dental  apparatus,  we  will  pass  to  the  second  great  division  of  the  fifth. 

THE   SUPERIOR    MAXILLARY   NERVE. 

This  nerve  proceeds  from  the  middle  of  the  Casserian  ganglion, 
passes  through  the  foramen  rotundum  of  the  sphenoid  bone,  into  the 
pterygo-maxillary  fossa ;  here  it  enters  the  canal  of  the  floor  of  the 
orbit  —  the  infra-orbital  canal,  —  traverses  its  whole  extent,  and 
emerges  on  the  face  at  the  infra-orbital  foramen,  where  it  terminates 
in  numerous  filaments  in  the  muscles  and  integuments  of  the  upper  lip, 
cheek,  lower  eyelid,  and  side  of  the  nose. 

The  superior  maxillary  nerve  supplies  the  upper  jaw,  and  gives  off 
many  important  branches,  which  are  as  follows: 

In  the  pterygo-maxillary  fossa  two  branches  descend  to  a  small  red- 
dish body  called  the  ganglion  of  Meckel,  or  the  spheno-palatine  gan- 
glion, situated  on  the  outer  side  of  the  nasal  or  vertical  plate  of  the 
palate  bone. 

From  this  ganglion  proceed  three  sets  of  branches : 

1.  Inferior,  Descending,  or  Palatine  Nerves. 

2.  Nasal,  or  Spheno-palatine. 

3.  Posterior,  Ptei-ygoid,  or  Vidian. 

The  Palatine  Nerves  descend  through  the  posterior  palatine  canal, 
come  out  at  the  posterior  palatine  foramen  along  with  an  artery  of  the 
same  name,  and  supply  with  filaments  the  soft  palate,  uvula,  tonsils, 
the  roof  of  the  mouth,  and  the  inner  alveoli  and  gums. 

The  Naml  Nerves  enter  the  nose  through  the  spheno-palatine  fora- 
men, and  divide  into  several  filaments  which  enter  the  mucous  mem- 
brane covering  the  upper  and  lower  turbinated  bones  and  vomer;  one 
long  branch  can  be  traced  along  the  septum  nasi  as  far  as  the  foramen 
incisivum.  where  it  meets  the  anterior  palatine  branches  in  a  ganglion 
called  the  naso-palatine. 

The  Vidian,  or  Pterygoid,  passes  backward  from  the  ganglion  of 
Meckel  through  the  pterygoid  canal  at  the  root  of  the  pterygoid  pro- 
cess ;  then  enters  the  cranium  through  the  foramen  lacerum  anterius, 
and  divides  into  two  branches,  one  of  which  enters  the  carotid  canal 


78  THE  NERVES  OF  THE  MOUTH. 

and  unites  with  the  sympathetic  branches  of  the  superior  cervical  gan- 
glion, thus  connecting  this  ganglion  with  the  ganglion  of  Meckel. 

The  other,  the  proper  vidian  nerve,  enters  the  vidian  foramen  or 
hiatus  Fallopii  in  the  petrous  bone,  joins  the  portio  dura  nerve,  accom- 
panies this  as  far  as  the  back  part  of  the  tympanum ;  then  leaves  it, 
enters  the  cavity  of  the  tympanum,  and  receives  there  the  name  of 
Chorda  Tyinpaiii.  It  leaves  this  cavity  by  the  glenoid  fissure,  then 
joins  the  gustatory  nerve,  continues  with  it  to  the  submaxillary  gland, 
where  it  leaves  it  and  is  lost  in  the  submaxillary  ganglion,  situated  at 
the  posterior  part  of  the  submaxillary  gland. 

The  exceedingly  intricate  course  of  the  vidian  nerve  is  interesting 
from  the  number  of  communications  which  it  establishes  between  dif- 
ferent and  distant  parts :  for  it  unites  the  ganglion  of  Meckel  wdth  the 
superior  cervical  ganglion  of  the  sympathetic,  and  both  with  the  sub- 
maxillary ganglion ;  it  also  connects  the  superior  and  inferior  maxil- 
lary nerves  to  one  another  and  to  the  portio  dura. 

The  Superior  Maxillary  Nerve  gives  off  next  in  the  spheno-maxil- 
lary  fossa : 

1.  The  Orbital. 

2.  The  Posterior  Dental. 

3.  The  Anterior  Dental. 

The  Orbital  enters  the  orbit  through  the  spheno-maxillary  fissure, 
and  then  sends  oflT  a  malar  and  temporal  branch,  which  pass  out 
through  the  malar  bone;  the  first  supplying  the  cheek,  the  latter  ac- 
companying the  temporal  artery  to  the  integuments  of  the  side  of  the 
head,  receiving  filaments  from  the  facial  and  auriculo-temporal  branch 
of  the  inferior  maxillary. 

The  Posterior  Dental  Nerves,  two  in  number,  descend  on-  the  tuber- 
osity of  the  superior  maxillary  bone,  and  enter  the  posterior  dental 
canals  to  supply  the  bicuspid  and  molar  teeth ;  one  branch  penetrates 
the  antrum  and  courses  along  the  outer  wall,  anastomosing  with  the 
anterior  dental  nerves,  while  another  runs  along  the  alveolar  border 
supplying  the  gums. 

The  Anterior  Dental  is  given  oflT  from  the  superior  maxillary  just 
before  it  escapes  from  the  infra-orbital  foramen.  It  anastomoses  with 
the  posterior  dental,  and  sends  filaments  to  the  incisor,  canine,  and 
first  bicuspid  teeth  ;  others  are  sent  to  the  mucous  membrane  of  the 
inferior  meatus. 

This  nerve  now  emerges,  as  before  mentioned,  at  the  infra-orbital 
foramen,  between  the  levator  labii  superioris  alseque  nasi  and  levator 
anguli  muscles,  dividing  here  into  many  branches ;  some  of  w^hich 
ascend  to  the  nose  and  eyelids,  others  pass  downward  and  outward  to 


THE    I^EEVES    OF    THE    MOUTH.  79 

the  lip  and  cheek,  anastomosing  with  the  nasal  branch  of  the  ophthal- 
mic, and  the  facial  branches  of  the  portio  dura. 

INFERIOR   MAXILLARY   NERVE. 

This  nerve  forms  the  third  great  division  of  the  fifth.  It  is  the 
largest  branch,  and  passes  from  the  ganglion  of  Casser  through  the 
foramen  ovale  of  the  sphenoid  bone  to  the  zygomatic  fossa. 

This  nerve,  as  stated,  is  attached  to  the  anterior  or  motor  root,  and 
they  come  together  on  the  outside  of  the  foramen  ovale  :  then  in  the 
zygomatic  fossa,  the  inferior  maxillary  nerve  divides  into  two  branches : 

1.  Anterior. 

2.  Posterior. 

The  Anterior  is  the  motor  branch,  and  gives  off  the  following  fila- 
ments to  the  several  muscles : 

1.  Masseteric,  crossing  the  sigmoid  notch  to  the  masseter  muscle. 

2.  Temporal,  anterior  and  posterior  deep,  to  the  temporal  mus- 

cle and  fascia. 

3.  Buccal,  to  the  buccinator,  external  pterygoid,  and  temporal 

muscles. 

4.  Pterygoid,  to  the  pterygoid  muscles. 

The  Internal  division  of  the  inferior  maxillary  nerve  consists  of 
three  branches,  all  of  which  are  sensitive ;  they  are : 

1.  The  Anterior  Auricular. 

2.  The  Gustatory. 

3.  The  Inferior  Dental. 

The  Anterior  Auricular  passes  behind  the  neck  of  the  lower  jaw  and 
m  front  of  the  meatus  of  the  ear,  and  ascends  through  the  parotid 
gland,  over  the  zygoma  along  with  the  temporal  artery,  and  divides 
into  anterior  and  posterior  branches. 

In  its  course  it  unites  with  the  facial  nerve,  and  supplies  the  parotid 
gland,  the  articulation  of  the  lower  jaw,  the  meatus,  and  cartilages  of 
the  ear  and  side  of  the  head. 

The  Gustatory  Nerve,  the  nerve  of  the  special  sense  of  taste,  imme- 
diately after  its  origin,  sends  a  branch  to  the  inferior  dental ;  it  then 
descends  between  the  pterygoid  muscles,  where  the  chorda  tympani 
joins  it ;  it  now  passes  along  the  ramus  of  the  lower  jaw,  covered  by 
the  internal  pterygoid  muscle,  then  above  the  submaxillary  glands, 
and  forward  above  the  mylo-hyoid  and  between  it  and  the  hyo-glossus 
muscles,  accompanied  by  the  duct  of  Wharton ;  and  finally  ascends 
above  the  sublingual  gland  to  the  lateral,  inferior,  and  anterior  parts 
of  the  tongue. 


80  THE  NERVES  OF  THE  MOUTH. 

In  itg  course,  Mr.  Harrison  enumerates  the  following  branches  as 
given  off  by  this  nerve: 

"  First,  one  or  two  small  filaments  to  the  internal  pterygoid  muscle. 
Second,  several  to  the  tonsils,  to  the  muscles  of  the  palate,  to  the  upper 
pa,rt  of  the  pharynx,  and  to  the  mucous  membrane  of  the  gums. 
Third,  the  chorda  tympani,  and  some  accompanying  filaments  to  form 
a  plexus,  which  supplies  the  submaxillary  gland.  Fourth,  a  few 
branches  which  descend  along  the  hyo-glossus  muscle  to  communicate 
with  the  ninth  or  lingual  nerve.  Fifth,  a  fasciculus  of  nerves  to  the 
sublingual  gland  and  to  the  surrounding  mucous  membrane.  Lastly, 
at  the  tongue  it  divides  into  several  branches,  some  pass  deep  into  the 
tissue  of  this  organ ;  others,  firm  and  soft,  rise  toward  its  surface,  and 
are  lost  in  the  mucous  membrane  and  in  a  small  conical  papilla  near 
its  tip." 

The  Injerior  Dental  Nerve  passes  between  the  pterygoid  muscles, 
then  along  the  ramus  of  the  lower  jaw  under  the  pterygoideus  internus 
to  the  inferior  dental  foramen,  which  it  enters  along  with  an  ai'tery  and 
vein ;  it  now-  traverses  the  inferior  dental  canal,  sending  twigs  into  all 
the  roots  of  the  molars  and  bicuspids.  Opposite  the  mental  foramen 
it  divides  into  two  branches,  the  sinaller  is  continued  forward  in  the 
substance  of  the  jaw  to  supply  the  roots  of  the  cuspids  and  incisors  ; 
while  the  larger  comes  out  at  the  mental  foramen,  is  distributed  to  the 
muscles  and  integuments  of  the  lower  lip,  and,  finally,  communicates 
with  the  facial  nerve. 

The  inferior  dental,  just  as  it  enters  the  posterior  dental  foramen, 
gives  off"  the  mylo-hyoid  nerve  ;  this  passes  forward  in  a  groove  of  the 
lower  jaw,  and  supplies  the  mylo-hyoid,  and  digastric  muscles,  and  oc- 
casionally the  submaxillary  gland. 

THE   FACIAL    NERVE. 

The  Portico  dura  of  the  seventh  or  facial  nerve  is  the  last  nerve  to 
be  noticed  as  particularly  belonging  to  the  mouth. 

The  Facial  Nerve  arises  from  the  medulla  oblongata  between  the 
olivary  and  restiform  bodies,  close  behind  the  lower  margin  of  the 
pons  Varolii ;  it  then  passes  forward  and  outward  with  the  portio 
mollis  to  the  foramen  auditorium  internum,  which  it  enters  and  2:>asses 
on  to  the  base  of  this  opening ;  here  these  two  nerves  separate,  the 
portio  mollis  going  to  the  labyrinth  of  the  ear ;  while  the  facial  enters 
the  aqueduct  of  Fallopius,  in  Avhich  it  is  joined  by  the  vidian.  Within 
the  aqueductus  Fallopii  it  gives  off*  two  branches  —  the  tympanic  and 
chorda  tympani.  The  former  supplies  the  stapedius  muscle.    The  latter 


THE    2fEEVES    OF    THE    MOUTH. 
Fia.  16. 


UPRRTFIOCHLEAn 

OF 
mFBATPOCHL£Af> 

F 
NASAL 


passes  along  a  distinct  canal  and  enters  the  cavity  of  the  tympanum  near 
the  attachment  of  the  membrana  tympani,  where  it  is  covered  by 
mucous  membrane.  It  escapes  from  this  cavity  by  the  inner  side  of 
the  Glasserian  fissure  ;  after  receiving  a  communicating  branch  from 
the  gustatory  nerve  it  passes  to  the  submaxillary  gland,  then  joining 
the  submaxillary  ganglion  it  is  lost  in  the  lingual  muscle.  The 
facial  then  goes  in  a  curved  direction  outward  and  backward 
behind  the  tympanum,  where  it  parts  with  the  vidian,  and  proceeds  on 
to  the  stylo-mastoid  foramen,  from  which  it  emerges.  At  this  point  it 
sends  off  three  small  branches  : 
6 


82  THE  NERVES  OF  THE  MOUTH. 

1.  The  Posterior  Auricular, 

2.  The  Stylo-hyoid,  aud 

3.  The  Digastric. 

The  Posterior  Auricular  ascends  behind  the  ear,  crosses  the  mastoid 
process,  where  it  receives  branches  from  the  pneumogastric,  and  the 
auricularis  magnus  ;  it  then  divides  into  two  branches,  one  of  which 
passes  to  the  retrahens  aurem,  the  other  to  the  occipito-froutalis 
muscle. 

The  Stylo-hyoid  is  distributed  to  the  stylo-hyoid  muscle.  It  com- 
municates with  filaments  of  the  sympathetic  sent  to  the  carotid 
artery. 

The  Digastric  is  distributed  to  the  posterior  belly  of  the  digastric 
muscle,  receiving  a  communicating  branch  from  the  glosso-pharyn- 
geal. 

The  facial  nerve,  while  deeply  imbedded  in  the  substance  of  the 
parotid  gland,  divides  into  two  sets  of  branches,  of  which  one  is 
superior  and  the  other  inferior;  these  two,  by  frequent  unions,  form  the 
pes  anserinus  ov  parotideaii  plexus,  and  send  branches  to  the  whole  of 
the  side  of  the  face. 

The  upper  division,  called  the  temporo-facial,  ascends  in  front  of  the 
ear  upon  the  zygoma,  accompanies  the  temporal  artery  and  its 
branches,  supplying  the  side  of  the  head,  ear,  and  forehead,  and  anas- 
tomosing wdth  the  occipital  and  supra-orbital  nerves  ;  a  set  of  branches 
pass  transversely  to  the  cheek,  furnishing  the  lower  eyelid,  lips,  and 
side  of  the  nose,  and  uniting  with  the  infra-orbital  nerve. 

The  inferior  or  cervico-facial  division  descends,  supplying  the  lower 
jaw  and  upper  part  of  the  neck,  giving  off  the  following  branches : 

1.  Buccal. 

2.  Inferior  Maxillary,  and 

3.  Cervical, 

The  Buccal,  or  superior  branches,  supply  the  muscles  of  the  cheek, 
nose,  and  upper  lip. 

The  lufefior  Maxillnry  nerves  are  distributed  in  the  muscles  of  the 
chin  and  lower  lip,  and  by  means  of  anastomotic  branches  communi- 
cate with  the  inferior  dental  nerve. 

The  Cervical  branches  form  a  close  connection  with  the  superior  cer- 
vical nerves,  and  supply  the  platysma  myoid  muscle  and  the  levator 
labii  superioris. 

The  facial  is  the  motor  nerve  of  the  face,  ^rd  by  its  means  the  pas- 
sions or  emotions  find  their  expression  in  the  peculiar  action  of  the 
muscles  to  which  it  is  distributed. 

In  consequence  of  the  numerous  communications  which  this  nerve 


SALIVARY    OLANDS. 


83 


has  with  other  nerves,  the  name  of  Sympatheticus  Minor  has  been  given 
to  it  by  some  anatomists. 

Mr.  Gray  furnishes  the  following  concise  statement  of  these  com- 
munications. 


In  the  internal  auditory  meatus. 


With  the  auditory  nerve. 

With  Meckel's  ganglion  by  the  large 
petrosal  nerve. 

With  the  otic  ganglion  by  the  smaller 
■i  petrosal  nerve. 

With  the  sympathetic  on  the  middle 
meningeal  by  the  external  petrosal 
nerve. 

[     With  the  pneumogastric. 
I  "     "     glosso-pharyngeal. 

"     "     carotid  plexus. 

"     "     auricularis  magnus. 

"      "     auriculo-temporal. 
On  the  face With  the  three  divisions  of  the  fifth 


In  the  aquasductus  Fallopii, 


At  its  exit  from  the  stylo-mastoid 
foramen. 


CHAPTER  VIII. 


SALIVARY    GLANDS. 

THE  Salivary  Glands  are  six  in  number,  three  on  each  side  of  the 
face,  named  the  Parotid,  Submaxillary,  and  Sublingual. 

These  glands  are  the  prime  organs  in  furnishing  the  salivary  fluids 
to  the  mouth  during  the  process  of  mastication. 

The  ParoUd  Gland  (Fig.  17),  so  called  from  its  situation  near 
the  ear,  is  the  largest  of  the  salivary  glands.  Its  form  is  very  irregu- 
lar ;  it  fills  the  space  lying  between  the  ramus  of  the  inferior  maxilla 
and  mastoid  process  of  the  temporal  bone,  as  far  back  as,  and  even 
behind,  the  styloid  process  of  the  same  bone.  Its  extent  of  surface  is 
from  the  zygoma  above  to  the  angle  of  the  lower  jaw  below,  and  from 
the  mastoid  process  and  meatus  behind  to  the  masseter  muscle  in  front, 
overlapping  its  posterior  portion. 

This  gland  is  one  of  the  conglomerate  order,  and  consists  of  numer- 


84 


SALIVARY    GLANDS. 


ous  small  lobes  connected  together  by  cellular  tissue ;  each  of  which 
may  be  considered  a  small  glund  in  miniature,  as  each  is  supplied  with 
an  artery,  vein,  and  excretory  duct. 

The  gland  thus  formed  presents  on  its  external  surface  a  pale,  flat, 
and  somewhat  convex  appearance. 

It  is  covered  by  a  dense,  strong  fascia  extending  from  the  neck,  and 
attached  to  the  meatus  externus  of  the  ear,  which  sends  countless  pro- 

FiG.  17. 


cesses  into  every  part  of  the  gland,  separating  its  lobules  and  con- 
ducting the  vessels  through  its  substance. 

The  use  of  this  gland  is  to  secrete  or  separate  from  the  blood  the 
greater  part  of  the  saliva  furnished  to  the  mouth.  As  the  parotid  is, 
however,  on  the  outside,  and  at  some  little  distance  from  the  mouth,  it 
is  furnished  with  a  duct  to  convey  its  fluid  into  this  cavity;  this  duct 
is  called  the  duct  of  Steno,  or  the  parotid  duct.  It  is  formed  of  the 
excretory  ducts  of  all  the  granules  composing  this  gland,  which,  suc- 
cessively uniting  together,  at  last  form  one  common  duct. 

The  duct  of  Steno  commences  at  the  anterior  part  of  the  gland  and 


SALIVARY    GLANDS.  85 

passes  over  the  masseter  muscle,  on  a  line  drawn  from  the  lobe  of  the 
ear  to  the  middle  part  of  the  upper  lip  ;  then  passes  through  a  quan- 
tity of  soft  adipose  matter,  and  finally  enters  the  mouth  by  passing 
through  the  buccinator  muscle  and  mucous  membrane  opposite  the 
second  molar  of  the  upper  jaw. 

The  arteries  supplying  this  gland  are  from  the  external  carotid  or 
some  of  its  branches. 

The  nerves  are  derived  from  the  carotid  plexus  of  the  sympathetic, 
and  from  the  facial,  temporal,  and  great  auricular. 

The  parotid  secretion  is  a  clear,  watery,  alkaline  liquid,  which  is 
poured  out  abundantly  during  mastication,  but  in  very  small  quantity 
when  the  mouth  is  at  rest.  Its  secretion  may  also  be  excited  by  men- 
tal emotion,  as,  when  observing  a  savory  article  of  food,  or  by  artificial 
stimuli,  as  of  glass  beads  or  other  irritants  in  the  mouth. 

The  following  analysis  is  taken  from  Dalton's  Physiology  : 

COMPOSITION    OF   HUMAN   PAROTID   SALIVA. 
Water,  .  .  .  .  .  .  .  .  .983-308 

Organic  matter  precipitable  by  alcohol,              ....  7 •352 

Substance  destructible  by  heat,  but  not  precipitated  by  alcoholar  acids,        4-810 

Sulpho-cyanide  of  sodium,     ......  0-330 

Phosphate  of  lime,             .             .             .             .             .             .             .  0-240 

Chloride  of  potassium,            .             .             .        '     .             .             .  0-900 

Chloride  of  sodium  and  carbonate  of  soda,          ....  3-060 


Total,         ........  1000-000 

It  will  be  seen  that  the  quantity  of  organic  matter  is  comparatively 
large. 

Observation  has  shown  that  this  secretion  is  unilateral,  the  saliva 
lowing  only  from  that  side  on  which  mastication  is  then  being  con- 
ducted, and  that  the  quantity  is  directly  related  to  the  physical  char- 
acter of  the  food,  and  not  to  its  chemical  constitution,  being  more  or 
less  abundant,  according  to  the  dryness  of  the  food. 

The  Submaxillary  is  the  next  in  size  of  the  salivary  glands.  It 
is  situated  under  and  along  the  inferior  edge  of  the  body  of  the 
lower  jaw,  and  is  separated  from  the  parotid  simply  by  a  process  of 
fascia. 

It  is  of  oval  form,  pale  color,  and,  like  the  parotid,  consists  in  its 
structure  of  small  lobules,  held  together  by  cellular  tissue ;  each 
having  a  small  excretory  duct,  which,  successively  uniting  with  one 
another,  finally  form  one  common  duct.  This,  the  duct  of  Wharton, 
passes  above  the  mylo-hyoid  muscle,  and  running  forward  and  inward, 
enters  the  mouth  below  the  tip  of  the  tongue  at  a  papilla  seen  on  either 
side  of  the  frsenum  linguge. 


o6  SALIVARY    GLANDS. 

The  use  of  this  gland  is  tlie  same  as  tlie  parotid,  to  secrete  a  fluid 
constituent  of  the  saliva,  and  its  duet  is  the  route  by  which  it  is  con- 
ducted into  the  mouth.  Its  arteries  are  derived  from  the  facial  and 
lingual.  The  veins  correspond.  Its  nerves  are  received  from  the  sub- 
maxillary ganglion,  the  inferior  dental  and  sympathetic  nerves. 

The  Sublingual  Glands  are  the  last  in  order  of  the  salivary  glands, 
and  the  smallest  in  size. 

They  are  situated  beneath  the  anterior  and  lateral  parts  of  the  tongue, 
are  covered  by  the  mucous  membrane,  and  rest  upon  the  mylo-hyoid 
muscle. 

They,  like  the  two  glands  just  described,  consist  of  a  lobular  struc- 
ture with  excretory  ducts;  which,  however,  do  not  unite  into  one  com- 
mon duct,  but  enter  the  cavity  of  the  mouth  by  many  ducts,  whose 
openings  are  through  the  mucous  membrane  between  the  tongue  and 
the  inferior  cuspid  and  bicuspid  teeth. 

Their  office  is  the  same  as  the  parotid  and  submaxillary.  Their 
arteries  are  derived  from  the  sublingual  and  submental.  Their  nerves 
from  the  gustatory. 

The  Mucous  Glands.  Besides  the  glands  furnishing  the  saliva,  there 
is  another  series  of  much  smaller  size,  called  the  mucous  glands.  They 
are  simply  the  little  crypts,  follicles,  or  depressions  everywhere  found 
in  the  mucous  membrane  of  the  mouth,  and  named,  according  to  their 
situation,  the  glandulse  labiales,  glandulie  buccales,  etc.  The  lips, 
cheeks,  and  palate  are  also  furnished  with  glands,  about  the  size  of  a 
small  pea,  which  present  the  true  salivary  structure. 

The  use  of  these  glands  is  to  furnish  the  mucous  of  the  mouth,  which 
they  pour  into  this  cavity  by  single  orifices,  opening  everywhere  on  its 
surface. 

The  Saliva  consists  of  the  commingled  secretion  of  all  these  glands  — 
salivary  glands  are  found  in  all  vertebrate  animals  except  fishes.  It  is 
a  glairy,  slightly  opalescent,  alkaline  fluid,  consisting  of  organic  and 
mineral  substances  held  in  solution  with  water.  Its  composition,  accord- 
ing to  Bidder  and  Schmidt,  is  as  follows : 

COMPOSITION  OF  SALIVA. 

Water, 995-16 

Organic  Matter, 1'34      • 

Sulpho-cyanide  of  Potassium, 0-06 

Phosphate  of  Soda,  Lime,  and  Magnesia, '98 

Chlorides  of  Sodium  and  Potassium,        .....  -84 

Mixture  of  Epithelium, 1-62 

1000-00 


SALIVARY    GLANDS.  SV 

Two  kinds  of  organic  matter  exist  in  the  saliva, —  the  first,  which  is 
found  in  the  submaxillary  and  sublingual  secretions,  is  called  ptyaline  f 
to  it  the  saliva  owes  its  viscidity.  Alcohol  coagulates  it,  but  heat  does 
not,  differing,  in  this  respect,  from  the  organic  matter  derived  from 
parotid  gland,  which  is  coagulated  by  heat  and  is  not  viscid. 

The  sulpho-cyanogen,  the  only  mineral  ingredient  that  is  peculiar  to 
saliva,  is  detected  by  a  solution  of  the  chloride  of  iron,  with  which  it 
strikes  a  red  color  characteristic  of  it. 

When  saliva  has  stood  for  some  time  it  deposits  a  whitish  flocculent 
sediment,  which  is  found  under  the  microscope  to  consist  of  epithelium 
scales,  and  other  small  nucleated  cells,  granular  matter,  and  oil  globules. 
Although  saliva  possesses  the  power  to  change  the  starchy  matter  of 
the  food  into  sugar,  yet  in  view  of  the  facts  that  this  change  is  inter- 
rupted by  the  gastric  juice  with  which  it  is  so  soon  to  come  in  contact, 
and  that  the  quantity  secreted  is  directly  related  to  the  physical  char- 
acteristics of  the  food,  and  not  to  its  chemical  constitution,  not  being 
more  abundant  during  the  mastication  of  starchy  food,  except  it  be 
dry,  than  of  any  other  aliment,  and,  furthermore,  since  the  conversion 
of  starch  into  sugar  is  otherwise  provided  for,  it  may  be  considered  as 
an  established  fact  that  its  only  purpose  is  to  aid  mechanically  in  mas- 
tication and  deglutition  by  moistening  and  lubricating  the  food.  The 
quantity  of  saliva  secreted  daily  has  been  variously  estimated  by 
difierent  observers.  Mitscherlich  thought  it  about  fourteen  ounces 
daily,  and  Todd  and  Bowman  consider  his  estimate  reliable.  Bidder 
and  Schmidt  estimated  it  at  about  three  and  a  half  pounds  avoirdupois, 
and  Mr.  Dalton  at  "  rather  less  than  three  pounds  avoirdujJoLj,"  which 
is  probably  very  nearly  correct. 

THE   TONGUE. 

The  Tongue  is  a  very  complicated  organ ;.  it  consists  of  a  great  va- 
riety of  parts,  and  performs'  a  great  variety  of  functions ;  it  is  one  of 
the  organs  of  deglutition  ;  a  glandular  organ,  to  secrete ;  a  sentient 
organ,  to  feel  and  taste;  and  likewise  an  intellectual  organ,  to  assist 
in  producing  speech. 

The  tongue  is  divided  into  apex,  body,  and  root ;  the  apex  is  the  an- 
terior free  and  sharp  portion ;  the  root,  which  is  thin,  is  attached  to 
the  OS  hyoides  and  is  posterior ;  while  the  body,  which  occupies  the 
centre,  is  thick  and  broad ;  it  is  confined  in  its  situation  by  the  origins 
of  its  component  muscles,  and  by  reflections  of  the  mucous  membrane. 

The  mucous  membrane  of  the  tongue  covers  its  free  surface  every- 
where; it  is  thinnest  on  its  under  surface,  where  it  may  be  traced 
along  the  ducts  of  the  submaxillary  and  sublingual  glands.     Passing 


S8  SALIVABY    GI.AXDS. 

over  fibe  Aawamm^  it  MBMiw*  a,  pajpillaiy  ehai^bcter,  and  beeomes  raQch 
thiftipfd. 

Tke  papSH*-  of  die  toogoe  are  the  papilla?  tsrcamraSlataE,  papillae 
jbagiifiwmes.  and  pap#lly  fililiMin^^ 

"Die  papiH*^  qiwuBvaDatg  (maximae)  ai«  skoated  <m  eadi  side  of 
die  IndL  part  of  Itiie  toi^ne,  mffftmg  at  die£»a]iien  oaecinn  bo  as  to 
farm  a,  triaiigBlar  Sgare.    Tbey  nmnber  £nNn  <^giit  to  fiftepaii. 

£jaieii  p*pall«  is  amuiged  in  die  £Hnn  of  an  inserted  eome,  fritb  its 
apex  leeeored  into  a  d^rraa^m  oaf  nraeoas  memlwane,  and  ids  base  ex- 
posed <Hi  dite  &iee  soxj&e^  and  upsa  it  may  1^  seen  numeivHis  anallo: 
papjlfap. 

The  fMpmiaB  {ongifiHira^  aie  scaitSBned.  iiT€g«3laiij  over  tiie  sor&oe 
ef  tiie  toi^ae,  bat  aie  most  nnmoKNis  at  its  ades  and  apex.  Th^ 
a^  aie  stoddei  <on  dieir  £nee  sor&ee  vidi  smaller  TpafaSisBL 

The  pwpiiBl*'  jfiliiiHmi^  aie  ^onmd  «m  the  antmor  two-dairds  of  the 
im^ae,  and  aie  verp'  imiwBrtip-  Tbey  are  s{»niaidia£  eoMieal  or  filiform 
in  dhape,  aie  eoveaed  vid&  an  mmsoalij  dense  egnthf^mm  wbieh  gives 
diem  a.  idBidsb  ^^eaiance,  and  axe  £lled  widi  secondaiy  papilba. 
Small  bails  axe  e^ibai  Soond  indsem. 

Sbrmdmre  ^  l3ke  P^^Usb. — Tbey  coma^  ©f  eapiHarr  loop=,  ttrougli 
«bieb  nerves  are  abondandj  distxibated,  ooverod  by  a  bomogeDeous 
ta^ote,  npon  vMndi  is  snpaps^ed  a  dniek  la  jt^  of  ^^[iiamoiQs  epitb^um. 

The  nerv<^  axe  huge  and  nnmez^ns  in  the  papilla  circumTallutse ; 
in  die  papOlse  fii^ijbnnes  and  pafwllaB  £li^nnes  diej  are  smaller. 

In  die  mneons  memtnane  axe  also  Sxind  ^llieles  or  glands.  Tbe 
ionner  axe  vecy  namtoons,  ^pedalfy  ^»  between  die  eireamvaUate 
papiTlap.  and  die  ^a^otds,  b<nt  are  £Mind  seattexed  o^^^  the  entixe  sor- 
£iieeafdaetiHigtie.  The  latter,  eaMed  maeous  or  lisigoal  glands,  are 
moat  abundant  &m.  die  pso^ierior  diixd  of  die  tongue,  but  are  found  also 
on  iSs  tip,  ^des,  and  in  die  ndl^iboihood  of  the  {nreamvallate  papilba. 
Tbe  diiete  c^en  csx  tbe  £nee  sssx&uoe  of  tbe  moeoos  membrase. 

1^1.   1:1.  irS  TSXXB&KSE,  USTSG  THE  MOrTH. 


The  -whole  mteriar  eavit^  of  ^^^e  month,  palate,  pbarynx,  and  lips, 
is  eovered  by  maeoos  membrane,  farming  £>lds  or  daplieatareg  at  dif- 
Serast  points,  called  &aena  @r  bridle&  Be^nning  at  die  margin  of  the 
lower  lip,  this  membrane  ean  be  iraeed  lining  its  postmor  sar£ace,  and 
fixmi  dience  re^eeted  tm  the  antorior  iaee  &t  die  lower  jaw,  -vheTe  it 
£»ms  a  &»ld  «i]^pofiite  "&<&  sym^yds  of  ihe  <^tin — die  &aenam  of  tbe 
Iowa*  lip;  it  h  now  txaeed  to  the  alveolar  xidge,  eovmng  it  in  fi-ont, 
and  passing  ovta-  iite  posjbaior  sarf^iee,  where  it  enters  the  montb.  Here 
it  h  reflected  from  the  poetezior  symphyas  of  ihe  lower  jaw  to  the 


5ALIVAET    GLAXD5.  89 

under  surface  of  the  tongue,  where  it  fornLs  a  fold  or  bridle  called  the 
frcsnum  linguce.  It  now  spreads  over  the  tongue,  covering  its  dorsum 
and  sides  to  the  root,  from  whence  it  is  reflected  to  the  epiglottis,  fonn^ 
ing  another  fold;  from  this  point  it  can  be  followed,  enteriog  the 
glottis  and  lining  the  larynx,  trachea,  etc. 

In  the  same  way,  commencing  at  the  upper  lip,  it  is  reflected  to  the 
upper  jaw,  and  at  the  upper  central  incisors  forming  a  fold,  the  jTtEmnM 
of  the  upper  lip ;  from  thi^  it  passes  over  the  alveolar  ridge  to  the 
roof  of  the  mouth,  which  it  completely  covers,  and  extends  as  &r  back 
as  the  posterior  edge  of  the  palate  bones ;  fit>m  this  it  is  reflected  down- 
ward over  the  soft  palate ;  or,  more  strictly  speaking,  the  soft  palate  k 
formed  by  the  duplicature  of  this  membrane  at  this  point,  between  the 
folds  of  which  are  placed  the  muscle  of  the  palate  already  described. 

From  the  palate  it  is  traced  upward  and  continuous  with  the  raen- 
brane  lining  the  nares,  and  downward  with  the  same,  lining  rie 
pharynx,  oesophagus,  stomach,  and  intestinal  canal. 

The  mucous  membrane,  after  entering  the  nostrils  and  lining  the 
roof,  floor,  septum  nasi,  and  turbinated  bon^,  enters  the  maxillary 
sinus  between  the  middle  and  lower  spongy  bones,  and  lin^  the  whole 
of  this  great  and  important  cavity  of  the  superior  maxilla. 

Many  mucous  glands  or  follicles,  already  enumerated,  are  scattered 
over  the  whole  of  this  membrane,  and  famish  the  mouth  with  its  mucus. 

THE   OTTMSb 

The  cums  are  composed  of  dense,  elastic,  fibrous  ti^ae  adhering  to 
the  periosteum  of  the  alveolar  processes.  They  are  remarkable  for 
their  insensibility  and  hardness  in  the  healthy  state,  but  exhibit  great 
tenderness  upon  the  slightest  injury,  when  diseased. 

In  the  infant  state  of  the  gums,  the  central  line  of  each  dental  area 
presents  a  white,  firm,  cartilaginous  ridge,  which  gradually  becomes 
thinner  as  the  teeth  advance  :  and  in  old  age,  after  the  teeth  drop  out, 
the  gums  again  resume  somewhat  their  former  in&ntile  condition, 
showing  "second  childhood." 

The  2ums,  being  endowed  with  a  high  degree  of  vascularity,  indi- 
cate very  correctly,  as  the  author  has  stated  in  another  part  of  the 
work,  the  state  of  the  constitutional  health. 


THE    ALVi:OLO-DE>TAl 


This  membrane  may  be  properly  noticed  here,  as  it  is  considered  by 
some  as  continuous  with  the  gums.  It  lines  the  alveolar  mritics,  or 
sockets  of  the  teeth,  covers  the  roots  of  each,  is  attached  to  the  gimis 
at  the  necks,  and  to  the  bloodvessels  and  nerves  where  they  enter  the 
roots  of  the  teeth  at  their  apices  ;.  and,  further,  Mr.  Thomas  Bell  be- 


90  SALIVARY    GLANDS. 

lieves  it  passes  into  the  cavities  of  the  teeth,  forming  their  lining  mem- 
brane, and  is  continuous  with,  or  the  same  as  that  of  the  pulp. 

The  original  sac  has  been  stated  in  another  place  to  consist  of  two 
membranes,  an  outer  and  an  inner;  these  are  attached  to  the  gums, 
and  when  the  teeth  come  through  these  membranes  and  tlie  gums,  the 
sac  remaining  ])chind,  especially  its  outer  coat,  is  supposed  by  some  to 
constitute  the  alveolo-dental  periosteum,  and  to  be  continuous  with  the 
gums ;  while,  on  the  other  hand,  Mr.  Bell  believes  both  membranes  of 
the  sac  to  be  wholly  absorbed,  and  that  the  true  alveolo-dental  peri- 
osteum is  the  same  as  the  periosteum  covering  the  upper  and  lower 
maxillary  bones,  continuing  into  the  alveolar  cavities,  lining  their 
parietes,  and  thence  being  reflected  on  the  roots  of  the  teeth. 

It  matters  little  whether  this  membrane  be  a  continuation  of  the 
gums,  the  remains  of  the  pulp-sac,  or  the  extension  of  the  periosteum 
of  the  maxillary  bones  into  the  alveolar  cavities,  since  the  great 
practical  truth  still  remains,  that  there  is  a  membrane  lining  the 
alveolar  cavities  and  investing  the  roots  of  the  teeth,  and  that  this 
membrane  is  fibrous,  and  constitutes  the  bond  of  union  between  the 
alveolar  cavities  and  the  roots  of  the  teeth. 

The  Dental  Ligament,  so  recently  discovered  by  a  dentist,  formerly 
of  Virginia,  but  now  of  Philadelphia,  is  attached  to  the  necks  of  the 
teeth,  and  whose  opinion,  I  am  sorry  to  add,  has  the  support  of  Dr. 
Goddard,  bears  no  more  resemblance  to  true  ligament  than  the  nails 
do  to  bone.  It  consists  of  the  fibres  that  unite  the  alveolar  to  the 
dental  periosteum,  which,  according  to  the  last-named  gentleman, 
"  are  very  numerous  just  at  the  margin  of  the  alveolus;"  but  it  can 
lay  no  reasonable  claim  to  the  title  of  ligament. 

ANATOMICAL   RELATIONS   OF   THE   MOUTH. 

The  mouth  has  many  interesting  anatomical  relations  with  the  rest 
of  the  body,  a  few  of  which  it  may  be  well  to  mention. 

By  means  of  its  lining  mucous  membrane  it  is  connected  through 
continuity  of  structure  with  the  pharynx,  oesophagus,  stomach,  and 
the  whole  of  the  intestinal  canal,  etc. 

Disease  still  further  establishes  this  structural  relation.  Inflamma- 
tion, ulceration,  or  any  other  pathological  change  in  the  stomach  or 
intestines  is  felt  and  reported  on  the  tongue,  gums,  and  other  parts  of 
the  mouth,  showing  the  sympathy  and  the  close  relationship  of  these 
several  parts. 

The  mouth  is  also  connected  by  the  same  mucous  membrane  with 
the  organs  of  respiration  by  being  continued  down  into  the  larynx, 
trachea,  and  bronchi. 


SALIVAEY    GLANDS.  91 

Wide-spread  sympathies  are  established  between  the  mouth  and 
other  parts  by  means  of  the  numerous  nerves  which  animate  the  parts 
constituting  its  boundaries  and  lying  in  its  cavity,  as  the  sympathetic, 
the  seventh,  the  glosso-pharyngeal,  the  par  vagum,  the  hypo-glossal,  and 
the  upper  cervical. 

Simple  irritation  from  teething  has  thrown  children  into  convul- 
sions, and  in  adults  toothache  often  creates  extreme  irritability  of  the 
whole  nervous  system.  But  it  is  not  necessary  to  dwell  here  on  the 
sympathies  of  the  mouth  in  disease  with  other  parts  of  the  body,  as 
the  author  will  have  occasion  to  do  this  in  other  parts  of  the  work. 

It  will  be  well,  however,  to  mention  in  this  place,  that  there  is  a 
general  anatomical  relation  of  the  mouth  with  the  rest  of  the  body, 
by  means  of  the  bloodvessels  and  areolar  tissue. 

PHYSIOLOGICAL   RELATIONS. 

It  has  been  shown  that  the  mouth  consists  of  a  great  variety  of  parts, 
and,  also,  that  it  has  an  equally  great  diversity  of  functions. 

The  functions  of  the  mouth  have  been  stated  to  be  those  of  pre- 
hension, mastication,  insalivation,  and  deglutition. 

These  functions,  it  has  been  seen,  are  all  closely  related  to  one 
another,  and  mutually  dependent ;  and  how  beautiful  is  the  harmony 
of  action  as  well  as  its  regular  and  orderly  succession !  We  see,  in 
the  first  place,  the  prehensile  instruments  laying  hold  of  and  intro- 
ducing the  food  into  the  mouth ;  then  the  organs  of  mastication,  the 
teeth  and  upper  and  lower  jaw  bones,  put  into  operation  by  the  tem- 
poral, masseter  and  pterygoid  muscles,  grind  it  down  into  minute  por- 
tions ;  these,  at  the  same  time,  are  formed  into  a  bolus  by  being  mixed 
with  the  salivary  fluids,  furnished  by  the  parotid,  submaxillary  and 
sublingual  glands ;  then  the  mass  is  taken  by  the  organs  of  deglu- 
tition, namely,  the  tongue,  palate  and  pharynx,  and  passed  into  the 
oesophagus,  to  be  thence  conducted  into  the  stomach,  thus  demon- 
strating the  harmony  existing  among  the  several  functions  belonging 
to  the  mouth. 

But  the  functional  relation  of  the  mouth  is  no  less  extensive  than 
its  structural  relation;  the  one  is  commensurate  with  the  other;  and 
as  the  structure  of  the  mouth  has  been  shown  to  be  continuous  with 
that  of  other  parts  of  the  body,  so  we  find  that  the  functions  of  the 
mouth  exert  an  influence  upon,  and  are  themselves  influenced  by  many 
great  and  leading  functions  of  the  body.  The  connection  between 
mastication  and  insalivation,  for  example,  with  stomachal  digestion, 
or  chymification,  is  especially  obvious. 

Again,  the  mouth  is  intimately  related  with  the  intellectual  func- 
tions, as,  for  instance,  that  of  speech.     Who  does  not  know  that  when 


92 


THE    TEETH. 


any  of  the  teetli  are  wanting,  the  palate  cleft,  or  there  is  a  hare-lip, 
how  much  the  speech  is  impaired  ?  And  so  with  all  the  other  func- 
tions of  the  body ;  the  relation  between  them  and  the  mouth,  and  the 
mutual  dependence  of  each  on  the  other,  is  equally  demonstrable. 


Fig.  18. 


CHAPTER  IX. 

THE    TEETH. 

^PHE  teeth  are  the  prime  organs  of  mastication,  are  the  hardest  por- 
J-  tions  of  the  body,  and  are  implanted  in  the  alveolar  cavities  of 
both  the  upper  and  lower  jaw. 

A  tooth  is  composed  of  four  distinct  structures:  —  1.  The  j9?//j9,  oc- 
cupying the  chamber  in  the  crown  and  the 
canal  extending  tlirough  the  root ;  2.  The 
dentine,  which  constitutes  the  principal  part 
of  the  organ  ;  3.  The  enamel,  which  forms 
the  covering  and  protection  of  the  crown ;  4. 
The  cementum,  or  crusta  petrosa,  which  covers 
the  root.     (See  Fig.  18.) 

The  teeth  of  first  dentition,  termed  the 
milk,  temporary,  or  deciduous  teeth,  are  de- 
signed merely  to  supply  the  wants  of  child- 
hood, and  are  replaced  with  a  larger,  stronger, 
and  more  numerous  set.  These  are  termed 
the  permanent  or  adult  teeth,  and  are  in- 
tended to  continue  through  life. 

The  anatomical  divisions  of  a  tooth  are : 
1.  The  crown  or  exposed  part  situated  above 
the  gum ;  2.  The  root  occujjying  the  alveolar 
cavity  or  socket ;  3.  The  neck  which  is  the 
constricted  portion  between  the  crown  and 
root. 


THE   TEMPORAEY   TEETH. 


Fig.  18. ^a,  The  coronal 
surface  divested  of  enam- 
el; b,  The  dentine  :  c.  The 
pulp  cavity ;  d.  The  ce- 
mentum. or  crusta  petro- 
sa; e,  The  enamel. 


The  temporary  teeth  are  divided  into  three 
classes  :  first,  the  incisors  ;  second,  the  cuspids 
or  canine  teeth  ;  third,  the  molars,  which  are 
succeeded  by  the  bicuspids  or  premolars. 
The  temporary  teeth  are  twenty  in  number,  ten  in  each  jaw,  namely: 
four  incisors,  two  cuspids,  and  four  molars. 


THE    TEETH. 


Fig.  19. 


Fig.  19 — Front  or  labial  view  of  the  temporary  teeth  of  the  left  side. 
Fig.  20. — Palatine  or  lingual  view  of  those  on  the  right  side. 

The  pulp-cavity  in  a  temporary  tooth  is  larger  in  proportion  to  the 
size  of  the  organ  than  in  a  permanent  tooth. 


Fig.  21. 


Fig.  22. 


Fig.  21. — Lateral  or  side  view  of  temporally  teeth. 
Fig.  22. — Section  of  ditto,  exposing  their  pulp  cavities. 

THE   PERMANENT   TEETH. 

There  are  thirty-two  teeth  in  the  permanent  set,  sixteen  to  each 
jaw — being  an  increase  of  twelve  over  the  temporary,  designated  as 
follows:  incisors,  four;  cuspids,  two;  bicuspids  or  premolars,  four; 
molars,  six  —  in  each  jaw.  The  third  or  last  molar  is  sometimes  de- 
nominated dens  sapientice  or  wisdom  tooth. 


DESCRIPTION   OF   TEETH   BELONGING  TO    EACH   CLASS. 

Each  tooth,  as  has  already  been  remarked,  has  a  body  or  crown,  a 
neck,  and  a  root  or  fang.  In  describing  these  several  parts,  I  shall 
begin  with 


94 


THE    TEETH. 


The  Incisors  (four  to  each  jaw,  Fig.  23,  a  a,  a  a)  occupy  the  anterior 
central  part  of  each  maxillary  arch.     The  body  of  each  is  wedge 


Fig.  23. 


Fig.  23. — a  a,  a  a.  Front  view  of  the  incisors  ;  b  b,  b  b,  Palatine  or  lingual  view; 
c  c,  c  c,  Side  or  lateral  view. 

shape  —  the  anterior  or  labial  surface  is  convex  and  smooth  ;  the  pos- 
terior or  palatine  is  concave,  and  presents  a  tubercle  near  the  neck ; 
the  palatine  or  labial  surfaces  come  together,  and  form  a  cutting  edge. 
In  a  front  view,  the  edge  is  generally  the  widest  part;  it  diminishes 
toward  the  neck,  and  continues  narrowing  to  the  extremity  of  the  root. 

The  crown  of  an  incisor  has  four  surfaces :  two  approximal,  one 
labial,  and  one  palatine  or  lingual  —  the  term  palatine  being  applied  to 
an  upper,  and  lingual  to  a  lower,  incisor.  It  also  has  four  angles ; 
namely,  a  right  and  a  left  labio-approximal,  and  a  right  and  left  palato- 
approximal,  or  lingua-approximal. 

The  two  large  incisors  Avhich  are  situated  one  on  each  side  of  the 
median  line,  are  termed  the  central ;  the  other  two,  the  lateral  incisors, 
or  laterals.  The  crowns  of  the  upper  central  incisors  are  about  four 
lines  in  breadth,  and  the  laterals  three.  In  the  lower  jaw,  the  crowns 
of  the  central  incisors  are  only  about  two  lines  and  a  half  in  width, 
while  the  laterals  are  usually  a  little  wider.  But  the  width  of  the 
crowns  of  all  the  incisors  varies  in  different  individuals. 

The  length  of  a  superior  central  incisor  is  usually  about  one  inch, 
and  that  of  a  lateral  is  half  of  a  line  less.  In  the  lower  jaw  the  central 
incisors  are  only  about  ten  lines  in  length  ;  the  laterals  are  about  one 
line  and  a  half  longer. 

The  length  of  the  crown  of  an  incisor  is  exceedingly  variable.   That 


THE    TEETH. 


95 


of  an  upper  central  varies  from  four  and  a  half  to  six  lines  ;  and  there 
is  the  same  want  of  uniformity  in  thid  respect  with  the  crowns  of  all  the 
incisors. 

The  roots  are  all  single,  of  a  conical  form,  flattened  laterally,  and 
slightly  furrowed  longitudinally.  The  enamel  is  thicker  before  than 
behind,  and  thinnest  at  the  sides. 

The  function  of  this  class  of  teeth,  as  their  name  imports,  is  to  cut 
the  food,  and  for  the  performance  of  this  office  they  are  admirably 
fitted  by  their  shape.  As  age  advances,  their  edges  often  become 
blunted ;  but  the  rapidity  with  which  they  are  worn  away  depends 
altogether  upon  the  manner  in  which  those  of  the  upper  and  lower  jaw 
come  together. 

THE   CUSPIDATI,    OR   CUSPIDS. 

The  Cuspidati,  Canini,  or  Cuspids  (Fig.  24),  are  situated  next  to  the 
incisors,  two  to  each  jaw,  one  on  either  side.  They  somewhat  resemble 
the  upper  central  incisors  with  their  angles  rounded.  Their  crowns 
are  conical,  very  convex  externally ;  and  their  palatine  surface  more 
uneven,  and  have  a  larger  tubercle  than  the  incisors.  Their  roots 
are  also  larger,  and  of  all  the  teeth  the  longest ;  like  the  incisors,  they 
are  also  siugle,  but  have  a  groove  extending 
from  the  neck  to  the  extremity,  showing  a  step 
toward  the  formation  of  two  roots.  A  cuspid, 
like  an  incisor,  has  four  surfaces  and  four 
angles,  designated  by  the  names  already  given. 

The  breadth  of  the  crown  of  an  upper  cuspid 
is  about  four  lines,  that  of  a  lower  is  about 
three  and  a  half;  but,  as  in  the  case  of  the  in- 
cisors, the  width  of  the  crowns  of  these  teeth  is 
variable.  The  length  of  a  cuspid  is  greater  than 
that  of  any  other  tooth  in  the  dental  series  —  it 
being  about  thirteen  lines.  The  breadth  of  the 
neck  of  one  of  these  teeth  is  about  one-third 
greater  in  front  than  behind,  and  from  before 
backward  it  measures  about  four  lines. 

The  upper  cuspids  are  called  eye  teeth ;  the 
lower  are  termed  stomach  teeth. 

These  teeth  are  for  tearing  the  food,  and  in 
some  of  the  carnivorous  animals,  where  they 

are  very  large,  they  not  only  rend  but  also  hold  ^      ^,  ^      ^ 

-'         »  '  ■      .'  J  Pjq   24  — a  g^  Front 

their  prey.  _  Tiew  of  the  cuspids;  6 

The  incisors  and  cuspids  together  are  termed  j^  Palatine  and  lingual 
the  oral  teeth.  Tiew ;  c  c,  Side  view. 


Fig.  24. 


96 


THE    TEETH. 


THE   BICUSPIDS. 

The  Bicuspids  (Fig.  25),  four  to  each  jaw,  and  two  on  either  side, 
are  next  in  order  to  the  cuspids.  They  are  so  called  from  their  having 
two  distinct  jM-ominences  or  cusps  on  their  grinding  surfaces.  They 
are  also  named  the  small  molars.  They  are  thicker  from  their  buccal 
to  their  palatine  surface  than  either  of  the  incisors,  and  are  flatter  on 
their  sides.  The  grinding  surface  of  each  is  surmounted  by  two  conical 
tubercles,  separated  by  a  groove  running  in  the  direction  of  the  alveolar 
arch ;  the  outer  is  larger  and  more  prominent  than  the  inner.  In  the 
lower  jaw  these  tubercles  are  smaller  than  in  the  upper,  and  the  inner  is 
sometimes  wholly  wanting. 

A  bicuspid  has  five  sur- 
faces :  namely,  two  approxi- 
mal,  one  anterior  and  one 
posterior;  one  buccal;  one 
jialatine  or  lingual  surface, 
as  the  tooth  may  be  in  the 
upper  or  lower  jaw,  and  one 
grinding  surface.  It  has  also 
four  angles  ;  one  anterior  and 
one  posterior  palato-apjyroxi- 
mal,  and  one  anterior  and  one 
J)  osterior  bucco-app>roximal 
angle. 

The  size  of  these  teeth, 
like  that  of  the  incisors  and 
cuspids,  is  variable.  The 
buccal  surface  of  the  crown 
of  a  superior  bicuspid  of 
ordinary  size  at  its  broadest  part  is  about  three  lines  in  breadth,  while 
the  anterior  and  posterior  approximal  surfaces  are  about  four  lines. 
The  palatine  is  not  quite  as  wide  as  the  buccal  surface.  All  the  diame- 
ters of  the  crown  of  a  lower  bicuspid  are  usually  a  little  less  than 
those  of  an  upper.  The  entire  length  of  a  bicuspid  is  ordinarily  about 
eleven  lines. 

The  roots  of  the  bicuspids  are,  generally,  simple  ;  though  the  groove 
is  deeper  than  in  the  cuspids,  and  not  unfrequently  terminates  in  two 
roots,  which  have  each  an  opening  for  the  vessels  and  nerves  to  enter. 
The  inner  root,  however,  is  always  smaller  than  the  outer.  Two-fanged 
bicuspids  are  more  frequently  met  with  in  negroes  than  in  whites ;  and 
the  double  fang  is  common,  if  not  constant,  in  the  aboriginal  Austra- 
lians. 


Fig.  25. — a  a.  a  a  Buccal  view  of  the  bicus- 
pids ;  b  b,  b  b  Palatine  and  lingual  view  ;  c  c, 
c  c  Side  view. 


THE    TEETH. 


97 


THE   MOLARS. 

The  Molars  (Fig.  26)  occupy  the  posterior  part  of  the  alveolar  arch. 

Fig.  26. 


and  are  six  in  each,  jaw,  three  on 
either  side.  They  are  distinguished 
by  their  greater  size, — the  first  and 
second  being  the  largest ;  the  grind- 
ing surfaces  have  the  enamel  thicker, 
and  are  surmounted  by  four  or  five 
tubercles  or  cusps,  with  as  many 
corresponding  depressions  arranged 
in  such  a  manner  that  the  tubercles 
of  the  upper  jaw  are  adapted  to  the 
depressions  of  the  lower,  and  vice 
versa. 

A  molar,  like  a  bicuspid,  has  also 
five  surfaces  and  five  angles,  desig- 
nated by  the  names  already  given. 

The  upper  molars  have  three 
roots,  sometimes  four,  and  as  many  as  five  are  occasionally  seen  ;  of 
these  roots  two  are  situated  externally,  almost  parallel  with  each  other, 
and  perpendicular ;  the  third  root  forms  an  acute  angle,  and  looks 
toward  the  roof  of  the  mouth.  The  former  are  called  the  buccal  roots, 
and  the  latter  the  palatine.  The  roots  of  the  two  first  superior  molars 
correspond  with  the  floor  of  the  maxillary  sinus,  and  sometimes  pro- 
trude into  this  cavity,  their  divergence  securing  them  more  firmly  in 
their  sockets.  The  lower  molars  have  but  two  roots  — the  one  anterior, 
the  other  posterior ;  they  are  nearly  vertical,  parallel  with  each  other^ 
and  much  flattened  laterally. 


Fig.  26. — a  a  a,  a  a  a  Outer  view  of 
the  molars ;  h  h  h,  b  b  b  Inner  view ; 
c  c  c,  c  e  c  Side  view. 


98  THE    TEETH. 

The  last  molar,  called  the  dens  sapienilce,  or  wisdom  tooth,  is  both 
shorter  aud  smaller  than  the  others ;  the  roots  of  the  upper  wisdom 
tooth  are,  occasioually,  united  so  as  to  form  but  one  ;  while  the  last 
molar  of  the  lower  jaw  is  generally  single  and  of  a  conical  form. 

The  roots  of  the  molar  teeth,  both  of  the  upper  and  lower  jaw,  after 
diverging,  sometimes  approach  each  other,  embracing  the  intervening 
bony  partition  in  such  a  manner  as  to  constitute  au  obstacle  to  their 
extraction. 

The  bucco-palatine  diameter  of  the  crown  of  an  upper  molar  is 
usually  a  little  less  than  the  antcro-posterior.  In  the  lower  jaw,  the 
bucco-lingual  and  antcro-posterior  diameters  are  generally  about  the 
same. 

The  crown  of  the  first  molar  is  generally  larger  than  the  second, 
and  the  second  larger  than  the  third  or  wisdom  tooth  ;  and  the  crown 
of  the  last-named  tooth  is  always  smaller  in  the  upper  than  in  the 
lower  jaw. 

The  length  of  a  molar  tooth  varies  from  eight  to  twelve  and  a  half 
or  thirteen  lines. 

The  molars  and  bicuspids  together  constitute  what  are  termed  the 
buccal  teeth. 

The  use  of  the  molars,  as  their  name  signifies,  is  to  triturate  or 
grind  the  food  during  mastication,  and  for  this  purpose  they  are  ad- 
mirably adapted  by  their  mechanical  arrangement. 

ARTICULATION    OF   THE   TEETH. 

The  manner  in  which  the  teeth  are  confined  in  their  sockets,  is  by  a 
union  called  gomphosis,  from  the  resemblance  of  this  kind  of  articula- 
tion to  the  way  in  which  a  nail  is  received  into  a  board.  Those 
teeth  having  but  one  root,  and  those  with  two  perpendicular  roots, 
depend  greatly  for  the  strength  of  their  articulation  on  their  nice 
adaptation  to  their  sockets. 

Those  having  three  or  four  roots  have  their  firmness  much  increased 
by  their  divergence. 

But  there  are  other  bonds  of  union ;  by  the  periosteum  lining  the 
alveolar  cavities,  and  investing  the  roots  of  the  teeth  ;  also  by  the 
bloodvessels  entering  the  apices  of  the  roots ;  and  finally,  by  the  gums, 
which  will  be  noticed  in  another  place. 

DIFFERENCES    BETWEEN    THE    TEMPORARY  AND    PERMANENT    TEETH. 

The  temporary  and  permanent  teeth  differ  in  several  respects,  and 
on  this  point  I  will  give  Mr.  Bell's  observations : 

"  The  temporary  teeth  are,  generally  speaking,  much  smaller  than 


THE    TEETH. 


99 


the  permanent ;  of  a  less  firm  and  solid  texture,  and  their  character- 
istic forms  and  prominences  much  less  strongly  marked.  The  incisors 
and  cuspids  of  the  lower  jaw  are 
of  the  same  general  form  as  in 
the  adult,  though  much  smaller; 
the  edges  are  more  rounded,  and 
they  are  not  much  more  than 
half  the  length  of  the  latter. 
The  molars  of  the  child,  on  the 
contrary,  are  considerably  larger 
than  the  bicuspids  which  suc- 
ceed thera,  and  resemble  very 
nearly  the  permanent  molars. 

"  The  roots  of  the  tooth,  in 
the  molars  of  the  child,  are  simi- 
lar in  number  to  those  of  the 
adult  molars,  but  they  are  flat- 
ter and  thinner  in  proportion,  more  hollowed  on  their  inner  surfaces, 
and  diverge  from  the  neck  at  a  more  abrupt  angle,  forming  a  sort  of 
arch." 


RELATIONS   OF   THE   TEETH   OF   THE   UPPER   TO  THOSE   OF   THE 
LOWER    JAW,    WHEN    THE    MOUTH    IS    CLOSED. 

The  crowns  of  the  teeth  of  the  upper  jaw  generally  describe  a  rather 
larger  arch  than  those  of  the  lower.  The  upper  incisors  and  cuspids 
usually  shut  over  and  in  front  of  the  lower ;  but  sometimes  they  fall 
plumb  upon  them,  and  at  other  times,  though  rarely,  they  come  on 
the  inside.  The  external  tubercles  or  cusps  of  the  superior  bicuspids 
and  molars  generally  strike  on  the  outside  of  those  of  the  corres- 
ponding inferior  teeth.  By  this  beautiful  adaptation  of  the  tubercles 
of  the  teeth  of  one  jaw  to  the  depressions  of  those  of  the  other,  every 
part  of  the  grinding  surface  of  these  organs  is  brought  into  immediate 
contact  in  the  act  of  mastication  ;  which  operation  of  the  teeth,  in 
consequence,  is  rendered  more  perfect  than  it  would  be  if  the  organs 
came  together  in  any  other  manner. 

The  incisors  and  cuspids  of  the  upper  jaw  are  broader  than  the 
corresponding  teeth  in  the  lower ;  in  consequence  of  this  difference  in 
the  lateral  diameter  of  the  teeth  of  the  two  jaws,  the  central  incisors 
of  the  upper  cover  the  centrals  and  about  half  of  the  laterals  in  the 
lower,  while  the  superior  laterals  cover  the  remaining  half  of  the 
inferior  and  the  anterior  half  of  the  adjoining  cuspids.  Continuing 
this  peculiar  relationship,  the  upper  cuspids  close  over  the  remaining 
half  of  the  lower  and  the  anterior  half  of  the  first  inferior  bicuspids, 


100  THE    TEETH. 

while  the  first  superior  bicuspids  cover  the  remaining  half  of  the  first 
inferior  and  the  anterior  half  of  the  second.  In  like  manner,  the 
second  bicuspids  of  the  upper  jaw  close  over  the  posterior  half  of  the 
second  and  the  anterior  third  of  the  first  molars  in  the  lower.  The 
first  superior  molars  cover  the  remaining  two-thirds  of  the  first  in- 
ferior and  the  anterior  third  of  the  second ;  while  the  two-thirds  of 
this  last  and  anterior  third  of  the  lower  dentcs  sapicntiiB  are  covered 
by  the  second  upper  molars.  The  dentes  sapientise  of  the  superior 
maxilla,  being  usually  about  one-third  less  in  their  antero-])osterior 
diameter,  cover  the  remaining  two-thirds  of  the  corresponding  teeth 
in  the  lower  jaw.     (See  Fig.  27.) 

Thus,  from  this  arrangement  of  the  teeth,  it  will  be  seen,  that  when 
the  mouth  is  closed,  each  tooth  is  opposed  to  two  ;  and  hence,  in  biting 
hard  substances,  and  in  mastication,  by  extending  this  mutual  aid,  a 
power  of  resistance  is  given  to  these  organs  Avhich  they  w^ould  not 
otherwise  possess.  Moreover,  as  a  late  English  writer,  Mr.  Tomes, 
very  justly  observes,  if  one,  or  even  two  adjoining  teeth  should  be 
lost,  the  corresponding  teeth  in  the  other  jaw  would,  to  some  extent, 
still  act  against  the-  contiguous  organs ;  and  thus,  in  some  degree, 
counteract  a  process,  first  noticed  by  that  eminent  dentist.  Dr.  L. 
Koecker,  which  nature  sometimes  sets  up  for  the  expulsion  of  such 
teeth  as  have  lost  their  antagonists. 

ORIGIN   AND    FORMATION   OF   THE   TEETH. 

Of  all  the  operations  of  the  animal  economy,  none  are  more  curious 
or  interesting  than  that  which  is  concerned  in  the  production  of  the 
teeth.  In  obedience  to  certain  developmental  laws  established  by  an 
all-wise  Creator,  it  is  carried  on  from^  about  the  sixth  week  of  intra- 
uterine existence,  with  the  nicest  and  most  wonderful  regularity  until 
completed,  but  so  secretly  conducted,  as  to  prevent  the  closest  scrutiny 
from  detecting  with  precision  the  manner  in  Avhich  it  is  effected ; 
enough,  however,  is  ascertained  from  its  progressive  results  to  excite 
in  the  mind  of  the  physiologist  the  highest  admiration. 

From  small  papillae,  observable  at  a  very  early  period  of  foetal  life, 
situated  in  a  groove  lined  with  mucous  membrane,  and  running  along 
the  alveolar  border  of  each  jaw,  the  teeth  are  gradually  developed. 
As  they  increase  in  size,  the  papillae  assume  the  shape  of  the  crowns  of 
the  several  classes  of  teeth  they  are  respectively  destined  to  produce. 
Having  arrived  at  this  stage  of  their  formation,  they  now  begin  to 
dentinify,  first  upon  the  cutting  edges  of  the  incisors,  the  apices  of  the 
cuspids,  bicuspids  and  eminences  of  the  molars ;  from  thence  the  pro- 
cess is  continued  over  the  whole  surface  of  their  crowns,  until  they 
become  invested  with  a  complete  layer  of  dentine ;  and  so  layer  after 


THE    TEETH,  101 

layer  is  formed,  one  within  the  other,  until  the  process  of  solidification 
is  completed.  But  before  it  has  progressed  very  far,  the  enamel  of 
the  teeth  begins  to  form,  and  this  formative  operation  is  gone  through 
with  previously  to  the  completion  of  the  dentinification  of  the  pulps. 

In  the  mean  time,  and  in  anticipation  of  the  fall  of  the  temporary 
teeth,  a  second  set  is  forming,  and  as  the  teeth  of  the  one  series  are  re- 
moved, they  are  promptly  replaced  by  those  of  the  other.  Thus,  by  a 
beautiful  and  most  admirable  provision  of  Nature,  the  first  set  of  teeth, 
intended  to  subserve  the  wants  only  of  childhood,  while  the  jaws  are  too 
small  for  the  reception  of  such  as  are  required  for  an  adult,  are  re- 
moved and  replaced  by  a  larger,  stronger,  and  more  numerous  set. 

The  older  writers,  regarding  a  knowledge  of  the  earlier  stages  of 
the  development  of  the  teeth  as  not  of  much  importance,  paid  little 
attention  to  the  subject,  and  hence  this  most  curious  and  interesting 
department  of  developmental  anatomy  has  remained,  until  recently, 
measurably  uncultivated.  Eustachius,  we  believe,  was  the  first  to 
notice  the  position  and  arrangement  of  the  teeth  in  the  jaws  previous 
to  their  eruption.  Bat  his  researches  were  confined  to  the  examina- 
tion of  the  jaws  after  birth,  at  which  period  he  speaks  of  having  dis- 
covered, by  dissection,  the  incisors,  cuspids,  and  three  molars  on  each 
side,  in  each  jaw,  partly  in  a  gelatinous  and  partly  in  a  solidified 
condition.  He  also  discovered  the  incisors  and  cuspids  of  the  per- 
manent set  behind  the  first. 

Eustachius  wrote  in  1563,  and  nineteen  years  later  Urbian  Her- 
mard,  a  French  anatomist  and  surgeon,  although  unacquainted  with 
the  work  of  the  former,  gave  a  very  similar  description  of  the  situa- 
tion of  the  crowns  of  the  incisors  and  cuspids  of  both  sets  in  the  jaws 
of  an  infant  at  birth.  He  represents  them  as  partly  bony  and  partly 
mucilaginous.  He  also  discovered  the  bicuspids;  but  he  was  unable  to 
^nd  the  molars  at  so  early  a  period  as  at  birth. 

The  researches  of  Albinus  threw  no  additional  light  upon  the 
manner  of  the  formation  of  the  teeth,  and  little  was  known  concerning 
the  earlier  stages  of  the  development  of  these  organs  until  the  time  of 
John  Hunter,  who  informs  us  that  in  the  alveoli  of  a  foetus  of  three  or 
four  months  "four  or  five  pulpy  substances,  not  very  distinct,  are  seen." 
But  he  says,  "about  the  fifth  month  the  alveolar  cavities  are  more  per- 
fect and  the  pulps  of  the  teeth  more  distinct,"  and  that  the  anterior 
are  more  advanced  than  those  further  back  in  the  jaws.  It  is  at  about 
this  age  that  he  dates  the  commencement  of  dentinification  on  the 
edge  of  the  temporary  incisors.  The  situation  and  arrangement  of 
the  teeth  in  the  jaws  at  this  period  he  describes  very  accurately.  At 
the  expiration  of  the  sixth  or  seventh  month,  he  represents  the  first 
permanent  molar  as  having  begun  to  be  formed  in  the  tubercle  of  the 


102  THE    TEETH. 

upper  jaw,  and  "under  and  on  the  inside  of  the  coronoid  process  of 
the  hjwer;"  and  he  states,  that  the  pulps  of  the  permanent  central  in- 
cisors begin  to  appear  in  a  foetus  of  "seven  or  eight  months,"  and  to 
dentinify  "five  or  six  months  after  birth."  The  pulps  of  the  per- 
manent lateral  incisors  and  cuspids,  he  says,  begin  to  be  formed  soon 
after  birth  ;  the  first  bicusjjids  about  the  fifth  or  sixth  year,  the  second 
bicuspids  and  molars  the  sixth  or  seventh,  and  the  dentes  sapientite 
about  the  twelfth  year. 

Although  Mr.  Hunter  gives  a  more  minute  and  accurate  description 
of  the  progress  of  the  formation  and  arrangement  of  the  teeth  in  the 
jaws  previously  to  their  eruption  than  any  previous  writer,  yet,  with 
regard  to  their  origin  and  appearance  during  the  earlier  stages  of  their 
development,  he  is  unsatisfactory.  Nor  do  the  researches  of  Jourdain, 
Blake,  Fox,  Cuvier,  Serres,  Delabarre,  and  other  writers,  throw  much 
additional  light  upon  the  subject.  In  fact,  they  could  not,  as  their 
researches  do  not  seem  to  have  been  commenced  at  periods  sufficiently 
early  in  foetal  subjects ;  and  even  from  the  time  when  they  were  first 
instituted,  the  progress  of  the  organs  does  not  appear  to  have  been 
traced  through  the  subsequent  stages  of  their  formation  with  the  re- 
quisite degree  of  care  and  accuracy.  It  is  not,  therefore,  necessary  to 
notice  the  description  given  by  these  authors  of  the  progress  of  the 
formation  of  the  teeth,  although  it  may  not  be  amiss  to  state  here, 
that  Dr.  Blake  describes  the  rudiments  of  the  permanent  teeth  as 
originating  from  the  sacs  of  the  temporary,  and  that  this  supposed 
discovery  has  been  confirmed  by  almost  every  subsequent  writer  upon 
the  subject.*  Indeed,  until  quite  recently,  this  has  been  the  prevail- 
ing opinion,  and  their  progress,  step  by  step,  from  the  time  when  the 
rudiments  of  these  teeth  are  apparently  given  off  as  small,  bud-like 
processes  from  the  sacs  of  the  temporary,  is  traced  with  a  degree  of 
minuteness  by  Mr.  Thomas  Bell  that  would  seem  to  preclude  the  pos- 
sibility of  deception.  This  last-named  gentleman  describes  the  pro- 
cess as  commencing  at  a  very  early  period  of  the  formation  of  the 
temporary  teeth,  and  as  first  perceivable  "  in  a  small  thickening  on  one 
side  of  the  parent  sac,"  which,  "  gradually  increasing,"  becomes  "more 
and  more  circumscribed ;  until  it  at  length  assumes  a  distinct  form, 
though  still  connected  with  it  by  a  peduncle,  which,"  he  says,  "  is 
nothing  more  than  a  process  of  the  investing  sac."  "  For  a  time," 
continues  Mr.  Bell,  "the  new  rudiment  is  contained  within  the  same 
alveolus  with  its  parent,  which  is  excavated  by  the  absorbents  for  its 
reception,  by  a  process  almost  unparalleled  in  the  annals  of  physiology. 

*  It  is  said,  but  with  how  much  truth  the  author  is  unable  to  say,  that  this 
supposed  discovery  was  made  about  twenty  years  before  the  publication  of  Dr. 
Blake's  Inaugural  Dissertation,  by  a  French  dentist  by  the  name  of  Herbert. 


THE    TEETH.  103 

It  is  not  produced  by  the  pressure  of  the  new  rudiment,  as  is  erro- 
neously believed,  but  commences  in  the  cancelli  of  the  new  bone, 
immediately  within  its  smooth  surface,  thus  constituting  what  may  be 
termed  a  process  of  anticipation.  The  new  cell,  after  being  sufficiently 
excavated,  and  as  the  rudiment  continues  to  increase,  is  gradually 
separated  from  the  former  one  by  being  more  and  more  deeply  ex- 
cavated in  the  substance  of  the  bone,  and  also  by  the  deposition  of  a 
bony  partition  between  them  ;  and  at  length  the  new  rudiment  is  shut 
up  in  its  proper  socket,  though  still  connected  with  the  temporary 
tooth  by  a  cord  or  process  of  the  capsule  already  described,  which  has 
in  the  mean  time  been  gradually  attenuated  and  elongated."  * 

Now,  it  would  hardly  seem  possible  for  a  man  of  Mr.  Bell's  accu- 
racy of  observation,  after  having  investigated  the  subject  as  closely 
and  thoroughly  as  he  must  have  done,  to  have  enabled  him  to  describe 
so  minutely  the  various  stages  of  the  progress  of  the  development  of 
the  permanent  teeth,  to  have  mistaken  their  origin ;  yet  that  he  has 
would  appear,  by  subsequent  researches,  to  be  rendered  certain.  I 
allude  to  those  of  Arnold  and  Goodsir. 

The  last-named  author  has  traced  the  progress  of  the  teeth,  almost 
from  the  moment  of  the  appearance  of  the  germs  of  the  first  set,  as 
simple  mucous  papillse,  until  the  completion  of  those  of  the  second; 
and  so  minutely  and  accurately,  that  little  remains  to  be  done  by  fu- 
ture anatomists  for  the  perfection  of  this  branch  of  odontology. 

His  investigations  were  commenced  in  an  embryo  at  the  sixth  week, 
at  which  period  a  deep  groove,  formed  by  two  „ 

semicircular  folds,  extending  around  each  jaw, 
may  be  perceived,  lined  with  mucous  mem- 
brane, and  as  this  gradually  widens  from  be- 
hind forward,  a  ridge,  commencing  posteriorly 
and  running  in  the  same  direction,  rises  from 
its  floor,  and  divides  the  original  groove  into 
two  others ;  the  outer  one  forming  the  dupli- 
cature  of  mucous  membrane  from  the  inside  ,       *^'  "y'T^^^!"! ^^^^  ?u 

human  foetus   at   the  sixth 

of  the  lip  to  the  outside  of  the  alveolar  pro-  week ;  a.  The  lip ;  b,  The 
cess  ;  the  inner  one  constituting  what  may  be  Primitive  dental  groove. 
very  properly  denominated  the  primitive  dental  groove,  as  the  germs  of 
the  teeth  appear  in  it. 

The  inner  lip  of  the  inner  groove  is  formed  by  the  outer  edge  of  a 

*  This  cord  has  been  noticed  and  minutely  described  by  several  other  writers. 
Delabarre  calls  it  the  appendage  of  the  dental  matrix,  and  traces  it  through  what 
is  usually  denominated  the  alveolo-dental  canal,  which  he  designates  by  the  name 
of  iter  dentis,  to  the  surface  of  the  gum  behind  the  temporary  teeth.  He  also  states 
that  it  is  hollow,  and  when  he  first  described  it  in  his  thesis  of  reception  in  1806, 
it  had  not  been  noticed  by  any  other  writer. 


104 


THE    TEETH. 


Fig.  29. 


semicircular  lobe  which  is  to  constitute  the  future  palate.  By  the 
seventh  week  after  conception,  the  germ  of  the  first  temporary  molar 
in  the  upper  jaw  may  be  seen  in  tlie  primitive  denial  groove,  rising  up 

from  the  mucous  membrane, 
lining  its  floor  in  the  form  of  a 
simple  free  granular  papilla,  of  an 
ovoidal  sluipe,  the  long  diameter 
of  which  is  antero-posterior.  By 
the  eighth  week,  another  papilla, 
of  a  rounded  and  granular  form, 
is  observable,  between  the  mid- 
dle and  anterior  curve  of  the 
ridge,  on  the  floor  of  the  same 
groove,  which  is  the  rudiment 
of  the  temporary  cuspid.  Dur- 
ing the  ninth  week,  the  germs 
of  the  incisors — the  central  first, 
and  soon  after  the  lateral  —  make 
their  appearance  in  the  form  also 
of  mucous  papillffi.  During  the 
tenth  week  the  sides  of  the  groove 
before  and  behind  the  anterior 
molar  papilla  have  been  gradu- 


FiG.  29. — Lower  jaws  of  human  embryo 
at.  the  ninth  week  of  intra-uterine  life 
(from  Kolliker),  magnified  nine  diameters  : 
a.  Tongue  thrown  back:  f).  Right  half  of  the 
lip  depressed  ;  b.  Left  half  cut  off";  c,  Outer 
alveolar  wall :  d.  Inner  alveolar  wall ;  e,  Pa- 
pilla of  the  first  molar;  /,  fapilla  of  the 
cuspid;  g.  Of  the  second  incisor;  h.  Of  the 
first  incisor ;  i.  Folds  where  the  ducti  Rivi- 
niani  subsequently  enter. 


•  ally  approaching  each  other,  and 
processes  from  its  side  are  sent  off,  from  before  and  behind  this  germ, 
which  meet  and  inclose  it  in  a  follicle.  In  the  mean  time,  a  similar 
follicle  is  gradually  forming  around  the  cuspid  germ.  Toward  the 
end  of  the  tenth  week,  the  papilla  of  the  second  or  posterior  tempo- 
rary molar  shows  itself 

The  papillae  of  the  incisor  teeth,  which,  uj)  to  this  time,  have  ad- 
vanced very  slowly,  now  begin  to  increase  more  rapidly;  and  during 
the  eleventh  and  twelfth  weeks,  processes  are  sent  off  from  the  outer 
and  inner  walls  of  the  groove,  forming  for  each  a  distinct  follicle,  and 
while  the  papillae  of  the  cuspid  and  first  molar  are  now  undergoing 
little  change,  that  of  the  second  molar  is  gradually  increasing.  During 
the  thirteenth  week,  a  follicle  is  formed  for  it,  and  a  gradual  change 
takes  place  in  the  different  papillae  ;  each  begins  now  to  assume  a  par- 
ticular shape — the  incisors,  that  of  the  future  teeth  —  the  cuspids 
"become  simple  cones," — the  molars  "become  flattened  transversely." 
The  papillae  now  "grow  faster  than  the  follicles,  so  that  the  former 
protrude  from  the  mouths  of  the  latter,  while  the  depth  of  the  latter 
varies  directly  as  the  length  of  the  fangs  of  their  future  corresponding 
teeth."     The  mouths  of  the  follicles,  in  the  mean  time,  are  becoming 


THE    TEETH.  105 

more  developed,  "  so  as  to  form  opercula  or  lids,  which  correspond  in 
some  measure  with  the  shape  of  the  crowns  of  the  future  teeth."  Of 
these,  the  incisor  follicles  have  two  —  one  anterior  and  one  posterior 
—  the  first  larger  than  the  latter;  the  cuspid  follicles  have  three, — 
one  external  and  two  internal ;  the  molar  follicles,  as  many  as  there 
are  eminences  or  tubercles  upon  the  grinding  surfaces  of  these  teeth. 

The  outer  and  inner  lips  of  the  primitive  dental  groove  have  in- 
creased so  much,  that  at  the  fourteenth  week,  they  meet  together  like 
two  valves,  so  as  to  give  the  papillse  the  appearance  of  receding  back 
into  their  follicles,  and  to  become  almost  wholly  hidden  by  their 
opercula.  The  appearance  and  progress  of  the  germs  of  the  lower 
teeth  and  their  follicles  are  almost  precisely  similar  to  those  of  the 
upper,  though  they  do  not  appear  at  quite  so  early  a  period. 

At  the  epoch  last  mentioned,  the  primitive  dental  groove  in  each 
jaw  is  situated  on  a  higher  level  than  at  first,  contains  the  germs  and 
follicles  of  the  ten  temporary  teeth,  and  "may  now  be  more  properly 
denominated  the  secondary  dental  groove,"  for  it  is  about  this  time  that 
provision  is  made  for  the  production  of  the  ten  anterior  permanent 
teeth.  It  consists  in  the  appearance  of  a  crescent-shaped  depression 
immediately  behind  the  inner  opercula  of  the  follicles ;  first,  of  the 
central  incisors,  next  of  the  laterals,  then  of  the  cuspids,  afterward  of 
the  first  bicuspids.  The  opercula,  in  the  mean  time,  close  the  mouths 
of  the  follicles,  but  without  adhering  to  them ;  beginning  with  the 
central  incisors,  then  continuing  with  the  lateral,  and  the  cuspids,  and 
ending  with  the  second  molars.  The  secondary  groove  is  now  soon 
closed  by  the  approach  and  adhesion  of  its  lips  and  Avails,  commencing 
from  behind  and  proceediiig  forward ;  changing  the  follicles  or  pits 
into  sacs,  the  papillse  into  the  pulps  of  the  temporary  teeth,  and  the 
crescent-formed  depressions  into  "  cavities  of  reserve,"  from  which  the 
pulps  and  sacs  of  the  teeth  of  replacement  are  developed.  The  primi- 
tive dental  groove,  which,  by  this  time,  has  extended  back  of  the 
second  temporary  molar,  still  retains  its  original  appearance ;  it  has 
a  grayish  yellow  color,  and  its  edges  continue  "smooth  for  a  fort- 
night or  three  weeks  longer "  for  the  development  of  the  papilla  and 
follicle  of  the  first  permanent  molar. 

The  papillae  of  the  temporary  teeth  are  now  gradually  moulded  into 
the  shape  of  the  dentine  of  the  crowns  of  the  teeth  they  are  destined 
to  form  ;  the  pulps  of  the  upper  molars  are  perforated  by  three  canals, 
and  the  lower  by  two,  which  penetrate  to  their  centre.  The  primary 
base  is  divided  into  an  equal  number  of  secondary  bases,  from  which 
the  roots  of  the  future  teeth  are  gradually  to  be  developed.  An  in- 
tervening space  is  now  formed  between  the  pulps  and  the  sacs,  by  the 
more  rapid  growth  of  the  latter  than  the  former,  "  in  which  is  de' 


106  THE    TEETH. 

posited  a  gelatinous  granular  substance,  at  first  small  in  quantity,  and 
adherent  only  to  the  proximal  surfaces  of  the  sacs,  but  ultimately, 
about  the  fifth  month,  closely  and  intimately  attached  to  the  whole 
interior  of  these  organs,  except  for  a  small  space  of  equal  breadth,  all 
round  the  base  of  the  pulps,  which  space  retains  the  original  gray 
color  of  the  inner  membrane  of  the  follicle  ;  and  as  the  primary  base 
of  the  pulp  becomes  perforated  by  the  canals  formerly  mentioned,  the 
granular  matter  sends  processes  into  them,  which,  adhering  to  the  sac, 
reserve  the  narrow  space  described  above,  between  themselves  and  the 
secondary  bases.  These  processes  of  granular  matter  do  not  meet 
across  the  canals,  but  disappear  near  their  point  of  junction."  The 
granular  matter,  although  not  adhering  to  the  pulp,  is  exactly  moulded 
to  all  its  eminences  and  depressions. 

The  outer  membrane  of  the  sac,  according  to  Mr.  Goodsir,  is  sup- 
plied with  blood  from  small  twigs  sent  off  by  each  branch  of  the  dental 
artery  at  the  fundus  of  its  destined  sac,  and  from  the  arteries  of  the 
gums,  which  inosculate  with  each  other,  and  then  ramify  in  the  "true" 
(inner)  membrane. 

The  follicle  of  the  first  permanent  molar  closes  about  this  time,  and 
has  granular  matter  deposited  in  its  sac,  and  by  the  non-adhesion  of 
the  walls  of  the  secondary  gi'oove,  a  cavity  ajjpears  below  the  sac  of 
this  tooth ;  from  the  lining  mucous  membrane  of  which  the  second 
molar  germ  originates,  and  from  the  second  sac  a  new  offset  shoots 
forth,  destined  to  contain  the  papilla  of  the  dens  sapientice. 

But  previously  to  this  period,  the  apices  and  eminences  of  the  tem- 
porary teeth  have  become  vascular,  and  now  earthy  salts  begin  to  be 
deposited.  Simultaneously  with  this  process,  the  inner  surface  of  the 
granular  matter  is  absorbed,  and  after  awhile  becomes  so  thin  as  to 
render  the  subjacent  vascularity  apparent.  This  continues  until,  by 
the  time  a  layer  of  dentine  has  formed  over  the  whole  surface  of  the 
pulp  and  reached  its  base,  no  remains  of  it  are  left. 

The  cavities  of  reserve  have  been  gradually  receding  and  assuming 
a  position  behind  the  temporary  teeth ;  the  distal  extremities  of  the 
anterior  ones  begin  to  distend  about  the  fifth  month,  and  it  is  here 
that  the  germs  of  the  teeth  of  replacement  first  appear,  and  are  indi- 
cated by  a  bulging  up  or  folding  of  this  portion  of  these  cavities. 
These  soon  acquire  the  appearance  of  dental  pulps,  and  the  mouths  of 
the  cavities  gradually  become  obliterated. 

By  the  sixth  month,  bony  septa  have  formed  across  the  alveolar 
groove,  and  niches  are  now  formed  on  the  posterior  walls  of  the  al- 
veoli for  the  sacs  of  the  permanent  teeth.  The  sac  of  the  first  perma- 
nent molar  remains  up  to  the  eighth,  and  even  the  ninth  month,  im- 
Dedded   in   the   maxillary   tuberosity.     The  roots  of  the   temporary 


THE    TEETH. 


107 


incisors,  at  or  a  little  before  birth,  begin  to  be  formed ;  in  the  accom- 
plishment of  which,  says  Mr.  Goodsir,  "  three  contemporaoeous  actions 
are  employed,  viz.,  the  lengthening  of  the  pulp ;  the  deposition  of 
tooth  substance  upon  it ;  and  the  adhesion  of  the  latter  to  that  portion 
of  the  inner  sac  which  is  opposite  to  it."  By  the  time  the  central  in- 
cisors appear  through  the  gum,  the  jaw  has  lengthened  so  much  that 
the  first  permanent  molar  begins  to  assume  its  proper  position  in  the 
posterior  part  of  the  alveolar  arch.  The  sacs  of  the  permanent  teeth 
continue  to  recede  during  the  advance  of  the  temporary  teeth,  and 
their  sockets  to  acquire  their  perfect  state,  and  to  insinuate  themselves 
between  the  sacs  of  the  former  until  they  are  connected  by  their  proxi- 
mal extremities  only,  through  the  alveolo-dental  foramina  or  itinera 
dentium  of  Delabarre. 

Fig.  30. 


Fig.  30. — a.  Mucous  membrane;  h,  Mucous  membrane  with  a  granular  mass 
deposited  in  it;  c,  The  primitive  dental  gi-oove  ;  d,  A  papilla  on  the  floor  of  the 
groove;  e,  The  papilla  inclosed  in  a  follicle,  and  the  secondary  dental  groove 
forming;  /,  The  papilla  assuming  the  shape  of  a  pulp,  the  opercula  forming,  and 
a  depression  for  a  reserve  cavity  behind  the  inner  operculum  ;  g.  The  papilla 
becomes  a  pulp,  and  the  follicle  a  sac  by  the  adhesion  of  the  lips  of  the  opercula; 
the  secondary  dental  groove  in  the  act  of  closing;  h,  The  secondary  groove  ad- 
herent, except  behind  the  inner  operculum,  where  it  has  left  a  shut  cavity  of 
reserve  for  the  formation  of  the  pulp  and  sac  of  the  permanent  tooth  ;  i,  The  last 
change  more  complete  by  the  deposition  of  the  granular  body,  deposition  of  tooth 
substance  commencing;  j,  The  cavity  of  reserve  receding;  its  bottom,  in  which 
the  pulp  is  forming,  dilating  ;  k,  The  cavity  of  reserve  becoming  a  sac  with  a  pulp 
at  its  bottom,  and  further  removed  from  the  surface  of  the  gums.  The  temporary 
tooth  covered  with  a  layer  of  bone,  and  the  granular  substance  absorbed;  I,  The 
temporary  tooth  acquiring  its  root  and  approaching  the  surface  of  the  gums;  m, 
Root  of  the  temporary  tooth  longer,  and  its  sac  touching  the  surface  of  the  gums ; 
n,  Eruption  of  temporary  tooth,  its  sac  again  a  follicle,  and  the  permanent  re- 
ceding further  from  the  surface  of  the  gum :  o,  Completion  of  temporary  tooth, 
free  portion  of  sac  become  the  vascular  margin  of  the  gum,  and  the  permanent 
sac  connected  by  a  cord  passing  through  the  alveolar  dental  canal  or  foramen. 

The  vessels  which  go  to  the  sacs  of  the  permanent  teeth  are  derived 
first  from  the  gums,  but  they  ultimately  receive  vessels  from  the  tem- 
porary sacs,  which,  uniting  with  the  others,  eventually  retire  into 
permanent  dental  canals. 

The  foregoing  diagram,  taken  from   Goodsir,  exhibits  at  one  view 


108 


THE    TEETH. 


the  origin  and  progress  of  the  formation  of  a  temporary  and  its  cor- 
responding permanent  tooth. 

The  cavity  of  reserve,  behind  the  first  permanent  molar,  begins  to 
lengthen  about  the  seventh  or  eighth  month  ;  a  papilla  soon  appears 
in  its  fundus,  it  then  contracts  and  separates  from  the  remainder  of 
the  cavity,  by  which  means  a  new  sac  is  formed,  —  that  of  the  second 
permanent  molar.  As  the  jaw  increases  in  length,  it  comes  downward 
and  forward.  The  papillae  of  the  wisdom  teeth  (dentes  sapientise) 
form  in  the  remaining  portion  of  the  cavities  of  reserve,  Avhich,  in  the 
upper  jaw,  occupy  the  maxillary  tuberosities,  and  in  the  lower,  the 
base  of  the  corouoid  processes,  which  places,  says  Goodsir,  they  do  not 
leave  until  the  nineteenth  or  twentieth  year. 

The  progress  of  the  formation  of  the  three  molar  teeth  will  be  seen 
in  the  diagram,  (Fig.  31,)  also  copied  from  Mr.  Goodsir. 

Fig.  31. 


1 


1 


~I 


) 


^ 


EXX) 


Fig.  31. — a,  The  non-adherent  portion  of  the  primitive  dental  groove;  b,  The 
papilla  and  follicle  of  the  first  molar  on  the  floor  of  the  non-adherent  portion, 
now  become  a  portion  of  the  secondary  groove ;  c.  The  papilla  a  pulp,  and  the 
follicle  a  sac,  and  the  lips  of  the  secondary  groove  adhering,  so  that  the  latter 
has  become  the  posterior  or  great  cavity  of  reserve ;  d,  The  sac  of  the  first  molar 
increased  in  size,  advancing  into  the  coronoid  process  or  maxillary  tuberosity, 
and  the  cavity  of  reserve  lengthened;  e.  The  sac  of  the  first  molar  returned  by 
the  same  path  to  its  former  position,  and  the  cavity  of  reserve  shortened;  /,  The 
cavity  of  reserve  sending  backward  the  sac  of  the  second  molar ;  ff.  The  sac  of 
the  second  molar  advanced  into  the  coronoid  process  or  maxillary  tuberosity;  h, 
The  second  molar  sac  returned,  and  the  cavity  of  reserve  shortened;  i,  The 
cavity  of  reserve  sending  off  the  sac  and  pulp  of  the  wisdom  tooth ;  j.  The  sac  of 
the  wisdom  tooth  advanced  into  the  coronoid  process  or  maxillary  tuberosity ;  k, 
The  sac  of  the  wisdom  tooth  returned  to  the  extremity  of  the  dental  range. 

From  the  foregoing  abridgment  of  the  description  given  by  Mr. 
Goodsir,  of  the  development  of  the  pulps  and  sacs  of  the  human  teeth, 
it  is  seen  that  the  papilla  of  the  first  temporary  molar  makes  its  appear- 


THE    TEETH.  109 

ance  at  about  the  seventh  week  of  embryonic  life ;  at  tbe  eighth  week, 
the  cuspid  papilla  is  developed ;  during  the  ninth,  the  papillse  of  the 
incisors  make  their  appearance,  and  by  the  end  of  the  tenth  week,  the 
papilla  of  the  second  temporary  molar  may  be  seen.  At  the  end  of 
the  fourteenth  week,  the  upper  part  of  the  primitive  dental  groove, 
containing  the  germs  and  follicles  of  the  ten  temporary  teeth,  becomes 
the  secondary  dental  groove,  from  which  the  papillse  of  the  teeth  of 
replacement  are  furnished.  The  secondary  groove  assumes  the  form 
of  crescent-shaj)ed  depressions  behind  the  palatine  opercula  of  the  fol- 
licles of  the  temporary  teeth.  The  cavities  of  reserve  for  the  perma- 
nent teeth  gradually  recede,  and  assume  a  position  behind  the  sacs  of 
the  deciduous  teeth,  and  from  the  distal  extremities  of  these  the  papillse 
of  the  replacing  teeth  are  developed. 

It  is  only  necessary  to  add  to  the  description  of  this  process  already 
given,  the  further  statement  that  the  papillse  are  little  oval  masses  of 
cells  resembling  epithelial  cells  which  have  had  their  origin  in  pre- 
existing cells,  that  the  follicle  is  simply  an  investing  fold  of  mucous 
membrane.  The  young  tooth  then  begins  in  the  midst  of  cells  which 
had  their  origin  in  a  pre-existing  epithelial-like  cell,  which  has  grown 
and  multij)lied  by  division.  It  is  everywhere  surrounded  by  cells,  and 
is  without  basement  membrane  or  sub-basement  tissue,  and  no  line  of 
demarcation  exists  between  what  shall  finally  be  epidermic  and  dermic 
tissues.  "It  is  certain  that  an  elevation  or  'papilla'  occurs  when  a 
tooth  is  to  be  formed ;  but  I  think  that  in  the  central  part  of  these 
'pajnlke,'  which  consist  of  collections  of  cells,  neiv  ones  appear,  and 
that  this  process  continues,  until  at  last  the  tooth  structure  commences 
to  be  formed  in  the  last  collection  of  cells  in  the  central  part.  I  consider 
that  the  dental  'papilla'  is  entirely  composed  of  modified  epithelium, 
developed  from  what  may  be  termed  an  epithelial  cell.  The  collection 
of  cells  afterward  becomes  inclosed  in  its  sac  by  the  growth  of  the 
mucous  membrane  over  it."  (Beale  On  the  Structure  and  Growth  of 
Tissues,  p.  189.) 

From  these  cells  is  formed  a  soft  matrix  of  animal  matter,  which 
becomes  impregnated  with  calcareous  matter  to  form  the  complete  den- 
tal tissue,  whilst  in  the  interior  of  the  cavity  of  the  dentine,  cells  are 
found  which  continue  to  form  new  matrix  for  a  considerable  time. 
Vessels  cannot  be  traced  to  the  cells  in  which  the  tooth  is  growing 
until  it  has  attained  a  considerable  size,  and  the  formation  of  the  fang 
has  commenced. 

THE   PULP. 

The  pulp,  occupying  the  pulp  cavity  in  the  centre  of  the  tooth,  is 
the  shrunken  condition  to  which  the  tooth-germ  is  permanently  re- 


110 


THE    TEETH. 


cluced  after  it  has  normallv  accomplished  the  work  of  dentinification. 
It  is  an  exquisitely  sensitive,  liiglily  vascular  substance,  of  a  reddish- 
gray  color,  enveloped  in  an  exceedingly  delicate,  and  apparently 
structureless  membrane,  continuous  with  the  alveolo-dental  periosteum, 
and  adherent  to  the  walls  of  the  pulp  cavity.  This  is  designated  by 
Mr.  Thomas  Bell  "the  proper  membrane  of  the  pulp,"  and  by  Pur- 
kinje  and  Raschkow,  "  the  preformative  membrane ;  "  because,  in  the 

Fig.  33. 


^"CP. 


Fig.  32. — A  portion  of  the  body  of  the  pulp,  showing  the  cellular  arrangement. 
Fig.  33. — A  portion  of  the  superficial  layer  of  the  pulp,  showing  the  appearance 
of  vesicles. 

formation  of  the  dentine,  the  deposition  of  earthy  salts,  according  to 
these  authors,  commences  in  it. 

The  pulp,  according  to  the  two  last  mentioned  authors,  is  composed 
of  minute  globules.  Schwann  describes  it  as  consisting  of  globular 
nucleated  cells,  with  vessels  and  nerves  passing  between  them,  the  cells 
having  the  same  radial  course  as  the  fibres  of  the  dentine.  Accord- 
ing to  the  microscopic  observations  of  Mr.  Nasmyth,  it  is  principally 
composed  of  minute  vesicular  cells,  varying  in  size  from  the  ten- 
thousandth  to  the  one-eighth  of  an  inch  in  diameter,  disposed  in 
concentric  layers  ;  these,  when  macerated,  have  an  irregular  reticulated 
appearance,  and  are  found  to  be  interspersed  with  granules,  the  paren- 
chyma being  traversed  by  vessels  having  a  vertical  direction.  See  Figs. 
32  and  33,  copied  from  Mr.  Nasmyth's  Researches  on  the  Develojiment 
and  Structure  of  the  Teeth. 

Mr.  Tomes  describes  it  as  consisting,  from  its  earliest  appearance,  of 
a  series  of  nucleated  cells,  united  and  supported  by  plasma ;  also, 
prior  to  the  commencement  of  the  formation  of  the  dentine,  of  delicate 
areolar  tissue,  occupied  by  a  thick,  clear,  homogeneous  fluid  or  plasma. 
The  pulp  is  liberally  supplied  with  bloodvessels,  furnished  by  the 
trunk  which  enters  its  base.  The  ramifications  of  these  vessels  are 
distributed  throughout  its  entire  substance,  forming  a  capillary  net- 
work which  terminates  in  loops  upon  its  surface. 

The  distribution  of  the  vessels  of  the  pulp  is  represented  in  Fig.  34, 


THE    TEETH. 


Ill 


copied  from  the  late  work  of  Mr.  Nasmyth,  and  made  from  an  in- 
jected preparation  of  an  upper  central  incisor.  The  communication  of 
the  arteries  with  the  veins  by  means  of  a  series  of  looped  capillaries, 
presenting  a  densely  matted  appearance  upon  the  surface,  are  beauti- 
fully represented.    The  nerves  of  the  pulp  have  a  very  similar  arrange- 


FiG.  34. 


Fig.  34. — n.  The  vessels  of  the  pulp  of  an  upper  central  incisor  injected,  as  seen 
under  the  microscope,  very  highly  magnified  ;  b,  The  natural  size  of  the  pulp. 

ment  in  their   distribution,  having   apparently  looped   terminations 
(Fig.  35). 


112 


TOOTH    STRUCTURES. 


Kollikcr  describes  the  pulp  as  consisting  of  an  indistinctly  fibrous 
connective  tissue,  containing  many  dis- 
persed, rounded  and  elongated  nuclei,  with, 
occasionally,  narrow  bundles  somewhat  like 
imperfect  foetal  connective  tissue,  filled 
with  a  fluid  substance.  Immediately 
beneath  the  structureless  membrane  in 
which  these  tissues  are  inclosed,  there  is  a 
layer  composed  of  many  series  of  cells, 
cylindrical  or  pointed  at  one  end,  with 
long  and  narrow  nuclei,  arranged  perpen- 
dicularly to  the  surface  of  the  pulp,  like 
a  cylinder  of  epithelium.  This  layer  is 
described  as  being  from  two  to  four  one- 
hundredths  of  a  line  in  thickness.  These, 
in  regular  series  proceeding  internally, 
become  less  and  less  distinct;  "but  the 
cells,  without  losing  their  radial  arrange- 
ment, are  more  intermixed,  and  pass 
finally,  by  shorter  and  rounder  cells,  with- 
out any  sharp  line  of  demarcation,  into 
the  vascular  tissue  of  the  pulp."  His  de- 
scription of  the  distribution  of  the  vessels 
and    nerves   of    the    pulp    is   similar   to 

that   given   by   Mr.   Nasmyth    and   Mr. 
Fig.  35.— The  nerves  of  the    rp 
pulp  of  an  upper  adult  bicuspid     -'■0     ^  • 
magnified  twenty  diameters. 


CHAPTER  X. 


TOOTH   STRUCTURES. 


DENTINE. — With  regard  to  the  manner  of  the  formation  of  the 
dentine,  odontologists  do  not  agree.  Mr.  Thomas  Bell  is  of  the 
opinion  that  it  is  secreted  by  the  external  surface  of  a  membrane 
which  immediately  invests  the  pulp,  designated  by  Raschkow  the  prcB- 
formative  membrane,  the  pulp  serving  only  as  a  mould  upon  which 
this  sub.stance  is  formed.  Purkinje  and  Schwann  believe  that  the 
pulp  is  converted  into  dentine  by  a  transition  process,  the  superficial 
cells  upon  the  surface  assuming,  first,  an  elongated  form,  correspond- 
ing in  diameter  and  direction  with  the  fibres  of  the  dentine ;  or,  in 


TOOTH    STRUCTURES. 


113 


other  words,  that  the  dentine  is  formed  by  the  dentinification  of  the 
pulp. 

Professor  Owen  maintains  that  it  is  by  "  centripetal  calcification  of 
the  pulp's  substance."  He  says,  "  In  the  cells  of  the  dentinal  pulp 
the  nucleus  fills  the  parent  cell  with  a  progeny  of  nucleoli  before  the 
work  of  calcification  (or,  more  properly,  of  dentinification)  begins." 
Again,  "  The  primary  cells  and  the  capillary  vessels  and  nerves  are 
imbedded  in  a  homogeneous,  minutely  subgranular,  mucilaginous  sub- 
stance. The  cells,  which  are  smallest  at  the  base  of  the  pulp,  and 
have  large,  simple,  subgranular  nuclei,  soon  fall  into  linear  series, 
directed  toward  the  periphery  of  the  pulp." 

Mr.  Alexander  Nasmyth  says,  "  The  cells  of  the  pulp  are  converted 
into  ivory"  (or  dentinal)  "cells  by  the  deposition  within  them  of 
earthy  salts,  and  the  cell  so  converted,  with  their  nuclei,  are  the  per- 
fect ivory ;  moreover,  the  nuclei  assume  a  peculiar  arrangement,  and 
constitute  the  structure  which  I  have  described  and  demonstrated  by 
the  name  of  baccated  fibres," 

The  walls  of  the  pulp  cavity  are  built  up  by  an  infinite  number  of 
minute  tubes,  cemented  together  by  a  subgranular  matter,  radiating 
from  the  cavity  to  the  surface  of  the  tooth.  From  these  tubes  branches 
are  given  off  in  great  number  in  the  roots  and  as  the  enamel  approaches 
the  dentinal  surface.     In  the  crown  these  branches  are  few  in  number. 


Fig.  36. 


d 


J'        e 


a  &^  (J 

Fig.  -36. — Dentine  and  cementum  from  the  root  of  a  human  incisor,  copied  from 
Kolliker  :  a.  Dentinal  fibres  or  tubes;  h.  Interglobular  spaces,  having  the  appear- 
ance of  the  lacunie  in  bone  ;  c,  Smaller  interglobular  spaces ;  d.  Commencement 
of  the  cementum,  with  numerous  canals  close  together;  e,  Its  lamellse ;  f,  Lacunse  ; 
g,  Canals. 

They  anastomose  freely  with  each  other  and  with  the  superficial  dental 
tissues.  They  terminate  in  loops  or  are  lost  in  the  enamel.  By  their 
extension  into  the  superficial  dental  tissues  a  close  union  is  formed  be- 
tween them  and  the  dentine,  notwithstanding  the  fact  that  each  tissue 


114  TOOTH    STRUCTURES. 

is  developed  from  a  distinct  formative  pulp.  Kollikcr  tliought  these 
tubes  contained  clear  fluid  in  the  fresh  state.  In  the  dried  prepara- 
tion they  are  emptyj  and  are  readily  permeated  by  colored  fluid. 
These  facts  gave  rise  to  the  opinion,  still  pretty  generally  entertained, 
that  their  sole  purpose  was  the  conduct  of  nutrient  fluids.  Mr.  Tomes, 
however,  following  Nasniyth,  objected  to  this  theory  on  purely  physio- 
logical grounds.  The  extreme  sensitiveness  of  an  exposed  coronal 
surface  from  which  a  portion  of  enamel  has  been  broken  ;  the  fact 
that  in  operations  for  the  removal  of  carious  dentine  the  sensitiveness 
was  found  to  be  greatest  just  beneath  the  enamel ;  and  furthermore, 
that  when  the  pulp  was  broken  up  or  destroyed  by  escharotics,  this 
sensibility  Avas  lost,  led  him  to  conclude  that  the  sensibility  of  the 
dentine  depended  on  its  connection  with  the  pulp,  and  to  suppose 
that  these  tube  contents  might  be  in  some  way  associated  with 
the  sensibility  of  the  structure  in  which  they  were  found,  serving  to 
establish  connection  between  it  and  the  j^ulps,  to  which  supposition 
fluid  contents  opposed  an  insurmountable  difiiculty.  Led  by  this 
train  of  reasoning  to  a  careful  examination  of  the  tubes,  he  found 
"each  dentinal  tube  tenanted  by  a  soft  fibril,  which,  after  passing 
from  the  pulp  into  the  tube,  follows  its  ramifications,  and  (Tomes' 
Dental  Surgery,  327)  that  these  fibrils  may  be  traced  into  the  dentinal 
pulps."  Professor  KoUiker  and  M.  Lent  had  pi'eviously  seen  pro- 
cesses extending  from  the  "j)eripheral  cells  of  the  dentinal  pulp;" 
but  had  supposed  them  "  organisms  for  the  development  of  the  den- 
tinal tubes."  Mr.  Tomes  was  unable  to  determine  the  manner  in 
Avhich  the  fibrils  terminated  in  the  pulp,  whether  by  cells  or  by  any 
communication  with  nerves;  but  does  not,  therefore,  question  the 
function  he  has  assigned  them,  since,  when  their  connection  with  the 
pulp  is  cut  off,  all  sensibility  is  lost  to  the  dentine.  He  adds,  "  It  is 
by  no  means  necessary  to  assume  that  the  dentinal  fibrils  are  actually 
nerves,  before  allowing  them  the  power  of  communicating  sensation. 
Many  animals  are  endowed  with  sensation  which  yet  possess  no  de- 
monstrable nervous  system;"  whilst,  at  the  same  time,  it  has  been  im- 
possible to  demonstrate  nerves  in  the  human  body,  so  numerous  as  to 
warrant  the  assumption  that  at  every  prick  of  a  needle  the  point  must 
touch  a  nerve  fibre.  Again,  the  greater  sensibility  of  the  dentine 
immediately  beneath  the  enamel  is  satisfactorily  accounted  for  by  the 
law  which  refers  to  all  nerves  the  greatest  sensibility  at  their  terminal 
extremities.  Mr.  Tomes  does  not,  however,  deny  to  the  dentinal 
tubes  the  additional  office  of  conveying  nutrient  fluids,  but  thinks 
"the  foregoing  facts  will  warrant  the  conclusion  that  the  dentinal 
fibrils  are  subservient,  not  only  to  sensation  in  the  dentine,  but  that 
they  ar'e  also  the  channels  by  which  the  nutrition  of  this  tissue  is  car- 


TOOTH    STEUCTUEES.  115 

ried  on,"  and  argues  very  forcibly  that  they  do  convey  nutrient  fluids, 
from  the  fact  that  the  tubes  are  capable  of  undergoing  structural 
change,  and  that  the  fibrils  may  also  become  calcified  at  their  distal 
extremities,  and  that  the  calcifying  material  must  be  derived  from  the 
pulp,  reaching  the  place  of  deposit  through  the  fibrils.  Differing  in 
this  from  Dr.  Beale,  who,  whilst  agreeing  with  Mr.  Tomes  as  to  the 
presence  of  these  fibrils,  which  he  has  himself  succeeded  in  demon- 
strating, is  of  the  opinion  that  the  -so-called  dentinal  tubes  "  are  not 
tubes,  nor  are  they  canals  for  the  transition  of  nutrient  substances 
dissolved  in  fluids."  He  considers  these  fibrils  as  simple  germinal 
matter  communicating  with  the  germinal  matter  on  the  surface  of  the 
pulp,  and  that  the  tubes  are  the  formed  material  of  this  fibrillar 
germinal  matter.  "The  wall  of  the  tubes  with  the  matter  between 
the  tubes  corresponds  to  the  'wall'  of  an  ordinary  cell,  or  to  this  and 
the  intercellular  substance  (my  formed  material),  and  the  central  part 
of  the  contents  of  the  tube  to  granular  cell  contents  with  the  nuclei 
(ray  germinal  matter).  If  you  look  at  the  tissue  of  the  pulp  just  be- 
neath the  surface  of  the  dentine  you  find  a  number  of  oval  masses 
of  germinal  matter  colored  intensely  red  by  carmine.  These  are 
nearly  equidistant,  and  separated  from  each  other  by  a  certain 
quantity  of  material  which  is  very  faintly  colored, 
and  in  cases  where  the  solution  was  not  very  strong 
it  remained  colorless.  This  colorless  matrix  is 
continuous  with  the  intertubular  or  dentinal  tissue, 
while  the  intensely  red  germinal  matter,  or  rather, 
a  prolongation  from  it,  extends  to  the  dentinal 
tubes."  (Beale  On  the  Structure  and  Growth  of 
Tissues,  155.)  Dr.  Beale  admits  that  the  dentinal 
tubes  do  convey  nutrient  fluids,  but  contends  that 
they  were  not  designed  for  that  purpose.  He  says, 
"As  in  the  formation'  of  bone  already  described, 

spaces  or  pores  are  left,  through  which  nutrient      ^''^-    '^I-  —  Trans- 

.  verse  section  through 

matter  passes  toward  the    germmal   matter.     In  the  dental  tubuli  of 

this  way  very  fine  channels  result,  which  mav  be  the  root  of  a  human 

,        ,  ,  .  „  1      "•      1   tooth,  magnified  350 

seen  m  the  dry  tooth   passing  from  one  dentmal  diameters,    showino' 

tube  to   the   other."     Structure  and   Growth   of  their  numerous  anas- 

rri-  -.nrr  tomOSeS. 

1  issue,  lo7. 

The  formation  of  dentine  begins  about  the  fourth  month  of  fcetal  life, 
at  the  summit  of  the  papilla.  The  superficial  portion  of  the  crown  is 
first  formed  and  afterwards  undergoes  no  alteration  in  size,  all  subse- 
quent growth  taking  place  on  the  surface  adjacent  to  the  dentinal 
pulp.  The  growth  of  the  fang  takes  place  from  above,  downward  into 
the  alveolus  destined  to  receive  it.     Placed  at  right  angles  to  the  outer 


116  TOOTH    STRUCTURES. 

surface  of  the  pulp,  between  it  and  the  dentine  already  formed,  or 
before  any  dentine  is  formed,  is  situated  a  layer  of  "  elongated  cylin- 
drical bodies  or  cells  with  nuclei"  somewhat  resembling  nucleated 
columnar  epithelium.  The  exact  share  taken  by  the  pulp  in  the  form- 
ation of  dentine  is  one  of  the  most  vexed  questions  in  the  physiology 
of  this  subject.  Mr.  Huxley  denies  it  any  direct  influence,  while  Kol- 
liker  says  a  layer  of  cells  forming  the  peripheral  portion  of  tlic  i)ulp 
are  immediately  concerned  in  its  formation.  He  says  that  fi-om  the 
base  of  the  dental  sacs  the  dental pulj)  proceeds  rich  in  vessels  and 
finally  also  in  nerves,  with  a  non-vascular  external  portion.  The  latter 
is  bounded  by  a  delicate  structureless  membrane,  the  membrana  prae- 
formativa  (Raschkow) — which  has  no  further  relation  to  the  formation 
of  the  tooth.  Beneath  this  lie  cells  of  0-016  to  0-024"'  in  length,  and 
0*002  to  0-0045  in  breadth,  with  very  beautiful  vesicular  nuclei,  and 
distinct  single  or  multiple  nucleoli.  They  are  arranged  close  together 
over  the  whole  surface  of  the  pulp,  like  an  epithelium,  though  not  so 
closely  defined  as  it  would  be,  but  gradually  passing,  at  least  ap- 
parently, by  smaller  cells  into  the  parenchyma.  In  vascular  pulps 
an  additional  boundary  line  may  be  traced,  inasmuch  as  the  capillary 
loops  in  Avhich  the  vessels  terminate  do  not  penetrate  between  the 
cylindrical  cells,  but  end  close  to  one  another  upon  their  inner  surfoces, 
so  that,  considering  that  the  dentine  is  produced  by  the  cells  in  question, 
we  might  be  justified  in  terming  them  the  dentinal  membrane  or  mem- 
brana eboris.  The  internal  portion  of  the  pulp,  he  thinks,  consists  of 
a  granular  matrix,  subsequently  becoming  more  fibrous,  and  that 
when  ossification  of  the  dentine  begins  numerous  vessels  are  developed, 
and  a  little  later  numerous  nerves  also  make  their  appearance.  Ac- 
cording to  this  observer,  it  is  "only  the  most  external  epithelium-like 
layer  of  cells,"  and  not  the  entire  pulp,  which  is  engaged  in  the  pro- 
duction of  dentine,  and  these  maintain  a  constant  thickness  "  by  the 
elongation  of  the  original  cells  accomj^anied  by  a  continual  multipli- 
cation of  their  nuclei."  He  does  not  consider  that  the  "  same  cell 
suflSces  for  the  whole  duration  of  the  dentine,"  but  that  new^  cells  may 
from  time  to  time  be  formed ;  and  denies  that  the  whole  pulp  is  pro- 
gressively changed  into  dentinal  cells,  and  thinks  its  only  purpose  is  to 
support  the  vessels  essential  to  the  growth  of  the  dentinal  cells,  from 
which  alone  the  dentine  is  formed,  by  the  gradual  reception  of  cal- 
careous salts.     (From  Tomes'  Dental  Surgery,  388.) 

M.  Lent  refers  the  formation  of  the  dentinal  tubes  to  a  "  series  of 
delicate  processes  extending  from  the  dentinal  pulp,"  to  which  Kolli- 
ker  assents,  and  thinks  it  probable  that  a  single  cell  may  generate  an 
entire  tube.     He  also  recognizes  the  existence  of  an  intertubular  sub- 


TOOTH    STRUCTURES.  117 

stance,  which  he  believes  to  be  "  excreted  by  the  cells  in  common, 
without  structural  relation  to  individual  cells  or  their  prolongation." 

The  theory  advanced  by  Mr.  Beal  is  much  more  satisfactory,  and 
of  far  greater  simplicity.  It  is  that  on  the  dentinal  surface  of  a  tissue 
lying  on  the  pulp  are  found  certain  "  cells  like  columnar  cells,"  which 
are  in  relation  with  the  nerves  and  bloodvessels  of  the  pulp  into  whicli 
they  send  prolongations,  and  that  from  these  cells  alone  is  developed 
the  dentine,  agreeing  in  so  much  with  Kolliker  and  Lent,  but  does  not 
hold  with  them  that  the  "  canals  are  direct  processes  of  the  whole  den- 
tinal cells,"  nor  that  the  intertubular  substance  is  a  direct  secretion 
from  the  cells.  His  views  are,  briefly,  that  these  cells  or  "  elementary 
parts  "  are  situated  on  the  surface  of  the  pulp ;  that  they  consist  as 
cells  do  everywhere,  of  germinal  matter  and  formed  material,  and  the 
so-called  intertubular  substance  is  but  the  oldest  part  of  the  formed 
material,  in  which,  by  the  gradual  deposition  of  mineral  matter,  the 
dentine  is  formed.  Growth  taking  place  here  as  elsewhere  from  within, 
outward  from  nuclei  or  germinal  matter  to  cell  wall  or  formed  material, 
while  calcification  takes  place  in  the  opposite  direction,  from  the  oldest 
and  most  distant  formed  material  toward  the  germinal  matter.  We 
have  said  calcification  takes  place  gradually,  probably  during  the  life 
of  the  individual  or  until  the  pulp  cavity  is  obliterated  ;  hence  we  have 
a  central  mass  of  germinal  matter,  the  so-called  dental  fibrils,  sur- 
rounded by  calcified  formed  material,  giving  rise  to  a  tubular  appear- 
ance, the  dental  tubes ;  and  since  the  calcifying  process  takes  place 
from  without,  inward  the  germinal  matter  is  made  to  present  the  ap- 
|)earance  of  an  attenuated  fibre  gradually  enlarging  as  it  approaches  the 
pulp.  Upon  this  fibrillar  mass  the  calcifying  process  continually  en- 
(I'oaches  until  the  so-called  tube  is  obliterated.  Until  this  is  accom- 
|»lished,  however,  the  germinal  matter  must  be  nourished  and  mineral 
matter  must  be  convej^ed  to  its  most  distant  part  for  deposition,  and 
if  this  conduct  of  nutrient  fluid  constitutes  a  claim  to  the  name,  they 
may  still  be  called  tubes. 

Notwithstanding  Mr.  Tomes'  inability  to  trace  any  communication 
between  this  fibrillar  matter  and  the  nerves  of  the  pulp,  such  connec- 
tion must  be  supposed  to  exist, — Prof.  C.  Johnston,  of  the  Baltimore 
Dental  College,  succeeded  in  tracing  nervous  communication  with  the 
dentine  —  and  to  it  we  must  refer  the  sensibility  of  this  tissue.  When 
the  process  of  calcification  is  completed,  the  dentine  is  no  longer 
endowed  with  Vife,  and  any  subsequent  change  which  may  take  place 
is  in  obedience  to  physical  laws  alone. 

Enamel. —  The  opinion  formerly  entertained  upon  this  subject  was, 
that  the  enamel  is  a  deposition  from  the  inner  membrane  of  the  dental 
sac ;  that  this,  after  the  surface  of  the  pulp  of  the  tooth  has  become 


118 


TOOTH    STRUCTURES. 


dentinified,  pours  out  upon  the  latter  a  thick  fluid,  which  soon  con- 
denses, assuming  at  first  a  chalky  appearance,  and,  afterward,  by  a 
process  somewhat  similar  to  crystallization,  attains  the  glossy  hardness 


Fio.  38. 


Fig.  39. 


Fig.  38. — The  hexagonal 
terminations  of  the  fibres 
of  a  portion  of  tlie  sur- 
face of  the  enamel  highly 
magnified.  At  1,  2,  8,  the 
crooked  crevices  between 
the  hexagonal  fibres  are 
more  strongly  marked. 


Fig.  39. — A  side  view  of  the  enamel 
fibres  magnificil  350  diameters:  1, 
Tlie  enamel  fibres;  2  2,  Transverse 
slria3  upon  them. 

by  which,  it  is  characterized.  Recent  observa-' 
tions,  however,  establish  the  erroneousness  of 
the  views  prevailing  among  older  writers. 

The  enamel  forms  a  smooth,  dense  layer,  en- 
veloping the  crown  of  the  tooth  as  far  as  the 
neck,  where  it  insinuates  itself  between  the 
cementum  and  dentine.  It  consists  of  hex- 
agonal or  polygonal  fibres  or  rods  arranged  in  w^aved  lines  perpendicu- 
larly to  the  dentine.  Concerning  its  mode  of  development,  and  the 
class  of  tissues  to  which  it  belongs,  much  difference  of  opinion  exists. 
Those  fibres,  or  rods,,  situated  on  the  most  prominent  part  of  the 
crown,  are  arranged  in  a  vertical  direction  ;  those  upon  the  side  are 
placed  horizontally,  whilst  the  intermediate  fibres  present  all  degrees 
of  obliquity.  As  these  fibres  necessarily  diverge  from  the  dentinal  to 
their  free  surface,  the  upper  space  thus  occasioned  must  be  filled  by 
the  gradual  enlargement  of  the  fibres  from  within  outward,  or  by  the 
addition  of  supplemental  fibres. 

The  latter  assumption  Mr.  Tomes  thinks  the  correct  one,  although 
difficult  of  demonstration.  The  enamel  rods  are  marked  by  transverse 
striae,  which  indicate,  according  to  Mr.  Beale,  the  successive  layers  of 
calcification,  and  are  much  more  strongly  pronounced  in  some  speci- 
mens than  in  others,  being  most  markedly  so  in  the  enamel  of  un- 
healthy subjects. 

Upon  opening  a  dental  sac  from  a  foetal  jaw,  interposed  between  the 
inner  surface  of  the  sac  and  the  coronal  surface  of  the  tooth,  a  semi- 
fluid, gelatinous  substance  will  be  found  composed  of  nucleated  cylin- 
drical columns  with  more  or  less  spherical  nucleated  cells  enveloped 
in  fluid.  Similar  columns  will  be  found  on  the  inner  surface  of  the 
sac.  This  is  the  enamel  organ,  or  enamel  pulp,  and  from  it  the  cells 
found  in  the  gelatinous  fluid  have  become  separated.     Columns  of  a 


TOOTH    STEUOTURES,  119 

like  kind  are  also  found  on  the  surface  of  the  enamel.  By  the  action 
of  hydrochloric  acid  a  membrane-like  substance  may  be  raised  from 
the  surface  of  the  enamel,  which  is  seen  under  the  microscope  to  con' 
sist  on  one  side  of  "  columns  of  the  enamel  pulp,  and  on  the  other  of 
decalcified  enamel  fibres,"  joined  end  to  end,  but  easily  separated  at 
their  point  of  junction. 

AVhen  the  columns  are  separated  from  the  sac,  and  the  fibres  from 
the  enamel,  there  remains  between  the  sac  and  enamel  a  thin  mem- 
brane, which  Mr.  Huxley  considers  the  membrana  prseformativa,  be- 
neath which  he  thinks  the  enamel  is  formed,  and  that  in  its  formation 
the  enamel  organ  takes  no  part,  and,  indeed,  that  the  enamel  is  not 
formed  by  any  "conversion  of  cell  structure."  (Beale,  p.  161.)  Mr. 
Tomes  has,  however,  conclusively  shown  that  the  membrane  raised  by 
Mr.  Huxley  is  not  properly  a  membrane,  but  simply  a  transitional 
stage  of  the  enamel  column  chemically  modified  by  the  action  of  the 
acid,  the  outer  uncalcified  portion  of  enamel  rods. 

There  can  be  little  doubt,  then,  that  the  enamel  is  formed  by  the 
development  of  elongated  cells,  or  "cylindrical  columns"  formed  on 
the  inner  surface  of  the  enamel  pulp.  Here,  as  in  the  dentine,  the 
germinal  matter  is  converted  into  formed  material,  which  is  the  or- 
ganic basis  into  which  mineral  matter  is  deposited  in  a  direction  pre- 
cisely the  reverse  of  that  which  takes  place  in  the  dentine,  i.  e.,  in  the 
dentine  calcification  takes  place  from  without  inward  ;  in  the  enamel 
from  within  outward,  though  in  each  case  commencing  at  the  point 
most  distant  from  the  respective  pulps.  The  enamel  pulps  sustaining 
precisely  the  relation  to  enamel  that  the  dentinal  pulp  sustains  to 
dentine. 

When  the  tooth  makes  its  way  through  the  gum,  though  fully 
formed,  the  enamel  is  still  comparatively  soft  and  delicate,  and  does 
not  attain  its  maximum  hardness  for  months,  or  even  several  years 
after.  Before  the  tooth  has  suflfered  from  friction,  a  membrane  may 
be  raised  by  the  action  of  acetic  acid,  which  Mr.  Nasmyth,  who  first 
drew  attention  to  it,  described  as  the  persistent  dental  capsule,  but 
■which  Mr.  Huxley  thought  identical  with  the  membrana  prseforraativa. 
Mr.  Tomes  has,  however,  shown  that  it  is  more  probably  a  very  thin 
layer  of  uncalcified  cementum. 

The  enamel  differs  from  dentine  in  its  greater  density  ;  the  much 
earlier  period  at  which  entire  calcification  takes  place ;  the  absence, 
except  in  abnormal  conditions,  of  any  uncalcified  portions  ;  the  direc- 
tion in  which  calcification  progresses,  the  fewer  cells  found  on  the 
pulps,  the  greater  fluidity  of  its  blastema;  and  in  the  fact  that  it  is  the 
least  constant  of  the  dental  tissues.  "  It  is  more  frequently  absent 
than  present  in  the  teeth  of  the  class  of  fishes ;  it  is  wanting  in  the 


120  TOOTH    STRUCTURES. 

entire  order  Opliidia  among  existing  reptiles;  and  it  forms  no  part 
of  the  teeth  of  the  Edentata,  and  many  cetacea  among  mammals." 
(Owen's  "Odontography,"  xxiv.) 

Cementum. —  Tlie  manner  of  the  formation  of  the  cementum  has 
been  variously  explained.  Raschkow  conjectures  that  it  is  probably 
produced  by  the  remains  of  the  enamel  pulp.  More  recent  writers 
seem  to  regard  the  cemental  pulp  as  a  production  of  the  dental  sac ; 
but  the  writer  is  inclined  to  believe  that  it  is  a  production  of  that 
portion  of  the  prreformative  membrane  which  invests  the  elongated 
part  of  the  pulp  destined  for  the  formation  of  the  root ;  and  that  this, 
as  earthy  salts  are  deposited  in  the  pulp,  pours  out  a  blastema  in  which 
nucleated  cells  are  developed.  He  was  led  to  the  adoption  of  this  be- 
lief from  an  examination  of  a  tooth,  on  every  part  of  the  surface  of 
which  there  is  a  development  of  exostosis.  Such  development  is  now 
universally  admitted  to  be  a  hypertrophied  condition  of  cementum, 
the  structure  of  the  exostosis  and  of  cementum  being  identical. 

The  tooth  in  question  belongs  to  the  Museum  of  the  Baltimore 
Dental  College,*  and  the  development  of  the  exostosis  must  have  com- 
menced simultaneously  w'ith  the  commencement  of  the  deposition  of 
earthy  salts  in  the  dentinal  pulp ;  and  so  rapidly  did  it  proceed,  that 
it  completely  broke  up  the  enamel  organ,  penetrating  every  part  of  it, 
so  that  only  here  and  there,  imbedded  in  its  substance,  small  patches 
of  enamel  are  seen.  This  phenomenon  can  only  be  accounted  for  by 
supposing  that  the  investing  membrane  of  the  pulp,  from  some  inex- 
plicable cause,  poured  out  a  blastema,  which  was  immediately  con- 
verted into  cementum,  and  that  this  took  on  an  hypertrophied  con- 
dition before,  or  simultaneously  with,  the  deposition  of  earthy  salts  in 
the  cells  of  the  fibres  of  the  enamel  organ. 

The  Cement,  or  Crusta  Petrosa,  is  the  most  highly  organized  of  the 
dental  structures.  It  covers  the  roots  of  all  the  teeth,  encroaching 
slightly  upon  the  crown  where  it  overlaps  the  enamel.  Its  purpose  is 
to  bind  the  teeth  securely  in  the  alveoli,  forming  the  vital  bond  be- 
tween the  bone  and  the  commonly  unvascular  constituents  of  the  teeth. 
It  is  thickest  about  the  terminal  part  of  the  fang,  gradually  thinning 
as  it  approaches  the  croAvn.  According  to  Mr.  Tomes,  "its  structural 
character  depends  upon  the  amount  of  tissue  present."  It  is  only  in 
the  thickest  portions  that  lacunse  and  canaliculi  can  be  seen.  In  the 
thicker  parts  the  canaliculi  are  seen  anastomosing  freely  with  each 
other,  and  establishing  vascular  relations  between  the  several  lacunse ; 
and  they  "occasionally  become  connected  with  the  terminal  branches 
of  the  dental  tubuli."  This  communication,  though  doubted  by  many 
observers,  Mr.  Tomes  considers  demonstrated  "beyond  cavil"  by  pre- 
*  It  was  presented  to  the  author,  for  this  institution,  by  Dr.  Swayze. 


TOOTH    STEUCTUEES.  121 

parations  in  his  possession.  Haversian  canals  are  also  found  in 
very  thick  sections  of  cementum.  M.  Morel  is  of  opinion  that 
Haversian  canals  are  only  found  where  cementum  has  been  morbidly 
developed ;  but  Mr.  Tomes  is  of  a  different  opinion,  and  says  that 
where  two  fangs  are  united  by  cementum  a  vascular  canal  will  not 
unfrequently  be  found  in  it,  and  that  this  appearance  "is  not  neces- 
sarily an  evidence  of  disease."  With  both  of  these  observers  Mr. 
Beale  differs  in  some  essential  particulars ;  and  as  his  description  of 
the  structure  and  growth  of  cementum  is  concise  and  clear,  and  ex- 
presses the  view  we  think  most  worthy  of  acceptance,  we  will  transfer 
it  entire  to  our  pages. 

"  The  cementum  is  often  stated  to  be  true  osseous  tissue,  but  it  differs 
from  bone  in  many  important  particulars.  The  lacunae  which  it  con- 
tains are  often  much  larger  than  those  in  bone,  and  they  are  most 
irregularly  arranged.  The  matrix  of  cementum  is  more  transparent 
and  harder  than  that  of  bone,  and  much  of  it  consists  of  a  very  clear, 
transparent  structure  of  a  refractive  power  and  hardness  much  resem- 
bling dentine,  with  small  tubes  traversing  it  here  and  there,  but  their 
arrangement  is  most  irregular. 

"Thin  layers  of  cementum,  it  is  well  known,  are  destitute  of 
lacunae;  but  I  have  specimens  even  of  the  1-lOOth  of  an  inch  in  thick- 
ness in  which  not  a  lacuna  is  to  be  seen,  and  even  in  cementum  much 
thicker  than  this  very  few  lacunal  spaces  are  sometimes  to  be  found. 
The  canaliculi  are  often  of  great  length,  and  many  are  seen  to  extend 
almost  in  a  right  line  from  a  space  in  the  substance  of  the  cementum 
quite  to  its  surface.  Nutritive  fluids  must  be  almost  entirely  derived 
from  the  outer  surface  of  the  cementum  ;  and  hence  these  channels  re- 
main as  the  tissiie  increases  in  thicknes-s  until  the  mass  of  germinal 
matter  in  the  lacuna  dies,  and  they  are  often  of  great  length. 

"  It  is  generally  stated  that  the  cementum  results  from  the  ossifica- 
tion of  the  tooth  sac ;  but,  as  remarked  by  Kolliker,  cells  take  part  in 
the  formation  of  this  tissue  as  in  the  formation  of  bone,  and  the  tooth 
sac  is  not  transformed  into  cement.  The  cement  is  continuous  with 
-the  dentine,  and,  as  observed  by  Mr.  Tomes,  the  dentinal  tubes  may 
often  be  traced  into  the  structure.  Cementum  is  formed  much  more 
slowly  than  bone. 

"  If  the  fang  of  an  adult  tooth,  properly  f)repared,  be  examined,  a 
very  soft,  beautiful  tissue  will  be  found  on  the  surface.  This  takes 
part  in  the  formation  of  the  cementum,  and  is  concerned  in  the  forma- 
tion of  those  exostoses  which  often  grow  upon  the  fangs  of  teeth. 

"It  is  composed  entirely  of  what  he  describes  as  branching  cells 
(elementary  parts),  the  processes  of  which  anastomose  freely  with  each 
other.     It  is  from  this  tissue  the  crusta  petrosa  is   formed.     It  is  a 


122  TOOTH    STRUCTURES. 

most  perfect  example  of  a  tissue,  consisting  entirely  of  cells,  the 
cavities  of  whicli  communicate  with  each  other  by  tubes.  The  stellate 
cells  are  here  as  distinct  as  they  are  in  the  pith  of  the  rush.  But  do 
these  cells  and  tubes  merely  constitute  an  elaborate  system  of  chan- 
nels for  the  distribution  of  nutrient  fluids  to  the  tissue  that  intervenes 
between  them,  as  Virchow  and  his  school  maintain  ?  This  tissue,  it 
may  be  remarked,  grows  very  slowly  ;  it  is  a  very  low,  simple  form  of 
tissue,  and  probably  requires  but  very  little  nutrient  matter.  If  the 
above  view  is  adopted,  it  must  be  admitted  that  the  means  for  nour- 
ishing the  structure  are  far  more  elaborate  than  would  be  expected, 
sujiposing  the  conclusion  is  accepted  that  there  ought  to  be  a  constant 
relation  between  the  activity  of  change  in  a  tissue  and  the  mechanism 
for  bringing  new  matter  to  the  elementary  parts  and  carrying  off  the 
effete  material  from  them. 

"  Neither  docs  it  appear  that  all  these  bodies  become  lacunje  of  the 
cementum.  The  stellate  cells  first  described  have  not  more  than  from 
ten  to  twelve  processes  or  tubes  projecting  from  them,  while  many  of 
the  lacunar  of  the  cementum  have  as  many  as  thirty  or  forty ;  hence 
the^e  tubes  are  certainly  not  an  early  stage  of  the  caualiculi,  and  the 
cells  cannot  become  lacunse  simply  by  the  deposition  of  calcareous 
matter  in  the  intervening  matrix  or  intercellular  substance. 

"  This  stellate  tissue  on  the  surface  of  the  fang  nevertheless  under- 
goes calcification.  The  processes  of  the  stellate  mass  become  nar- 
rower and  nai'rowcr  until  the  germinal  matter  which  they  contained, 
having  undergone  conversion  into  formed  material,  cease  to  be- 
come colored  by  carmine.  They  now  look  like  roundish,  highly-re- 
fracting cords,  which  are  colorless,  and  connect  the  several  stellate 
masses  of  dark-red  germinal  matter  w4th  each  other.  Here  and  there, 
in  the  intervals  between  these  processes,  small  globules  of  calcareous 
matter  have  been  deposited,  and  these  increase  and  completely  surround 
the  cord-like  processes.  Many  of  these  processes  gradually  assume 
the  character  of  the  surrounding  matrix,  disappear  as  distinct  cords, 
and,  like  the  rest  of  the  tissue,  become  impregnated  with  calcareous 
matter.  It  is  in  this  manner  that  the  tissue  of  the  cementum,  which 
exhibits  a  laminated  arrangement,  but  is  destitute  of  lacunae,  is  pro- 
duced. 

"  Many  of  the  stellate  masses  of  germinal  matter  (cells)  shrink  and 
disappear  in  consequence  of  the  same  changes  having  occurred.  Others 
remain  with  their  processes,  and  their  nuclei  possibly  remain  as  the 
nuclei  of  the  lacunre  which  ai'e  irregularly  distributed  through  the 
cementum  ;  but  I  cannot  express  myself  positively  on  this  point.  It 
is  certain  that  all  the  cells  do  not  become  lacunse;  for  in  this  tissue 
there  are  half  a  dozen  stellate  cells  to  one  lacuna  in  the  cementum. 


TOOTH    STRUCTURES.  123 

and  many  of  the  canaliculi  are  five  times  as  long  as  these  tubes.  Are 
these  processes  tubes  ?  This  question  would  doubtless  be  answered  in 
the  afiirmative  by  every  one  who  examined  the  tissue  long  after  death  ; 
but  during  life  they  contain  a  solid  or  semi-solid  substance  corresj)ond- 
ing  to  that  which  occupied  the  so-called  dentinal  tubes.  They  con- 
tain portions  of  the  germinal  matter  which  is  undergoing  conversion 
into  formed  material,  and  the  situation  in  which  these  'tubes'  existed 
are  the  last  portions  of  the  formed  material  to  undergo  calcification. 

"  This  is  precisely  the  same  change  which  takes  place  in  the  calcifi- 
cation of  the  dentine,  the  only  difierence  being  in  the  form  which  the 
masses  of  germinal  matter  assume  in  the  first  instance.  Cementum  is 
a  more  permanent  but  less  perfect  tissue  than  bone."  (Structure  and 
Growth  of  Tissue,  163-166). 

Classification  of  Teeth. —  We  come  now  to  consider  the  classi- 
fication of  teeth.  To  what  class  of  tissues  do  they  belong, —  epidermic, 
dermic,  or  osseous?  Each  has  its  advocates  of  no  mean  distinction. 
Professor  Owen  refers  them,  or  at  least  part  of  their  component  ele- 
ments, to  the  osseous  structures.  Of  dentine,  he  says,  "The  transition 
from  vascular  dentine  to  true  bone  is  gradual  and  close;"  and  again, 
of  cement,  "  Cement  always  closely  corresponds  in  texture  with  the 

osseous  tissues  of  the  same  animal Purkinje  also  discovered 

the  distinct  layer  of  substance  previously  known  to  surround  the  simple 
teeth  of  man,  and  many  mammalia  contained  corpuscles  like  those 
which  characterize  the  structure  of  true  bone ;  and  he  observed  in  one  in- 
stance that  this  bone-like  substance  was  continued  on  the  enamel  of  the 
crown  of  a  human  incisor This  fact  I  have  confirmed  as  re- 
gards the  human  teeth  and  the  teeth  of  many  mammals  and  reptiles." 
(Owen's  "Odontography.")  Retzius  discovered  the  corpuscles  of  Pur- 
kinje in  the  dentine.  In  the  transplantation  of  teeth  to  the  comb  of 
cocks,  the  surface  in  contact  with  the  comb  is  said  to  be  "  composed 
of  a  well-organized  tissue  resembling  bone."  The  cement  is  also  rep- 
resented to  present  variations  in  microscoping  character  corresponding 
with  the  variation  in  the  character  of  the  osseous  tissue  in  the  skeleton 
of  different  classes  of  animals.  Thus  the  cement  in  the  osseous  fishes 
in  which  the  bone  is  not  characterized  by  the  radiated  calcigerous 
cells  likewise  cease  to  present  that  character.  (Owen.)  Retzius  also 
declares  that  in  the  teeth  of  the  pike  there  is  a  "  direct  transition  from 
dentine  to  bone;"  that  in  the  dentine  hollow  cones  are  formed  "which 
are  filled  by  bone,"  which  is  traversed  by  canals  resembling  the  or- 
dinary canals  in  bone,  except  that  they  are  less  regular,  and  also  that 
the  dentinal  tubes  are  connected  with  the  "  medullary  canals  of  the 
proper  osseous  structure  "  The  cement,  Professor  Owen  thinks,  should 
"  unquestionably  rank  with  the  osseous  tissues,"  and  that  the  dentine 


124  TOOTH    STRUCTURES. 

bears  a  "close  structural  resemblance  to  bone,  and  is  almost  identical 
in  chemical  compof^ition  ;  its  modifications  (vaso-dentiue  and  osteo- 
dentine)  forming  intermediate  gradations  between  the  hard  dentine  and 
true  bone."  True  enamel  he  considers  "  a  tissue  per  se,"  though  in 
the  teeth  of  fishes  there  are  intermediate  stages  which  link  enamel  to 
dentine,  as  the  dentine  itself  in  most  fishes  gradually  passes  into  bone; 
and  he  thus  sums  up  his  remarks  on  this  subject:  "The  analogy  of  the 
dental  organs  to  those  of  the  corneous  system  holds  only  in  their 
mode  of  development,  in  their  shedding  and  reproduction,  and  in 
their  exposure  to  external  influences  and  to  the  contact  of  extraneous 
bodies  ;  but  the  antlers  of  deer  are  similarly  exposed,  are  likewise  shed 
and  reproduced  annually,  and  also  contemporaneously  with  the  fall  of 
the  hair  ;  but  antlers  are  not  therefore  classed  with  the  corneous 
tissues,  any  more  than  is  the  bony  core  of  the  horn  of  the  Cavicorn 
Ruminants."     ("Odontography,"  74.) 

M.  Morel  also  considers  the  ivory  as  "identical  with  the  funda- 
mental substance  of  bone,"  and  the  cementura  as  "true  bone;"  whilst 
of  the  enamel  he  says,  "Its  chemical  nature  seems  to  connect  it  with 
the  epithelial  structures."  Mr.  Tomes  considers  the  cementum  "  most 
closely  allied  to  primary  bone,  from  which  it  is  difficult  to  point  out 
any  distinguishing  structure."  Besides  those  fx'om  whom  the  prece- 
ding brief  citations  have  been  made,  many  other  distinguished  ob- 
servers have  ranked  one  or  more  of  the  dental  tissues  with  the  osseous 
structures.  By  Mr.  Huxley,  both  the  enamel  and  dentine  are 
classed  with  the  dermic  structures,  together  with  hairs,  feathers,  and 
scales ;  basing  this  conclusion  on  the  assumption  that  all  the  dentinal 
tissues  are  formed  beneath  a  membrana  prreformativa,  and  on  certain 
general  resemblances  which  they  bear  to  the  dermic  structures. 

Dr.  Beale,  whose  views  we  have  advocated  throughout  this  work, 
refers  them  to  the  epidermic  class  of  tissues  ;  and  as  this  is  the  view  we 
are  at  present  disposed  to  entertain,  we  shall  briefly  state  the  argument 
in  its  favor.  It  has  already  been  shown  that  the  so-called  tubes  of 
dentine  and  cementum  differ  in  some  essential  particulars  from  the 
canaliculi  of  bone;  that  they  are  found  only  in  thicker  sections  ;  that 
its  matrix  is  harder  and  more  transparent ;  that  cementum  is  of  slower 
growth;  and  that  upon  the  assumption  that  its  "cells  and  tubes"  cor- 
respond to  the  lacunte  and  canaliculi  of  bone,  the  number  and  extent 
of  them  are  out  of  all  relation  to  the  nutritive  changes  that  take  place 
in  it,  and  that  their  mode  of  formation  differs  from  the  lacnnse  and 
canaliculi.  By  instituting  a  comparison  between  the  antlers  of  a  deer, 
which  are  true  bone,  and  a  horn  which  is  recognized  as  belonging  to 
the  "  cuticular  or  epithelial  structures,"  and  at  the  same  time  showing 
to  which  of  these  the  tooth  is  most  closely  allied.  Dr.  Beale  has  sue- 


TOOTH    STRUCTURES.  125 

ceeded  in  putting  the  subject  very  clearly.  Xow  while  the  teeth  of 
some  animals  continue  to  fall  and  be  reproduced  during  the  life  of  the 
animal,  others  as  the  tusk  continue  to  grow  steadily  throughout  life, 
whilst  others  fall  and  are  never  replaced.  The  tusk  and  horn  continue 
to  grow  on  from  the  nutrient  pulp.  The  part  most  distant  from  the 
pulp  is  oldest,  that  nearest  to  it  is  youngest.  jN"either  in  the  tusk,  horn 
or  tooth,  do  the  vessels  penetrate  their  structure.  They  are  composed 
from  youth  to  age  of  the  same  tissue,  and  where  it  has  been  worn  away 
it  is  not  reproduced.  In  the  bony  antler  we  see  quite  a  different  state 
of  affairs.  It  is  permeated  everywhere  by  vessels,  and  undergoes  nutri- 
tive change  in  every  part.  It  does  not  continue  to  grow  uninter- 
ruptedly from  youth  to  age, — the  growth  of  last  year  being  in  relation 
with  the  growth  of  this, —  but  each  year  the  entire  antler  falls,  and  an 
entirely  new  growth  takes  its  place.  Calcification  of  a  horn  would 
give  us  a  tusk ;  but  the  antler  differs  from  both  horn  and  tooth  in  its 
mode  of  development,  growth,  structure,  and  duration.  The  tooth  or 
tusk  thus  far  then  seems  to  correspond  most  closely  to  the  epithelial 
structures. 

Upon  the  position  of  the  basement  membrane,  however,  depends  the 
final  adjustment  of  the  dispute.  It  must  be  remembered,  however, 
that  Mr.  Beale  denies  to  this  membrane — the  membrana  prseformativa 
—  any  fcTmative  power,  or  even  that  any  "  jjreformative  memhrane  has 
been  actually  demonstrated  over  the  enamel,  as  Huxley  asserts,  between 
the  enamel  and  dentine,  as  many  observers  hold,  or  beneath  the  dentine," 
as  he  himself  holds. 

The  transparent  membranoid  structure  raised  by  Mr.  Huxley  from 
the  surface  of  the  enamel,  it  has  already  been  stated,  was  shown  by 
Mr.  Tomes  to  be  merely  the  "outer  uncalcified  portion  of  the  enamel 
rods,"  which  are,  however,  situated  entirely  beneath  a  thin  membrane, 
to  the  under  surface  of  which  the  most  superficial  portion  or  summit 
of  these  cells  adheres.  "This  membrane  is  highly  vascular."  It  does 
not  hold  that  relation  to  the  enamel  which  Mr.  Huxley  gives  his  "pre- 
formative  membrane." 

The  generally  received  opinion  is  that  this  membrane  is  situated 
between  the  enamel  and  dentine, —  the  former  corresponding  to  epithe- 
lium, the  latter  "to  the  connective  tissue  of  a  mucous  membrane."  Mr. 
Tomes  has  shown  that  the  dentine  frequently  extends  into  the  enamel, 
and  therefore  there  can  be  no  interposing  membrane.  This  theory 
then  is  certainly  wrong.  Mr.  Huxley  places  both  enamel  and  dentine 
beneath  the  basement  membrane,  making  them  both  dermic  structures. 
By  Mr.  Beale  the  basement  membrane  is  situated  beneath  the  dentine ; 
hence,  he  considers  both  the  enamel  and  dentine  as  epidermic.  In 
support  of  his  classification,  he  traces  an  analogy  between  the  arrange- 


126  TOOTH    STRUCTURES. 

mcnt  of  the  epithelial  cells  and  those  of  the  enamel  and  dentine.  "  In 
many  cuticular  structures  great  difference  is  observed  between  the  cells 
upon  the  surface  and  those  beneath,  so  that  it  would  seem  that  the 
outer  cells  grew  outward  while  the  inner  cells  grew  inward  toward 
the  sub-basement  tissue."  A  like  arrangement  has  been  shown  to  exist 
between  the  enamel  and  dentine,  holding  respectively  the  relation  of 
the  superficial  and  deep  layers  of  epithelium.  Dentine  presents  a  gen- 
eral arrangement  closely  resembling  epithelial  structures.  It  grows 
from  a  pulp  as  a  hair  does ;  like  a  hair,  it  is  not  penetrated  to  its 
extremity  by  nerves  and  bloodvessels  ;  in  texture  they  have  many 
points  in  common,  and  many  epithelial  structures  present  an  arrange- 
ment of  cells  closely  resembling  that  of  the  "  anatomical  elements  of 
the  dentine." 

Mr.  Beale  admits  that  if  dentine  be  composed  of  "  cells"  and  "  inter- 
cellular substance,"  as  is  generally  supposed,  it  belongs  to  the  class  of 
connective  tissues,  and  is  without  doubt  formed  beneath  the  line  cor- 
responding to  the  basement  membrane ;  but  we  have  already  endeavored 
to  show  that  the  so-called  "intercellular  substance"  is  but  the  outer 
calcified  portion  of  the  cell,  the  oldest  portion  of  the  elementary  part, 
and  is  in  no  sense  a  "secretion"  distinct  from  the  cell  wall.  That  it 
should  be,  involves  "  one  of  the  following  suppositions : —  1.  T'^ie  exist- 
ence of  an  analogous  substance  in  the  blood  itself;  or, 

2.  "  The  possibility  of  the  cell  exerting  some  metabolic  action  upon, 
or  converting  the  matter  deposited  from  the  blood  into  the  peculiar 
and  characteristic  matter  constituting  the  intercellular  substance." 

Of  neither  of  these  things  is  there  the  slightest  evidence  ;  on  the  con- 
trary, it  has  been  clearly  shown  that  cells  increase  in  size  by  deposition 
from  within,  which  exercises  an  expansive  force,  and  not  by  a  deposit 
upon  their  surface.  Mr.  Beale,  therefore,  concludes  that  both  "  dentine 
and  enamel  must  be  looked  upon  as  calcified  epithelial  structures,  and 
I  think  they  may  be  regarded  as  epithelial,  in  the  same  sense  that  a 
hair,  or  the  cells  in  a  glandular  follicle,  such  as  the  sebaceous  gland 
cells,  or  che  sweat  gland  cells,  or  the  calcified  cells  of  the  mantles  of 
mollusca,  are  regarded  as  modified  epithelial  structures." 


PART    SEC  OND 


lATHOLOGY,  THERAPEUTICS. 


127 


CHAPTER  I. 

GENERAL    CONSIDERATIONS. 

THE  susceptibility  of  the  human  body  to  morbid  impressions  differ? 
in  different  individuals.  In  some,  its  functional  operations  art 
liable  to  derangement  from  the  most  trifling  causes ;  in  others,  they 
are  less  easily  disturbed.  ISTor  do  the  same  causes  always  produce  the 
same  results.  Their  effects  are  determined  by  the  tendency  of  the 
organism  and  the  susceptibility  of  the  part  on  which  they  act ;  both 
with  regard  to  constitutional  and  local  diseases,  this  is  true  of  the 
organism  generally  and  of  all  its  parts  separately  considered,  but  of 
none  more  than  the  teeth,  gums,  and  alveolar  processes.  The  teeth  of 
some  persons  are  so  susceptible  to  the  action  of  corrosive  agents,  as  to 
become  involved  in  general  and  rapid  decay,  as  soon  as  they  emerge 
from  the  gums ;  while  those  of  others,  though  exposed  to  the  same 
causes,  remain  unaffected  through  life.  A  similar  difference  of  suscep- 
tibility also  exists  in  the  parts  within  which  these  organs  are  containe'd. 

With  the  teeth,  these  differences  of  susceptibility  to  morbid  impres- 
sions are  implanted  in  them  at  the  time  of  their  formation,  and  are 
the  result  of  the  different  degrees  of  perfection  in  which  this  process  is- 
accomplished.  In  proportion  as  these  organs  are  perfect,  is  their 
capability  of  resisting  the  action  of  destructive  agents  increased,  and 
as  they  are  otherwise,  it  is  diminished.  This  is  true  of  every  part  of 
the  body ;  but  as  the  teeth  are  formed,  so  they  continue  through  life, 
if  not  impaired  by  disease,  except  that  they  gradually  acquire  a  very 
slight  increase  of  density,  whereby  their  liability  to  caries  is  corres- 
pondingly lessened. 

Not  so,  however,  with  the  other  parts  of  the  body.  They  may  be 
innately  delicate,  or  imperfectly  developed,  and  afterward  become 
firm  and  strong,  or  be  at  first  healthy  and  well  formed,  and  subse- 
quently become  impaired  ;  and  in  propoi'tion  as  they  undergo  these 
changes,  is  their  susceptibility  to  disease  increased  or  diminished.  But 
the  teeth  are  not  governed  by  the  same  laws,  either  physical  or  vital, 
that  regulate  the  operations  of  the  other  parts  of  the  animal  economy. 
Not  only  the  manner  of  their  formation,  but  their  diseases,  also,  are 
9  129 


130  GENERAL    CONSIDERATIONS, 

different.  The  other  tissues  of  the  body,  not  excepting  the  osseous,  are 
endowed  with  recuperative  powers,  whereby  an  injury  is  repaired  by 
their  own  inherent  energies ;  but  the  teeth  do  not  possess  such  attributes. 

Assuming  these  propositions  to  be  true  —  and  that  they  are,  especially 
those  with  regard  to  the  teeth,  we  shall  endeavor  to  show  —  it  becomes 
an  object  of  considerable  importance  to  discover  the  signs  by  which 
the  susceptibility  of  the  human  organism  to  disease  may  be  determined. 
But  to  do  this,  except  in  so  far  as  the  teeth,  gums,  and  alveolar  pro- 
cesses are  concerned,  is  not  our  present  object ;  yet,  in  the  prosecution 
of  the  task  we  have  undertaken,  we  shall  have  occasion  to  advert  to 
certain  constitutional  and  local  tendencies  indicated  by  the  appear- 
ance and  condition  of  the  teeth  and  other  parts  of  the  mouth. 

M.  Delabarre  affirms,  that  by  an  inspection  of  the  teeth,  we  can 
ascertain  whether  the  innate  constitution  is  good  or  bad,  and  our  own 
observations  go  to  confirm  the  truth  of  this  opinion ;  but,  as  this 
author  adds,  these  are  not  the  only  organs  that  should  be  interrogated. 
The  lips,  the  gums,  the  tongue,  and  the  fluids  of  the  mouth  should  also  be 
examined  to  discover  the  health  of  the  organism,  and  ascertain  whether 
the  original  condition  of  the  constitution  has  undergone  any  change. 

Those  who  have  not  been  in  the  constant  habit  of  closely  observing 
the  appearances  met  with  in  tbe  mouth,  may  be  skeptical  with  regard 
to  the  information  that  may  thus  be  derived ;  but  those  who  have 
studied  them  with  care,  will  not  hesitate  to  say  that  they  are,  in  many 
instances,  more  certain  and  accurate  than  any  which  can  be  obtained 
from  other  physical  appearances.  For  example  :  the  periods  of  the 
dentinification  of  the  different  classes  of  both  sets  of  teeth  being  known, 
we  are  enabled  to  infer  whether  the  innate  constitution  be  good  or  bad, 
from  the  physical  condition  of  these  organs;  for  as  the  functions  of  the 
organism  are  at  this  time  healthily  or  unhealthily  performed,  will  they 
be  perfect  or  imperfect,  or,  in  other  words,  will  their  texture  be  hard 
or  soft. 

It  is  well  known  to  writers  on  odontology,  that  the  teeth  of  the 
child,  like  other  parts  of  the  body,  usually  resemble  those  of  its 
parents ;  so  that  when  those  of  the  father  or  mother  are  bad  or  irregu- 
larly arranged,  a  similar  imperfection  is  generally  found  to  exist  in 
those  of  the  offspring ;  but  this  does  not  necessarily  follow,  and  when 
it  does,  it  is  the  result  of  the  transmission  of  some  constitutional  im- 
pairment, whereby  the  formative  operation  of  these  organs  is  either 
disturbed  or  prevented  from  being  effected  in  a  perfect  and  healthy 
manner.  The  quality  of  the  teeth  of  the  child,  therefore,  may  be  said 
to  depend  on  the  health  of  the  mother,  and  the  aliment  from  which  it 
derives  its  subsistence.  If  the  mother  be  healthy,  and  the  nourish- 
ment of  the  child  of  good  quality,  the  teeth  will  be  dense  and  compact 


GENERAL    CONSIDERATIONS.  131 

in  their  texture,  generally  well  formed  and  well  arranged,  and  as  a 
consequence  less  liable  to  be  acted  on  by  morbid  secretions  than  those 
of  children  deriving  their  being  from  unhealthy  mothers,  and  subsist- 
ing upon  aliment  of  a  bad  quality.  Temperament,  also,  exercises  an 
influence  upon  the  functional  operations  of  the  body. 

Before  proceeding  further,  it  may  be  well  to  notice  the  individual 
conditions  or  qualities  known  as  temperaments.  The  word  tempera- 
ment is  derived  from  the  Latin  tenvpero,  "  to  mix  together,"  and  implies 
the  constitution  as  determined  by  the  predominance  of  certain  con- 
stituents of  the  body.  For  among  the  ancients  it  was  supposed  that 
the  manifestations  of  the  functions  were  tempered  or  so  determined 
by  the  predominance  of  any  one  of  the  three  humors  then  recognized, 
namely :  blood,  lymph,  bile,  and  atrabilis,  or  black  bile.  Dunglison,  in 
Lis  Medical  Dictionary,  defines  the  temperaments  to  be  those  individ- 
ual diflerences  which  consist  in  "such  disproportion  of  parts,  as  regards 
volume  and  activity,  as  to  sensibly  modify  the  whole  organism,  but 
without  interfering  with  the  health  ;  "  in  other  words,  a  physiological 
condition  in  which  the  function  of  the  different  organs  are  so  regulated 
as  to  impress  certain  characteristics  upon  each  individual.  Others  con- 
tend that  these  individual  differences  "  though  they  can  scarcely  be 
called  morbid,  yet  certainly  give  a  proclivity  to  disease  in  the  direc- 
tion indicated  by  the  temperaments." 

At  the  present  time  five  temperaments  are  recognized,  namely:  the 
sanguine  or  sanguineous,  the  bilious,  the  lymphatic,  the  nervous,  and 
the  melancholic  or  encephalic. 

The  sanguineous  temperament  is  characterized  by  a  fair,  ruddy 
complexion,  yellow,  red  or  light  auburn,  or  light-brown  hair,  a  good 
class  of  teeth,  a  full  muscular  development,  large,  full  veins  and  active 
pulse,  indicating  an  abundant  supply  of  blood,  and  warm  extremities, 
all  showing  perfect  health,  and  in  females  a  tendency  to  voluptuous- 
ness. The  mind  is  hopeful  and  elastic,  yet  at  tlie  same  time  fickle  and 
volatile,  with  little  determination  and  perseverance.  Although  indi- 
cating perfect  health,  yet  in  this  temperament  diseases  are  prone  to 
assume  the  acute  form,  and  speedily  run  their  course  either  to  recovery 
or  a  fatal  termination. 

The  bilious  temperament  is  characterized  by  a  preponderance  of 
bile,  indicated  by  a  dark  or  sallow  countenance,  black  hair,  generally 
luxuriant,  a  slow  or  moderate  circulation  of  the  blood,  shown  by  a 
hard,  strong  pulse,  dark  eyes,  strong  teeth,  with  a  yellow  tinge  over 
entire  crown  ;  and  the  body,  instead  of  the  roundness  of  form  peculiar 
to  the  sanguine  temperament,  is  angular.  Wanting  in  ease  and  grace 
of  manner ;  there  is  restlessness,  but  at  the  same  time  great  force  of 
character  and  quickness  of  perception  and  power  of  will.     The  digest- 


132  GENERAL.    CONSIDERATIONS. 

ive  organ?,  however,  are  more  liable  to  derangement  than  in  other 
temperaments,  indicating  some  defective  action  in  these  organs ;  the 
liver,  of  course,  being  the  principal  one  affected,  and  necessitating  the 
use  of  mercury  as  a  stimulus. 

The  lymphatic  temperament  is  characterized  by  a  predominance  of 
lymph  or  phlegm  in  the  system  ;  and  persons  possessing  it  have  a 
general  softness  or  laxity  of  the  tissues,  the  proportion  of  the  fluids 
being  too  great  for  that  of  the  solids,  the  lymphatics  and  absorbents 
not  acting  so  thoroughly  as  to  prevent  the  cellular  tissue  from  being 
filled  with  humors  \  so  that  there  is  a  want  of  sensibility.  The  com- 
plexion is  fiiir,  but  not  ruddy,  and  the  hair,  either  light  or  dark,  is 
not  luxuriant,  but  thin  and  straight.  The  eyes  are  light,  generally 
blue,  the  circulation  feeble,  and  the  pulse,  as  a  consequence,  weak,  and 
a  want  of  tone  in  the  system.  The  skin  is  pale,  flabby,  and  moist, 
and  the  body  is  heavy  and  rounded,,  while  the  teeth,  although  they 
may  often  appear  comparatively  good,  yet  are  sensitive  and  not  highly 
organized.  Although  the  expression  denotes  a  Avant  of  activity,  yet 
there  is  a  clear  and  active  mind,  characterized  by  prudence  and  sound 
judgment  without  enthusiasm.  Owing  to  the  predominance  of  lymph, 
there  is  a  tendency  to  dropsy  and  chronic  disease. 

The  nervous  temperament  is  characterized  by  the  predominance  of 
the  nervous  element,  and  by  great  activity  or  susceptibility  of  the 
great  nervous  centre — the  brain.  Persons  possessing  this  temperament 
are  distinguished  by  their  impressibility,  susceptibility  to  intense  feel- 
ing or  intense  excitement.  There  is  great  irritability,  anxiety,  and 
agitation,  which  peculiarities  enable  us  readily  to  recognize  it  by  the 
tone  of  voice  and  manner  of  speaking.  The  body  is  slender,  though 
well  formed,  the  complexion  pale  and  soft,  and  the  muscles  small  and 
yielding.  In  illness,  symptoms  are  often  complicated  with  those  of 
nervous  disor.der,  and  the  mind  desponding.  There  is  want  of  power 
and  endurance. 

The  fifth  and  last  temperament,  the  melancJioUc  or  encephalic,  is  said 
by  Dr.  Powell  to  be  characterized  by  a  large  cerebrum  and  a  small 
cerebellum,  slender  limbs,  long  neck,  narrow  chest,  flat  abdomen,  thin 
face,  massive  forehead,  especially  expanded  in  the  upper  third.  A 
severe,  thoughtful,  and  often  gloomy  expression,  with  vital  powers 
slowly  developed,  and  yet  compatible  with  health  and  long  life. 
Persons  possessing  this  temperament  are  capable  of  profound  investiga- 
tion, but  are  subject  to  monomania. 

Upon  the  temperament  the  constitutional  health  depends  to  a 
greater  extent  than  pathologists  generally  admit ;  and  hence  it  is  that 
that  of  the  child  usually  partakes  of  that  of  one  or  other,  or  both,  of 
its  parents.  "This,"  says  M.  Delabarre,  "is  particularly  observable 
in  subjects  that  have  been  suckled  bv  a  mother  or  nurse  whose  tem- 


GENERAL    CONSIDERATIONS.  133 

perament  was  similar  to  theirs."  To  obviate  the  entailment  of  this 
evil,  he  recommends  mothers  having  teeth  constitutionally  bad  to  ab- 
stain from  suckling,  and  that  this  highly  important  office  be  intrusted 
to  a  nurse  having  good  teeth ;  asserting,  at  the  same  time,  that  by  this 
means  the  transmission  of  so  troublesome  a  heritage  as  bad  teeth  may 
be  avoided. 

Depending,  then,  as  the  physical  condition  of  the  teeth  and  the  or- 
ganism generally  confessedly  do,  upon  the  quality  of  the  nourishment 
from  which,  subsistence  is  derived  during  infancy  and  childhood,  it  is 
highly  essential  that  this  be  good ;  and  that  that,  especially,  derived 
from  the  breast,  be  from  those  only  who  are  in  the  enjoyment  of  per- 
fect health,  and  possess  good  constitutions. 

The  teeth,  while  in  a  pulpy  state,  partake  of  the  health  of  the 
organism  generally.  As  that  is  healthy  and  strong,  or  unhealthy  and 
weak,  so  will  the  elementary  principles  of  which  they  are  then  com- 
posed, be  of  a  good  quality,  or  deteriorated ;  but  after  d^ntinification 
has  commenced,  the  solid  parts  cease  to  be  influenced  by,  or  to  obey 
the  laws  of,  the  other  parts  of  the  body.  If  the  general  health  be 
good  at  the  time  this  process  is  going  on,  it  will  be  evidenced  by  their 
density  and  color  ;  if  bad,  in  the  looseness  of  their  texture,  etc. 

This  is  a  subject  to  which  we  have  paid  some  attention,  having  for 
a  long  time  been  in  the  habit  of  carefully  noting  the  differences  in  the 
appearance  of  the  teeth  of  different  individuals,  and  of  both  denti- 
tions ;  and,  though  we  have  been  able  to  conjecture  in  some  instances 
what  had  been  the  state  of  the  mother's  health  during  the  first  months 
of  pregnancy,  candor  compels  us  to  confess  that  we  have  never  been 
able  to  find  any  signs  in  the  peculiarity  of  their  shape,  size,  density, 
or  arrangement  that  indicated  it.  But  from  the  moment  that  the 
part  of  the  formative  process  of  these  organs,  which  is  not  influenced 
by  subsequent  changes  in  the  general  economy,  commences,  certain 
peculiarities  of  appearance  are  impressed  upon  them  that  continue 
through  life,  and  about  the  certainty  of  the  indications  of  which,  in 
regard  to  the  general  health,  we  think  there  can  be  no  doubt. 

With  regard  to  the  information  concerning  the  innate  constitution, 
to  be  derived  from  an  inspection  of  the  teeth,  it  has  been  well  re- 
marked by  Delabarre,  that  physicians  may  derive  much  advantage  in 
pointing  out  the  rules  of  domestic  hygiene  for  the  physical  education 
of  children  ;  for,  says  this  eminent  dentist,  "  Can  he  admit  of  but  one 
mode  ?  Has  he  not,  then,  the  greatest  interest  in  being  well  assured 
of  the  innate  constitution  of  each  child,  for  whom  advice  is  required, 
to  enable  him  to  recommend  nutriment  suited  to  the  strength  of  its 
organs  ?  Will  he  report  only  on  a  superficial  examination  of  the  face, 
its  paleness,  the  color  of  the  skin,  all  of  which  are  variable  ?     Will 


134  GENERAL    CONSIDERATIONS. 

he  not  regard  the  repletion  or  leanness  of  the  subject,  the  state  of  the 
pulse,  etc.?  Surely  he  will  make  good  inductions  from  all  these 
things  ;  but  the  minute  examination  of  the  mouth  will  give  him,  be- 
yond doubt,  the  means  of  confirming  his  judgment ;  for,  besides  what 
we  already  know  of  the  teeth,  the  mucous  membrane  of  the  buccal 
cavity  receives  its  color  from  the  blood,  and  varies  according  to  the 
state  of  that  fluid."  This  is  a  matter  which  the  observation  of  the 
dentist  has  an  opportunity  of  confirming  almost  every  day;  and 
which,  when  taken  in  connection  with  the  physical  characteristics  of 
the  teeth,  together  with  those  of  the  salivary  and  mucous  secretions  of 
the  mouth,  constitute  data  from  which  both  the  innate  and  present 
state  of  the  constitutional  health  may  be  determined  with  accuracy 
and  certainty. 

The  symptoms  of  actual  disease  have  been  minutely  and  repeatedly 
described,  but  the  physiognomical  signs  by  which  the  susceptibility  of 
the  human  organism  to  morbid  impressions  is  detei'mined,  and  the 
kind  of  malady  most  likely  to  result  therefrom,  do  not  appear  to  be 
so  well  understood.  "  Whatever,"  says  the  author  last  quoted,  "  may 
be  the  knowledge  which  a  practitioner  may  acquire  of  the  changes 
which  a  disease,  or  even  any  tendency  to  disease,  may  effect  in  the 
functions  of  some  organs,  it  is,  at  least,  advantageous  to  be  able  to 
conjecture  what  has  happened  in  the  whole  of  the  system  at  some 
other  time.  In  fact,  can  a  physician,  when  about  to  prescribe  for  a 
slight  indisposition  of  a  person  whom  he  hardly  knows,  rely  entirely 
upon  the  symptomatology  of  the  tongue  ?  Does  not  its  aspect  singu- 
larly vary?  Is  it  not  notorious  that  in  certain  persons  it  is  always 
red,  white,  yellow,  or  blackish  ?  I,  as  well  as  others,  have  had  occa- 
sion to  make  these  observations  on  persons  with  whom  it  was  always 
thus,  yet  without  their  being  subject  to  any  of  those  indispositions  that 
are  so  common  in  the  course  of  life."  These  signs  are  as  variable  in 
sickness  as  in  health,  and,  consequently,  can  only  be  relied  upon  as 
confirmatory  of  the  correctness  of  other  indications  which  manifest 
themselves  in  other  parts  of  the  body. 

The  physical  changes  produced  by,  and  characteristic  of,  disease 
have  been  described,  both  by  ancient  and  modern  medical  writers ;  but 
the  works  which  have  appeared  upon  this  subject  do  not  comprise  all 
that  is  necessary  to  be  known.  For  example,  if  we  examine  the  lips, 
tongue,  and  gums  of  a  dozen  or  more  individuals  who  are  regarded  as 
in  health,  differences  in  their  appearance  and  condition  will  be  found 
to  exist.  The  lips  of  some  will  be  red,  soft,  and  thin ;  others,  red, 
thick,  and  of  a  firm  texture ;  some  will  be  thin  and  pale ;  others,  red 
on  the  inside  and  pale  on  the  edges ;  some  are  constantly  bathed  with 
the  fluids  of  the  mouth ;  others  are  dry ;  and  these  dififerences  of  ap- 


GENERAL    CONSIDERATIONS.  135 

pearance  and  cc'ndition  are  as  marked  on  the  tongue  and  gums  as  they 
are  upon  the  lips,  and  are  supposed  to  be  attributable  to  the  pre- 
ponderance or  v/ant  of  existence  in  sufficient  quantity  of  some  one  or 
more  of  the  elementary  principles  of  the  organism.  Hence  may  be 
said  to  result  the  differences  in  temperament  and  susceptibility  of  the 
body  to  the  action  of  morbid  excitants. 

If  the  quality  and  respective  proportions  of  the  materials  furnished 
for  the  growth,  reparation,  and  maintenance  of  the  several  organs  of 
the  body  be  good,  and  in  proper  proportion,  all  the  organs  will  be 
well  formed  and  endowed  with  health,  and,  as  a  consequence,  capable 
of  performing  their  respective  functions  in  a  healthy  manner.  But  if 
their  elementary  ingredients,  to  use  an  expression  of  the  author  from 
whom  we  have  just  quoted,  be  bad,  their  functions  will  be  more  or  less 
feebly  performed. 

These  materials  are  furnished  by  the  blood.  From  this  fluid  each 
organ  receives  such  as  are  necessary  to  its  own  particular  organization. 
The  blood,  therefore,  exercises  an  important  influence  upon  the  whole 
system,  determining  the  health  of  all  its  parts,  which,  as  Delabarre 
says,  "  is  relative  to  the  quantity  of  the  blood,  and  the  general  health 
results  from  that  of  all  parts  of  the  system."  In  order  to  this,  har- 
mony must  exist  between  all  the  organs ;  but  in  consequence  of  the 
great  variety  and  intermingling  of  temperaments,  it  rarely  does, 
except  perhaps  in  those  in  whom  the  sanguine  predominates,  and  who 
have  not  become  enervated  by  irregular  and  luxurious  living.  Even 
when  it  does  exist,  we  are  by  no  means  certain  that  it  will  continue  to  do 
so ;  for,  exposed,  as  the  body  is,  to  a  thousand  causes  of  disease,  its 
ftinctional  operations  may,  at  almost  any  moment,  become  disturbed. 
Among  the  civilized  nations  of  the  earth,  the  peasantry  of  Great 
Britain  probably  possess  as  good  constitutional  temperaments  as  are 
anywhere  to  be  found  ;  and  yet,  with  these  people,  we  are  told,  that 
although  the  sanguineous  predominates  in  a  majority  of  cases,  it  is 
combined  and  intermingled,  in  a  greater  or  less  degree,  with  others. 

In  all  these  modifications  the  blood  plays  an  important  part :  it 
determines  the  temperament  of  the  individual,  and,  by  consequence, 
the  physical  condition  of  all  the  tissues  of  the  body  subject  to  the  gen- 
eral laws  of  the  economy.  But  the  dependence  between  the  solids  and 
this  fluid  is  mutual ;  it,  also,  is  dependent  upon  them,  and  the  con- 
dition of  one  is  relative  to  that  of  the  other.  The  solids,  if  we  may 
be  permitted  the  use  of  the  metaphor,  are  the  distillery  of  the  fluids, 
while  they,  in  turn,  nourish,  repair,  and  maintain  the  solids.  A  change, 
then,  in  the  condition  of  one  is  followed  by  a  corresponding  change  in 
the  condition  of  the  other.  If  the  blood  be  of  an  impure  quality,  or 
any  of  the  ingredients  entering  into  its  composition  exist  in  too  great 


136  THE    TEETH. 

or  too  small  a  quantity,  it  will  fail  to  supply  the  solids  with  the  ma- 
terials necessary  to  the  healthful  performance  of  their  functions,  and, 
if  not  actual  disease,  a  tendency  to  it,  will  be  the  result.  And,  again, 
the  purity  of  the  blood  is  dependent  upon  the  manner  in  which  the 
solids  perform  their  offices.  While,  therefore,  duly  appreciating  the 
importance  of  this  fluid,  and  its  existence  in  a  pure  state,  to  the  gen- 
eral health  of  the  economy,  we  cannot  ascribe  to  it,  regardless  of  the 
functions  of  the  solids,  a  controlling  influence  over  the  organism. 

To  distinguish  all  the  nice  and  varied  shadings  of  temperament,  or 
states  of  the  constitutional  health,  by  the  physiognomical  appearances 
of  the  body,  is  perhaps  impossible,  or  can  only  be  done  with  great 
difficulty,  and  by  those  who  have  been  long  exercised  in  their  ob- 
servance; but  to  discover  that  which  predominates  is  not  so  difficult  a 
matter,  and  the  indications  are  nowhere  more  palpably  manifested 
than  in  the  mouth.  By  an  inspection  of  the  several  parts  of  this 
cavity,  together  with  the  fluids  and  the  earthy  matter  found  upon  the 
teeth,  we  believe  inductions  may  be  made,  not  only  with  regard  to  the 
innate  constitution,  but  also  with  regard  to  the  present  state  of  health, 
serviceable  both  to  the  dental  and  medical  practitioner;  and,  in  the 
further  prosecution  of  this  inquiry,  we  shall  endeavor  to  point  out 
some  of  the  principal  of  the  indications  here  met  wath,  to  state  the 
appearances  by  which  they  are  distinguished,  and  to  offer  such  other 
general  reflections  as  the  subject  may,  from  time  to  time,  seem  to 
suggest. 


CHAPTER   II. 

THE    TEETH. 


MOST  dental  physiologists  have  observed  the  marked  differences 
that  exist  in  the  appearances  of  the  teeth,  gums,  lips,  tongue,  and 
secretions  of  the  mouth  of  different  individuals  ;  and  of  that  earthy 
substance  (commonly  called  tartar),  deposited  in  a  greater  or  less 
abundance  on  the  teeth  of  every  one ;  and,  although  all  may  not  have 
sought  their  etiology,  many  have  had  occasion  to  notice,  at  least,  their 
local  indications,  and  to  profit  by  the  information  which  they  have 
thus  obtained.  Nor  have  they  failed  to  observe  that  the  size,  color, 
length,  and  arrangement  of  the  teeth  vary,  and  that  these  are  indica- 
tive of  their  susceptibility  to  disease. 

There  are  five  principal  classes  or  descriptions  of  teeth,  each  of 
which  differs,  in  some  respects,  from  the  others, —  a  knowledge  of  which 
is  very  essential  to  the  dental  practitioner,  in  order  that  he  may  de- 


THE    TEETH.  137 

termine  their  liability  to  decay,,  strength  of  attachment,  and  the  form 
and  size  of  their  roots. 

Class  First. —  The  teeth  belonging  to  this  class  are  white,  with  a 
light  cream-colored  tinge  near  the  gum,  which  becomes  more  and 
more  apparent  as  the  subject  advances  in  age,  of  a  medium  size,  rather 
short  than  long,  with  thick,  square  edges ;  those  of  each  class  of  uni- 
form dimensions,  and  very  hard.  This  description  of  the  teeth  is  most 
frequently  met  with  in  persons  of  sanguineous  temperament,  or,  at 
least,  those  in  whom  this  predominates ;  they  rarely  decay,  and  gene- 
rally occupy  their  proper  position  in  the  dental  arch,  the  most  common 
deviation,  and  one  almost  peculiar  to  this  class  is  that  of  the  superior 
incisors  antagonizing  vv'itli  the  inferior,  causing  the  form  of  abrasion 
known  as  mechanical.  They  are  not  easily  acted  upon  by  corrosive 
agents,  and  caries  attacking  them,  usually  of  the  black  variety,  makes  but 
slow  progress,  and  often  exists  for  a  considerable  time  without  causing 
pain  or  inconvenience.  Operations  performed  upon  teeth  of  this  class 
are  those,  above  all  others,  on  which  we  can  predict  the  most  jDerfect 
success..  They  indicate,  if  not  perfect  health,  at  least  a  state  which 
bordered  very  closely  on  it  at  the  time  of  their  dentinification. 

This  first  description  of  teeth  is  occasionally  found  among  persons 
of  all  nations.  They  are  very  common  in  cold  and  temperate  climates, 
and  especially  in  the  middle  classes  of  the  inhabitants  of  England, 
Ireland,  and  Scotland.  They  are  also  frequently  met  with  in  some 
parts  of  the  United  States,  the  Canadas,  the  mountainous  districts  of 
Mexico,  and  so  far  as  we  have  had  an  opportunity  of  informing  our- 
self,  in  France,  Russia,  Prussia,  and  Switzerland.  Those  who  have 
them  usually  enjoy  excellent  health,  and  are  seldom  troubled  with 
dyspepsia  or  any  of  its  concomitants.  It  is  this  kind  of  teeth  which, 
Lavater  says,  he  has  never  met  with,  excejDt  in  "good,  acute,  candid, 
honest  men,"  and  of  whose  possessors  it  has  been  remarked,  that  their 
stomachs  are  always  willing  to  digest  whatever  their  teeth  are  ready 
to  masticate. 

In  confirmation  of  what  has  before  been  said  with  regard  to  the  in- 
fluence which  the  state  of  the  constitutional  health,  at  the  time  of  the 
solidification  of  the  teeth,  exerts  upon  the  susceptibility  of  these  organs 
to  morbid  impressions,  it  is  only  necessary  to  mention  the  fact,  well 
known  and  frequently  alluded  to,  of  the  early  decay  of  a  single  class, 
or  a  pair  of  a  single  class  of  teeth,  in  each  jaw,  while  the  rest,  pos- 
sessing the  characteristics  just  described,  remain  sound  through  life. 
Thus,  when  it  happens  that  a  child  of  excellent  constitution  is  affected 
with  any  severe  disease,  the  teeth,  which  are  at  the  time  receiving  their 
earthy  salts,  are  found,  on  their  eruption,  to  differ  from  those  which 
have  received  their  solid  material  at  another  time,  when  the  operations 


138  THE    TEETH. 

of  the  b(xly  were  healthfully  performed.  Instead  of  having  a  white, 
smooth,  and  uniform  surface,  they  have  a  sort  of  chalky  aspect,  or  are 
faintly  tinged  with  blue,  and  are  rougher  and  less  uniform  in  their 
surfaces.  Teeth  of  this  description  are  very  susceptible  to  the  action 
of  corrosive  agents,  and,  as  a  consequence,  rarely  last  long. 

But,  not  willing  to  rest  the  correctness  of  these  views  upon  mere 
hypothesis,  we,  in  a  great  number  of  instances,  where  we  have  seen 
teeth  thus  varying  in  their  physical  appearance,  have  taken  pains  to 
inquire  of  those  who  had  an  opportunity  of  knowing  the  state  of  the 
general  health  of  the  individuals,  at  the  different  periods  of  dentinifi- 
cation  ;  and  in  every  case  where  we  have  been  able  to  procure  the  de- 
sired information,  it  has  tended  to  the  confirmation  of  the  opinion 
here  advanced.  Nor  have  we  neglected  to  improve  the  many  oppor- 
tunities that  have  presented,  in  the  course  of  a  somewhat  extended 
professional  career,  of  making  these  observations. 

Although  the  operations  of  the  economy  are  so  secretly  carried  on, 
that  it  is  impossible  to  comprehend  their  details  fully,  it  is  known  that 
the  phenomena  resulting  therefrom  are  influenced  and  modified  by  the 
manner  in  which  they  are  performed.  If  they  are  deranged,  the 
blood,  from  which  the  earthy  materials  forming  the  basis  of  all  the 
osseous  tissues  are  derived,  is  deteriorated,  and  furnishes  these  salts  in 
less  abundance  and  of  an  inferior  quality.  Hence,  teeth  that  solidify 
when  the  system  is  under  the  influence  of  disease,  do  not  possess  the 
characteristics  necessary  to  enable  them  to  resist  the  assaults  of  corro- 
sive agents,  to  which  all  teeth  are  more  or  less  exposed,  and  which 
rarely  affect  those  that  receive  their  solidifying  ingredients  from  pure 
blood. 

The  calcareous  salts  of  these  organs  are  furnished  chiefly  by  the 
red  part  of  this  fluid,  the  gelatine  is  derived  from  the  white  or  serous 
part;  "whence,"  as  Delabarre  remarks,  "it  results  that  the  solidity 
of  these  bones  varies  according  as  one  or  other  of  these  principles  pre- 
dominates," and  the  relative  proportions  of  these  are  regulated  by  the 
state  of  the  blood  at  the  time  the  teeth  are  undergoing  solidification. 

Class  Second. —  Having  digressed  thus  far,  we  shall  now  proceed  to 
notice  the  teeth  belonging  to  the  second  class.  They  have  a  faint, 
azure -blue  appearance;  are  rather  long  than  short;  the  incisors  are 
generally  thin  and  narrow,  the  centrals  being  frequently  a  little  longer 
than  the  laterals.  In  some  cases  the  lateral  incisors  are  very  small 
and  pointed.  The  cuspids  are  usually  round  and  pointed ;  the  bicus* 
pids  and  molars  small  in  circumference,  with  prominent  cusps  and 
protuberances  upon  their  grinding  surfaces. 

Teeth  possessing  these  characteristics  are  usually  very  sensitive, 
caused,  doubtless,  by  a  superabundance  of  animal  matter,  and  are 


THE    TEETH.  139 

more  easily  acted  upon  than  teeth  of  the  first  class  by  corrosive  agents, 
and  to  the  ravages  of  which,  unless  great  attention  is  paid  to  their 
cleanliness,  they  often  fall  early  victims.  The  variety  of  caries  almost 
peculiar  to  this  class  is  known  as  the  white,  the  parts  attacked  being 
rendered  soft  and  humid;  and  as  they  retain  their  natural  color,  it  but 
too  frequently  happens  that  such  teeth  are  almost  irretrievably  ruined 
before  its  presence  is  suspected.  They  are,  also,  more  frequently  af- 
fected with  atrophy,  or  have  upon  their  surfaces  white,  brown,  or 
opaque  spots,  varying  in  size  and  number;  several  are  sometimes  found 
upon  a  single  tooth,  and  in  some  instances  every  tooth  in  the  mouth  is 
more  or  less  marked  with  them. 

But  this  is  not  the  only  description  of  teeth  liable  to  be  affected 
with  this  disease.  These  spots  are  occasionally  met  with  on  teeth  of 
every  degree  of  density,  shape,  shade,  and  size ;  but  they  are,  probably, 
more  frequently  seen  on  teeth  of  the  second  class  than  on  those  first 
described ;  besides  which,  it  often  happens  that  they  are  affected  with 
erosion  on  emerging  from  the  gums,  and  sometimes  so  badly  as  to  place 
either  their  restoration  or  preservation  beyond  the  reach  of  art.  This 
species  of  erosion,  or  that  which  occurs  previously  to  the  eruption  of 
the  teeth,  is  caused  by  some  diseased  condition  of  the  fluid  which  sur- 
rounds them  before  they  appear  above  the  gums,  and  is  denominated 
congenital. 

Teeth  like  those  now  under  consideration  are  indicative  of  a  weakly 
constitution,  of  a  temperament  considerably  removed  from  the  san- 
guineous, resembling  the  lymphatic,  and  of  blood  altogether  too  serous 
to  furnish  materials  such  as  are  necessary  for  building  up  a  strong  and 
healthy  organism.  They  are  more  common  to  females  than  males, 
though  many  of  the  latter  have  them.  They  are  met  with  among 
people  of  all  countries,  but  more  frequently  among  those  who  reside 
in  sickly  localities,  and  with  individuals  wdiose  systems  have  become 
enervated  by  luxurious  living.  In  Great  Britain  they  are  more  rare 
than  in  the  United  States,  and  those  who  have  them  seldom  attain  to 
a  great  age.  Nevertheless,  some,  under  the  influence  of  a  judicious 
regimen  and  a  salubrious  climate,  though  innately  delicate,  do  acquire 
a  good  constitution,  and  live  to  a  great  age ;  while  the  teeth,  less  for- 
tunate, unless  the  most  rigid  and  constant  attention  is  paid  to  the  use 
of  the  means  necessary  for  their  preservation,  generally  fall  early  vic- 
tims to  the  ravages  of  disease. 

Class  Third.- —  The  teeth  of  this  class,  though  differing  in  many  of 
their  characteristics  from  those  last  described,  are,  nevertheless,  not 
unlike  them  in  texture  and  sensibility  to  disease.  They  are  peculiar 
to  those  who  have  inhabited  a  scrofulous  habit  or  diathesis.  In  this 
state  of  the  system  we  find  a  sufficient  supply  of  blood,  but  it  is  usually 


140  THE    TEETH. 

of  a  pernicious  character ;  the  whole  organism  is  affected  by  it  and 
rendered  very  susceptible  to  disease,  more  especially  to  that  class  super- 
induced by  cold.  Teeth  developed  under  constitutional  defects  of 
this  nature  are  larger  than  teeth  of  the  first  or  second  class;  their 
faces  are  rough  and  irregular,  with  protuberances  arising,  not  only 
from  the  grinding  surfaces  of  the  bicuspids  and  molars,  but  also  not 
unfrequently  from  their  sides,  with  correspondingly  deep  indentations. 
They  have  a  muddy  white  color.  The  crowns  of  the  incisors  of  both 
jaws  are  broad,  long,  and  thick.  The  posterior  or  palatine  surfaces 
of  those  of  the  superior  maxilla  are  rough  and  usually  deeply  indented. 
In  the  majority  of  cases  their  arrangement  is  quite  regular,  though 
frequently  found  to  project.  The  alveolar  ridge  usually  describes  a 
broad  arch.  The  excess  in  size,  both  here  and  in  the  teeth,  seems  to 
consist  moi'e  of  gelatine  than  calcareous  phosphate.  This  description 
of  teeth  decay  rapidly,  and  in  some  instances  appear  to  set  at  defiance 
the  resources  of  the  dentist.  They  are  liable  to  be  attacked  at  almost 
every  point,  but  more  particularly  in  their  indentations  and  approxi- 
mal  surfaces.  The  caries  to  which  these  teeth  are  liable  is  in  color 
and  consistence  between  the  two  kinds  mentioned  in  connection  with 
the  first  and  second  classes. 

The  author  is  acquainted  with  a  family,  consisting  of  seven  or  eight 
members,  most  of  whom  are  adults,  all  having  this  sort  of  teeth.  The 
most  thorough  attention  has  been  paid  by  each,  and  yet  all  have  lost 
most  of  their  teeth.  They  are  usually  first  attacked  in  their  approxi- 
mal  surfaces  and  indentations,  but  neither  their  labial  faces  nor  most 
prominent  points  are  exempt  from  caries.  No  sooner  is  its  progress 
arrested  in  one  place  or  part  than  it  appears  in  another.  The  author 
has  had  occasion  to  fill  a  single  tooth  in  as  many  as  four,  five,  and 
even  six  different  places;  and  in  this  way,  though  his  efforts  at  the 
preservation  of  any  considerable  number  have  proved  unavailing,  he 
has  been  able  to  save  some  of  them.  But  it  is  not  necessary  to  particu- 
larize cases.     Every  dentist  has  seen  teeth  of  this  description. 

The  corrosive  properties  of  the  fluids  of  the  mouth,  however,  are 
sometimes  so  changed  by  an  amelioration  of  the  constitution  that,  not- 
withstanding the  great  susceptibility  of  the  teeth  to  disease,  they  are 
sometimes  preserved  to  a  late  period  of  life,  or  until  the  general  health 
relapses  into  its  former  or  some  other  unfavorable  condition.  This 
has  happened  in  several  instances  that  have  come  under  the  author's 
immediate  observation,  and  it  should  be  borne  in  mind  that  the  sol- 
vent qualities  of  these  juices  are  influenced  by  the  state  of  the  consti- 
tutional health. 

Class  Fourth.  —  Teeth  of  this  class  usually  have  a  white  chalky 
appearance,  are  unequally  developed,  and   of  a  very  soft   texture. 


THE    TEETH.  141 

They  are  easily  acted  upon  by  corrosive  agents,  and,  like  the  teeth  last 
noticed,  generally  fall  speedy  victims  to  disease,  unless  great  care  is 
taken  to  secure  their  preservation. 

Persons  who  have  teeth  such  as  described  in  this  class,  generally 
have  Avhat  Laforgue  calls  lymphatico-serous  temperaments.  Their 
blood  is  usually  pale,  the  fluids  of  the  mouth  abundant,  and  for  the 
most  part  exceedingly  viscid.  They  do  not  have  that  white,  frothy 
appearance  observable  in  healthy,  sanguineous  individuals. 

As  teeth  that  are  neither  too  large  nor  too  small,  and  that  have  a 
close,  compact  texture,  and  tinged  with  yellow,  are  indicative  ckf  an 
originally  good  constitution,  whatever  it  may  be  at  the  present  time, 
so  those  that  are  long,  narrow,  and  faintly  tinged  with  blue,  as  well  as 
those  that  greatly  exceed  the  ordinary  size,  and  that  are  irregular  in 
shape,  and  have  a  rough,  muddy  appearance,  furnish  assurance  of  a 
constitution  originally  bad.  The  first  of  the  latter  descriptions  of 
teeth  are  more  frequently  met  with  among  females  than  males,  and 
among  those  of  strumous  habit,  than  those  in  whom  this  diathesis  does 
not  exist. 

Class  Fifth. — The  teeth  belonging  to  this  class  are  characterized  by 
whiteness  and  a  pearly  gloss  of  the  enamel.  They  are  long  and  usually 
small  in  circumference,  though  sometimes  well  developed.  They  are 
regarded  by  many  as  denoting  a  tendency  to  phthisis  pulmoualis,  and 
are  supposed  by  some  to  be  very  durable ;  but  the  author  has  observed 
that  individuals  who  have  this  sort  of  teeth,  when  attacked  by  febrile 
or  any  other  form  of  disease  having  a  tendency  to  alter  the  fluids  of 
the  body,  are  very  subject  to  toothache  and  caries ;  and  that  when  this 
condition  of  the  general  system  is  continued  for  a  considerable  length 
of  time,  the  teeth,  one  after  another,  in  rapid  succession,  crumble  to 
pieces. 

It  would  seem,  from  this  circumstance,  that  the  fluids  of  the  mouth 
in  subjects  of  strumous  habit,  if  free  from  other  morbid  tendencies,  are 
less  prejudicial  to  the  teeth  than  they  are  in  most  other  constitutions, 
and  the  author  is  of  the  opinion  that  it  is  owing  to  this  that  they  are 
so  seldom  attacked  by  caries. 

M,  Delabarre,  in  speaking  of  persons  who  have  teeth  which,  though 
beautiful  from  having  smooth  and  apparently  polished  surfaces,  pre- 
sent shades  intermixed  with  a  dirty  white,  says,  they  "have  had 
alternations  of  good  and  indifferent  health  during  the  formation  of 
the  enamel.  These  teeth,"  he  continues,  "  ordinarily  have  elongated 
crowns,  and  many  present  marks  of  congenital  atrophy."  Again  he 
observes,  "  Teeth  of  this  sort  deceive  us  by  appearing  more  solid  than 
they  are ;  they  remain  sound  until  about  the  age  of  fourteen  or 
eighteen ;  at  this  period  a  certain  number  of  them  decay,  especially 


142  THE    TEETH. 

wlieu  in  infancy  the  subject  was  lymphatic,  and  continued  to  be  so  in 
adolescence.  This  description  of  teeth  is  frequently  met  with  among 
the  richer  classes,  in  which  children  born  feeble  reach  puberty  only  by 
means  of  great  care,  and,  consequently,  owe  their  existence  solely  to 
the  unremitting  attention  of  their  parents  and  the  strengthening  regi- 
men that  the  physician  has  caused  them  constantly  to  jmiisuc.  Hav- 
ing reached  the  eighteenth  or  twentieth  year,  their  health  is  coiifirmed, 
but  the  mucous  membranes  ever  after  have  a  tendency  to  be  affected ; 
the  redder  color  of  the  mouth,  more  especially  its  interior  part,  and 
that»of  the  lips,  and  the  upper  part  of  the  palate,  which,  by  degrees, 
discovers  itself  as  the  subject  gradually  advances  in  years,  showing  an 
ameliorated  condition.  It  is  thus  that  numerous  persons,  having 
gained  a  sanguineous  temperament,  would  deceive  us ;  if  it  were  not 
that  some  marks  of  erosion  are  seen  on  the  masticating  surfaces  of  the 
first  permanent  molars,  which  informs  us  that  the  present  health  is  the 
result  of  amelioration." 

There  are  other  cases  in  wdiich  the  teeth  are  of  so  inferior  a  quality 
that  they  no  sooner  emerge  from  the  gums  than  they  are  attacked  and 
destroyed  by  caries,  while  the  subjects  who  possess  them  are  enabled, 
by  skilful  treatment,  to  overcome  the  morbid  constitutional  tendencies 
against  which,  during  the  earlier  years  of  their  existence,  they  had  to 
contend,  and  eventually  to  acquire  excellent  health.  But  in  forming 
a  prognosis,  it  is  essential  to  ascertain  whether  the  general  organic 
derangement  which  prevented  the  teeth  from  being  well  formed,  and 
thus  gave  rise  to  their  premature  decay,  is  hereditary,  or  whether  it 
has  been  produced  by  some  accidental  cause  subsequent  to  birth.  The 
procurement  of  health  in  the  former  case  will  be  less  certain  than  in 
the  latter,  for  when  the  original  elements  of  the  organism  are  bad,  the 
attainment  of  a  good  constitution  is  more  difficult. 

Persons  of  sanguineo-mucous  temperaments,  having  suffered  in  early 
childhood  from  febrile  or  inflammatory  diseases,  often  have  their  teeth 
affected  with  what  Duval  calls  the  decorticating  process  (denudation 
of  their  enamel),  resulting,  no  doubt,  from  the  destruction  of  the  bond 
of  union  between  it  and  the  dentine. 

There  are  other  characteristics  which  the  teeth  present  in  shape, 
size,  density,  and  color,  and  from  which  valuable  inductions  might  be 
made,  both  with  regard  to  the  innate  constitution  and  the  means 
necessary  to  their  own  preservation ;  but  as  the  limits  assigned  to  this 
part  of  our  subject  will  not  admit  of  their  consideration,  we  shall  con- 
clude by  observing  that  the  appearances  of  these  organs  vary  almost 
to  infinity.  Each  is  indicative  of  the  state  of  the  general  health  at 
the  time  of  their  formation,  and  of  their  own  physical  condition  and 
susceptibility  to  disease. 


THE    MUCOUS    MEMBRANE.  143 


CHAPTER  III. 

THE   MUCOUS   MEMBRANE. 
STOMATITIS. 

THE  diseases  of  the  mucous  membrane  lining  the  mouth,  very  com- 
mon at  the  periods  for  the  eruption  of  the  teeth  and  later  in  life, 
are  comparatively  rare  during  foetal  life,  and  differ  as  regards  symp- 
toms in  accordance  with  the  nature  of  the  affection  and  the  part  of 
the  mucous  surface  in  which  it  may  have  its  origin. 

The  most  common  affection  of  the  membrane  lining  the  mouth  is 
known,  by  the  general  term  stomatitis,  from  the  Greek  word  ato/xa, 
"  mouth,"  and  itis,  "  a  suffix  denoting  inflammation,"  and  is  described 
by  Prof  Wood  as  follows : 

"  Inflammation  of  the  mouth  appears  in  reddened,  somewhat  ele- 
vated patches,  or  occupies  large  portions  of  the  surface,  sometimes 
extending  apparently  over  the  whole  mouth.  In  some  cases  it  is  su- 
perficial, with  little  or  no  swelling,  and  may  be  designated  as  ery- 
thematous, from  the  Greek  word  spu^poj,  '  red ; '  in  others  it  occupies 
the  whole  thickness  of  the  membrane,  extending  sometimes  to  the 
sub-mucous  tissue,  and  even  to  the  neighboring  structures,  as  the  sub- 
lingual and  submaxillary  glands,  and  the  absorbent  glands  of  the 
neck,  and  occasions  considerable  tumefaction  in  all  these  parts.  In 
the  erythematous  form,  it  is  characterized  by  redness,  and  sense  of 
heat,  and  sometimes  considerable  tenderness,  but  is  not  usually  attended 
with  acute  pain ;  when  deeper  in  the  tissue,  it  is  often  very  painful. 

"Portions  of  the  epithelium  sometimes  become  opaque,  giving  an 
appearance  of  whiteness  in  streaks  or  patches.  Occasionally  this 
coating  is  elevated  in  blisters,  or  even  detached,  like  the  cuticle,  from 
the  skin  in  scales.  Superficial  ulcerations  not  unfrequently  occur, 
which  may  spread  over  considerable  portions  of  the  membrane.  In 
certain  states  of  the  constitution,  the  ulcerative  tendency  is  very 
strong  and  deep,  and  extensive  sores  occur,  which  are  sometimes  at- 
tended with  gangrene. 

"  There  is  often  a  copious  flow  of  saliva ;  though  in  some  instances 
this  secretion,  as  well  as  that  of  the  mucous  follicles,  is  checked,  and 
the  mouth  is  clammy  or  dry.  The  sense  of  taste  is  usually  more  or 
less  impaired,  and  speech  and  mastication  are  often  difiicult  and  pain- 
ful.    When  the  tongue  is  affected,  its  surface  is,  in  general,  first  cov- 


144  THE    MUCOUS    MEMBRANE. 

ered  with  a  -whitish  fur,  through  wliich  the  red  and  swollen  follicles 
may  often  be  seen  projecting.  This  fur  sometimes  breaks  off,  leaving 
the  surface  red,  smooth,  and  glossy,  with  here  and  there  prominent 
follicles ;  or  the  surface  may  be  hard,  dry,  or  gashed  with  painful 
fissures.  Wlien  the  gums  are  involved,  they  swell,  and  rise  up  between 
the  teeth,  around  the  necks  of  which  they  frequently  ulcerate.  In 
some  cases  this  ulceration  does  not  cease  until  it  has  extended  into 
the  sockets,  and  destroyed  altogether  the  connections  of  the  teeth, 
which  become  loosened  and  fall  out,  after  which  the  gums  will  heal. 

"Ordinary  inflammation  of  the  mouth  is  seldom  so  violent  as  to 
induce  symptomatic  fever.  This  form  of  inflammation  is  more  fre- 
quently a  complication  of  other  diseases  than  an  original  affection. 
When  of  the  latter  character,  it  is  generally  caused  by  the  direct 
action  of  irritant  bodies,  as  by  scalding  drinks,  acrid  or  corrosive  sub- 
stances taken  into  the  mouth,  or  unhealthy  secretions  from  decayed 
teeth.  The  sharp  edge  of  a  broken  tooth  sometimes  gives  rise  to  much 
inflammation,  and  even  deep  and  obstinate  ulcers,  especially  of  the 
tongue.  Inflammation  of  the  mouth  may  also  result  from  the  reaction 
which  follows  the  long  contact  of  very  cold  substances,  such  as  ice, 
with  the  interior  of  the  mouth.  It  sometimes  proceeds  from  the  propa- 
gation of  inflammation  from  the  fauces,  and  is  a  frequent  consequence 
of  gastric  irritation  produced  by  sour  or  acrid  matter  in  the  stomach. 
Drunkards  seem  peculiarly  predisposed  to  it.  Of  the  constitutional 
causes  none  are  so  frequent  as  the  state  of  fever,  which,  whatever  may 
be  its  peculiar  character,  is  very  apt  to  affect  the  mouth,  and  not  un- 
frequently  occasions  inflammation." 

Simjile  Erythematic  Stomatitis. — This  is  a  form  of  stomatitis  com- 
mon to  children,  even  at  an  early  period  of  childhood,  and  may  be 
confined  to  the  tongue  alone,  or  be  universally  diffused  over  the  whole 
mucous  membrane  of  the  mouth.  It  is  characterized  by  an  increase 
of  the  heat  and  redness  of  the  part  affected,  and  more  or  less  dryness 
of  the  surface,  with  a  high  degree  of  sensibility,  and  pain  when  the 
lips  or  tongue  are  moved.  Among  the  early  symptoms  are  restlessness 
and  fretfulness,  with  refusal  to  take  food,  or  when  attempting  to  do  so, 
suddenly  ceasing  on  account  of  the  pain  experienced. 

The  intensity  of  this  affection  varies  in  different  cases,  sometimes 
existing  in  such  a  slight  form  as  to  cause  little  uneasiness,  and  quietly 
disappearing,  while  at  other  times  it  may  cause  intense  pain,  and  con- 
tinue for  Aveeks  or  months. 

In  a  severe  form  it  may  extend  to  the  oesophagus  and  stomach,  or 
the  larynx  and  trachea,  and  at  last  prove  fatal. 

When  it  occurs  during  the  period  of  dentition,  to  which  it  is  com- 
mon, it  is  often   accompanied  with  fever,  and  sometimes,  especially 


THE    MUCOUS    MEMBRANE.  145 

when  long  continued,  by  a  profuse  flow  of  saliva ;  occurring  previous 
to  dentition,  it  is  seldom  accompanied  vriih  fever. 

This  form  of  stomatitis  is  caused  either  by  the  irritation  of  dentition, 
exposure  to  cold,  hot  and  stimulating  food,  or  a  diseased  condition  of 
the  alimentary  canal. 

In  very  young  children  it  may  result  from  violent  exertions  of  the 
tongue  and  lips  in  attempting  to  suck  from  an  over-distended  breast 
or  a  malformed  nipple. 

The  simplest  form  of  erythematic  stomatitis  is  readily  relieved  by 
means  of  emollient  washes,  such  as  solutions  made  from  the  slippery 
elm  bark  or  the  pith  of  sassafras,  in  cold  water.  "When  severe,  a 
leech  or  two  applied  to  the  angle  of  the  jaws  will  prove  serviceable, 
and  as  a  wash,  the  acetate  of  lead  in  a  solution  composed  of  three 
grains  to  one  fluidounce  of  water. 

When  the  inflammation  of  the  mouth  is  symptomatic  of  a  diseased 
condition  of  the  alimentary  canal,  the  remedies  adajDted  to  such  a 
condition  are  necessary. 

Ulcerative  Stomatitis  is  another  affection  of  the  mouth  which  is  com- 
mon to  childhood,  the  premonitory  symptoms  being  the  same  as  in 
simple  erythematic  stomatitis.  An  examination  of  the  mouth,  how- 
ever, at  this  stage  of  the  disease,  reveals  one  or  more  small,  inflamed 
and  slightly  elevated  joimples,  which  sometimes  within  a  few  hours, 
but  more  commonly  after  one  or  two  days,  present  a  softened  and 
yellowish  apex,  and  at  length  a  small  ulcer,  superficial  at  first,  but 
gradually  becoming  deeply  excavated,  with  often  an  inflamed  and 
elevated  margin.  The  surfaces  of  these  ulcers  are  covered  with  an 
ash-colored  or  a  y^ellowish  matter  in  the  majority  of  cases ;  but  some- 
times, instead  of  being  thus  covered,  their  surfaces  are  bare,  and  bleed 
readily.  These  ulcers  result  from  acute  phlegmonous  inflammation, 
and  may  attack  any  part  of  the  raucous  membrane  lining  the  mouth, 
but  are  most  commonly  found  on  the  sides  of  the  frsenum,  along  the 
inferior  margin  and  edges  of  the  tongue. 

It  is  but  seldom  that  they  are  found  on  the  upper  surface  of  the 
tongue ;  but  when  they  do  appear  on  this  surface,  they  are  generally 
superficial,  and  not  deeply  excavated. 

When  the  ulcers  in  this  form  of  stomatitis  are  fully  formed,  there 
is  usually  a  profuse  flow  of  saliva,  and  a  decrease  of  the  febrile  ex- 
citement. The  bowels,  which  in  the  first  stage  of  the  disease  are 
costive,  now  become  loose,  and  often  very  much  so  during  its  con- 
tinuance. A  simple  form  of  ulcerative  stomatitis  is  characterized  by 
but  one  or  two  small  ulcers,  which  in  a  little  time  fill  up  with  granu- 
lations and  soon  heal  over.  In  a  more  severe  form  of  this  disease  a 
considerable  number  of  these  ulcers  exist,  in  some  cases  covering, 
10 


14Q  THE    MUCOUS    MEMBRANE. 

almost  the  whole  of  the  mucous  membrane  of  the  gums,  the  inside 
of  the  cheeks,  arch  of  tlie  palate,  sides  and  inferior  surface  of  the 
tongue. 

Another  form  of  this  disease  is  sometimes  met  with  where  but  one  or 
two  ulcers  exist,  but  wliich  gradually  extend  over  the  mucous  surface, 
at  the  same  time  increaf^ing  in  depth,  and  with  no  appearance  of  heal- 
ing. This  form  of  the  attection  is  attended  with  hectic  fever,  the  exac- 
erbations occurring  night  and  morning,  and  rapidly  wearing  away 
the  strength. 

There  is  yet  another  form  of  ulcerative  stomatitis  occasionally  met 
with,  which  consists  of  a  softening  of  the  mucous  membrane  of  the 
palate  in  its  centre,  either  on  the  median  line  or  outside  this  line.  The 
membrane  appears  to  be  softened  into  a  kind  of  pulp  of  a  red  or  fown 
color,  which,  on  its  removal,  discloses  an  ulcer  with  perpendicular 
walls ;  the  bone,  however,  forming  its  base  is  found  to  be  perfectly 
healthy.  It  is  the  opinion  of  some  that  ulcerative  stomatitis  is  con- 
tagious ;  that  is,  that  it  may  be  communicated  by  using  the  same  spoon  in 
eating,  and  also  that  it  is  endemic  and  epidemic.  Ulcerative  stomatitis 
is  common  to  the  period  of  dentition,  especially  when  there  is  disorder 
of  the  digestive  organs.  For  the  treatment  of  the  simple  form  of  this 
disease,  when  it  is  accompanied  by  no  serious  disorder  of  the  digestive 
organs,  mucilaginous  washes  are  serviceable ;  and  when  the  bow^els  are 
costive  or  irregular,  a  small  dose  of  calomel,  followed  in  a  few  hours 
by  a  dose  of  castor-oil,  the  daily  use  of  a  warm  bath  and  a  plain  diet. 
Dr.  Condie  recommends  the  following  treatment  where  the  ulcers  are 
slow  in  healing:  A  solution  of  borax,  gr.  xv.  to  the  ounce  of  water,  or 
a  weak  solution  of  the  nitrate  of  silver,  gr.  j.  to  the  ounce  of  water, 
or  sulphate  of  copper,  gr.  v.  to  the  ounce  of  water,  or  acidum  nitricum 
dilutum  applied  by  means  of  a  camel's-hair  pencil  to  the  whole  of 
the  ulcerated  surface,  w-hich  will  improve  the  character  of  the  ulceration 
and  arrest  its  progress.  At  the  same  time  that  these  local  applications 
are  being  made.  Dr.  Mackenzie  recommends  the  administration  of  the 
sesquicarbonate  of  ammonia  in  full  doses,  combined  with  citrate  of 
iron.  "  Also,  when  the  tongue  is  coated  and  the  alvine  discharges  are 
unhealthy,  an  emetic  of  ipecacuanha  and  squills,  as  well  as  a  purga- 
tive of  calomel  and  rhubarb,  together  with  a  nutritious  diet  and  wine." 

"  Any  apparent  cause  of  irritation,  such  as  a  decayed  tooth,  should 
be  removed."  When  there  is  great  derangement  of  the  alimentary 
canal  accompanying  ulcerative  stomatitis,  or  this  disease  occurs  during 
the  course  of  other  acute  and  chronic  diseases,  such  as  pneumonia, 
scarlet  fever,  sraall-pox,  etc.,  the  proper  remedies  adapted  to  the  re- 
moval of  these  diseases  are  necessary. 

Gangrene  of  the  Mouth.  —  This  disease,  characterized  by  such  names 


THE    MUCOUS    MEMBRANE.  147 

as  "Cancrum  Oris,"  " Gangraenopsis,"  "Canker  of  the  Mouth," 
"  Water  Canker,"  is  common  to  children  of  debilitated  constitutions 
and  a  decided  lymphatic  temperament,  the  result  of  scanty  nourish- 
ment, improper  clothing,  and  damp,  unhealthy  places  of  abode,  or 
where  many  children  are  crowded  together  in  charitable  institutions. 
There  are  several  forms  of  this  affection,  the  most  common  perhaps 
being  preceded  by  inflammation  of  the  gums,  with  such  premonitory 
symptoms  as  great  languor  and  listlessness,  indisposition  to  any  exer- 
cise, irritable  temper,  loss  of  sleep  and  appetite,  and  increase  of  thirst. 
The  countenance  becomes  pale  and  dejected,  and  a  peculiar  pucker- 
ing of  the  cheeks  is  observed  about  the  corners  of  the  mouth.  Ema- 
ciation and  night  sweats  are  not  uncommon. 

These  premonitory  symptoms  ma}^  continue  for  several  days,  or  even 
weeks,  when  an  acute  pain  is  felt  in  the  mouth  and  gums,  with  a  sense 
of  heat  and  itching  about  their  margins,  the  free  edges  of  which  become 
congested  and  thickened,  spongy,  and  of  a  dark  red  or  purple  hue, 
bleeding  readily. 

The  flow  of  saliva  increases  greatly,  and  is  frequently  mixed  with 
blood.  From  about  the  necks  of  the  teeth  a  muco-purulent  matter  is 
discharged,  which  after  a  time  becomes  thin,  watery,  and  acrid,  ren- 
dering the  breath  very  offensive.  In  the  majority  of  cases  this  disease 
is  confined  to  one  side  of  the  mouth  and  to  the  lower  jaw,  and  if 
allowed  to  progress,  the  gums  separate  from  the  necks  of  the  teeth  and 
alveolar  processes,  and  become  ragged,  flabby,  and  livid ;  the  teeth  on 
the  affected  side  loosen,  and  at  length  drop  out,  and  at  this  stage  there 
is  an  increase  of  the  febrile  symptoms  and  night  sweats.  In  such  a 
state  the  gums  may  continue  for  weeks  or  even  months,  but  usually 
after  a  few  days  a  number  of  ash-colored  vesicles  make  their  appear- 
ance, which  rapidly  increase  in  size  and  become  confluent,  the  divided 
gum  presenting  a  gangrenous  appearance.  The  dead  portions  separate, 
a  gangrenous  ulcer  follows,  and  soon  the  entire  part  is  destroyed,  and 
the  inferior  maxillary  bone  exposed.  The  ulceration  is  more  common 
to  the  labial  surface  than  to  the  lingual,  and  commences  in  the  front 
part  of  the  mouth,  extending  to  posterior  parts.  The  ulcers  before 
becoming  gangrenous  are  covered  with  a  yellow  or  gray  secretion, 
which,  on  being  removed,  exposes  many  small,  red  papillae,  which 
correspond  to  imperfect  granulations.  After  a  time  the  gangrenous 
ulceration  extends  to  the  mucous  membrane  of  the  cheek  and  lips, 
causing  pain  and  difiiculty  in  attempting  to  open  the  mouth,  which  is 
sometimes  impossible. 

In  a  short  time  the  whole  of  the  mouth  becomes  affected,  and  death 
usually  occurs  at  about  the  eighth  or,  at  the  farthest,  upon  the  four- 
teenth day  from  the  commencement  of  the  gangrene. 


148  THE    MUCOUS    MEMBRANE. 

Mr.  Tomes  remarks,  that  although  the  disease  is  usually  confined 
to  children  during  the  shedding  of  the  temporary  teeth,  yet  adults  are 
not  wholly  exempt  from  its  attacks. 

There  is  aujther  form  of  this  disease  which  differs  considerably 
from  that  just  described,  from  the  fact  that  it  is  not  preceded  by 
inflammation  of  the  gums,  but  commences  in  the  cheek,  usually  at  the 
angle  of  the  lips,  and  comes  on  abruptly  without  the  premonitory 
symptoms  characteristic  to  the  first  form  described. 

There  is  first  seen  a  hard,  indolent  tumor,  about  the  size  of  an  almond, 
in  some  part  of  the  lips  or  cheek,  which  is  deeply  seated,  the  skin  cov- 
ering it  being  somewhat  redder  than  natural.  This  tumor  gradually 
increases  in  size  for  a  few  days,  when  the  mucous  membrane  covering 
it  presents  a  gangrenous  appearance,  with  an  offensive  odor.  Before 
this  occurs,  however,  the  external  redness  of  the  skin  covering  the  tumor 
becomes  pale,  then  liviil,  then  of  a  grayish  hue,  surrounded  by  a  red  cir- 
cle, which  spreads  rabidly,  and  in  a  few  hours  changes  to  a  black  color. 

The  gums  nearest  to  this  tumor  then  become  gangrenous,  and  the 
teeth  loosen,  and  at  length  fall  out.  Death  usually  occurs  before  the 
death  of  the  bone  of  the  jaw.  There  is  also  a  superficial  form  of  gan- 
grene sometimes  met  with  in  the  form  of  spots  of  a  dark-brown  color 
surrounded  by  a  red  margin,  which  vary  in  size,  and  have  for  their 
seat  the  corners  of  the  lips  and  inner  surfaces  of  the  cheeks.  These 
spots  may  first  appear  in  the  form  of  slightly  reddened  patches,  but  in 
this  mild  form  are  always  superficial,  confined  to  the  mucous  mem- 
brane alone,  the  sloughs  separating  with  little  loss  of  substance,  soon 
to  be  followed  by  healthy  granulations  and  cicatrization. 

Gangrene  of  the  mouth  may  occur  at  any  period  between  the 
second  and  tenth  year  of  age,  but  is  more  common  between  the  second 
and  fourth  years  ;  and  the  children  subject  to  it  are  those  of  a  lymphatic 
temperament,  delicate  constitution,  soft,  flaccid  muscles,  pale  skin,  and 
whose  digestive  organs  are  deranged.  It  sometimes  follows  the  erup- 
tive fevers,  and  such  diseases  as  pneumonia,  scrofula,  whooping-cough, 
typhus  fever,  ague,  etc. 

In  the  treatment  of  gangrene  of  the  mouth  no  little  depends  upon 
the  time  this  is  instituted.  Before  the  gangrene  makes  its  appearance 
much  may  be  done  in  the  way  of  preventive  treatment  in  order  to 
remove  the  existing  predisposition.  A  dry,  pure  air,  cleanliness,  and 
a  diet  adapted  to  the  condition  of  the  digestive  organs  are  very  essen- 
tial. If  the  gums  are  inflamed,  such  local  remedies  should  be  applied 
as  are  recommended  for  this  affection  under  "  Diseases  of  the  Gums." 

The  administration  of  the  sulphate  of  quinia,  and  the  local  applica- 
tion of  a  strong  decoction  of  white  oak  bark,  is  thought  by  Dr.  Condie 
to  be  beneficial  in  preventing  gangrene  of  the  mouth  in  cases  in  which 


THE    MUCOUS    MEMBRANE.  149 

tliere  is  every  reason  to  anticipate  its  speedy  occurrence.  Benefit  is 
also  derived  from  leeches  applied  to  the  part  when  symptoms  of  local 
inflammation  exist,  as  well  as  blisters  over  the  tumor.  The  author 
just  referred  to  has  found  the  following  lotion  very  successful :  sulphate 
of  copper,  gr.  xxx. ;  water,  3j.;  to  be  applied  very  carefully  twice  a 
day,  or  oftener,  to  the  full  extent  of  the  gangrenous  ulceration.  A 
solution  of  sul^jhate  of  zinc  (one  drachm  to  the  ounce  of  water),  to 
which  is  added  honey  and  tincture  of  myrrh,  two  drachms  of  each, 
will  also  prove  serviceable.  Nitrate  of  silver,  either  in  the  solid  form 
or  in  solution,  applied  to  the  afiected  -part,  has  been  successfully  em- 
ployed in  a  large  number  of  cases.  Dr.  Dunglison  recommended  a 
solution  of  alcohol  and  creasote,  equal  parts,  applied  to  the  gangrenous 
part,  incision  being  first  made  through  it. 

In  the  hands  of  some,  hydrochloric,  nitric,  sulj)huric,  and  acetic 
acids,  chloride  of  lime  or  soda,  tincture  of  iodine,  etc.,  have  succeeded 
in  effectually  arresting  the  disease. 

All  teeth  which  act  as  irritants,  owing  to  their  diseased  condition, 
should  be  promptly  extracted,  and  the  patient  sustained  by  beef-tea, 
beef-  or  mutton-broth,  with  rice,  tapioca,  sago,  and  such  farinaceous 
diet,  to  which  wine  may  at  times  be  added  to  sustain  the  strength. 

Dr.  Condie  recommends  the  administration  of  sulphate  of  quinia 
during  the  time  the  local  remedies  are  being  applied,  as  follows; 

R.  Quiniae  sulphat.,  gr.x. 
Acid  sulph.  dil.,  TTI.x. 
Sacch.  alb.,  ^iv. 

Aq.  cinnamon,      ^iv. — M. 
Dose  :  A  tea-ppoonful  every  three  hours. 

Dr.  Dunglison  has  used  with  advantage  chlorine  water  and  the  chlo-. 
«ide  of  lime  internally  administered,  as  follows : 
R.  Calcis  chlorin,  gr-x.  vel. 

Liq.  sodae,  chlorin.,  fll.viij. 
Syrup,  3ij. 

Aquae,  ^iv.  —  M. 

Dose :  A  dessert-spoonful  every  three  hours  for  a  child  six  years  old. 

Dr.  Hunt  recommends  the  free  internal  use  of  the  chlorate  of 
potassa,  one  to  three  scruples  in  twelve  hours,  according  to  the  age  of 
the  child. 

For  the  diarrhoea  accompanying  the  disease,  and  especially  when  it 
is  profuse,  Dr.  Condie  recommends  acetate  of  lead,  as  follows  : 
R.  Acetat.  plumbi.,  gr.xvj.- 
Cretge  ppt.,  ^ijss. 

Ipeeacuanhge,      gr.iv. 
Opii   pulv.  gr.ij. — M, 

To  be  divided  in  xvj.  portions :  one  to  be  given  every  three  or  four  hours. 


150  THE    MUCOUS    MEMBRANE. 

Mercurial  Stomatitis.  —  The  employment  of  mercury  as  a  medicinal 
agent  causes  increased  watery  evacuations,  increased  flow  of  bile  and 
saliva,  and,  as  a  consequence,  increases  the  flow  of  blood  to  the  secret- 
ing j)art.  But  when  administered  in  excess  other  effects  follow.  It  is 
capable  of  producing  inflammation,  especially  the  acute,  phlegmonous, 
adhesive  variety.  The  effects  of  its  use  depend  upon  the  quantity 
administered  and  the  susceptibility  of  the  patient  to  its  action.  When 
carried  to  excess,  the  mucous  membrane  of  the  mouth  becomes  tender, 
red,  and  swollen,  the  glands  beneath  the  jaw  become  painful,  and  at 
length  ulceration  occurs,  which  spreads  from  the  gums  —  where  the 
effects  of  the  drug  are  first  observed  —  to  fauces  and  throat,  and,  iu 
extreme  cases,  the  parts  affected  may  perish. 

Prof  Wood  describes  this  disease  as  follows :  "  Among  the  first 
indications  of  the  action  of  mercury  are  often  a  metallic  taste  in  the 
mouth,  like  that  of  brass  or  copper,  and  some  increase  of  saliva.  At 
the  same  time  a  close  examination  will  detect  a  slight  redness  and 
swelling  of  the  gums,  particularly  about,  the  necks  of  the  lower  inci- 
sors, while  somewhat  below  their  edge  a  broad,  white  line  may  be 
observed,  depending  on  opacity  of  the  epithelium. 

"  The  patient  soon  begins  to  feel  some  uneasiness,  complaining  of 
soreness  when  the  gums  are  pressed,  and  of  pain  when  the  teeth  are 
forcibly  closed  together.  There  is  also  a  sense  of  stiffiiess  about  the 
jaws  when  the  mouth  is  opened,  and  they  feel  as  if  projecting  above 
their  proper  level.  The  flow  of  saliva  increases,  the  inflammation 
extends,  the  gums  and  palate  become  obviously  swollen,  and  the  tongue 
covers  itself  with  a  yellowish-white  or  brownish  fur,  and  is  often  so 
much  enlarged  as  to  exhibit  the  impression  of  the  teeth  upon  being 
projected  from  the  mouth.  The  throat  frequently  becomes  sore,  and 
the  cheeks  and  salivary  and  absorbent  glands  swollen  and  painful. 
There  is  often  sevei'e  toothache  or  pain  in  the  jaws.  A  whitish  exuda- 
tion along  the  edges  of  the  gums  is  very  common. 

"The  breath,  which  sometimes  from  the  beginning,  and  sometimes 
even  before,  the  appearance  of  any  one  of  the  symptoms  mentioned, 
has  a  peculiar,  disagreeable  odor,  now  becomes  extremely  offensive, 
and  in  bad  cases  almost  intolerable.  Ulceration  often  occurs,  especially 
about  the  necks  of  the  teeth,  which  are  consequently  loosened,  and  in 
the  cheeks,  lips,  and  fauces.  The  ulcers  often  have  their  origin  in  a 
vesicular  eruption.  Tlie  whole  mouth,  with  its  appendages,  is  some- 
times so  swollen  that  it  can  scarcely  be  opened,  and  the  tongue  so 
much  enlarged  as  to  project  beyond  the  lips. 

"  The  patient  is  now  nearly  or  quite  unable  to  articulate  or  to  masti- 
cate his  food,  and  sometimes  can  scarcely  swallow.  Hemorrhage  is 
not  an  unfrequent  attendant  upon  the  bad  cases,  and  is  sometimes  so 


THE    MUCOUS    MEMBRANE.  151 

profuse  as  to  be  alarming.  Sloughiug  also  takes  place,  and  portions 
of  the  jaw  bone  are  occasionally  laid  bare.  There  is  always  in  the 
severe  cases  more  or  less  fever,  which  is  partly  symptomatic  of  the 
local  affection  and  partly  the  direct  effect  of  the  mercury.  Death, 
from  the  exhausting  influence  of  the  irritation,  want  of  nourishment, 
and  hemorrhage,  has  occurred  in  numerous  instances,  but  the  patient 
usually  recovers  from  the  worst  forms  of  the  affection,  though  some- 
times with  a  deformed  mouth. 

The  tongue  and  cheeks  have  occasionally  adhered  at  points  where 
their  ulcerated  surfaces  were  in  contact,  and  a  surgical  operation  has 
been  necessary  to  remove  the  evil. 

For  the  treatment  of  mercurial  stomatitis,  see  "  Treatment  of  Mer- 
curial Inflammation  of  the  Gums." 

Scurvy- Scorbutus  is  a  disease  characterized  by  spongy  gums,  offensive 
breath,  livid  spots  on  the  skin,  great  general  debility,  and  a  pale, 
bloated  countenance. 

"Scurvy,"  remarks  Prof  Wood,  "is  generally  very  gradual  in 
its  approach,  so  that  it  is  scarcely  possible  to  say,  in  any  particular 
case,  what  was  its  precise  time  of  attack.  Attention  is  commonly  first 
attracted  by  an  unhealthy  paleness  of  complexion,  a  feeling,^  on  the 
part  of  the  patient,  of  languor  and  despondency,  with  an  indisposition 
to  bodily  action,  and  unusual  fatigue  after  exercise ;  a  sensation  of 
weariness  and  aching  in  the  limbs,  as  from  over-exertion,  though  the 
patient  may  have  been  at  rest ;  and  some  swelling,  redness,  and  tender- 
ness of  the  gums,  with  a  tendency  to  bleed  from  slight  causes.  With 
the  advance  of  the  disease,  the  face  becomes  paler,  and  assumes  a 
somewhat  sallow  or  dusky  hue,  and  often  a  degree  of  pufiiness  ;  the 
lips  and  tongue  become  pallid,  and  contrast  strikingly  with  the  gums, 
which  are  purple  or  livid,  especially  at  their  edges,  rise  up  between 
and  around  the  teeth,  are  soft  and  spongy,  and  bleed  from  the  slightest 
touch  ;  the  breath  is  offensive ;  purplish  spots  or  blotches  appear  upon 
various  parts  of  the  surface,  beginning  usually  upon  the  lower  ex- 
tremities, and  afterward  extending  to  the  trunk,  arms,  and  neck,  though 
seldom  affecting  the  face ;  hemorrhage  frequently  occurs,  most  com- 
monly from  the  nose,  gums,  and  mouth,  but  sometimes  from  the 
stomach,  bowels,  and  urinary  passages ;  the  feet  become  edematous 
and  the  legs  swollen  and  painful ;  the  general  debility  increases,  and 
muscular  exertion  is  apt  to  be  attended  with  palpitation  of  the  heart, 
panting,  vertigo,  dizziness,  and  a  feeling  of  faintness.  The  petechial 
spots  are  evidently  owing  to  the  extravasation  of  blood  within  the 
cutaneous  tissue.  Occasionally  portions  of  the  surface  look  as  if 
bruised  without  having  suffered  any  violence ;  and  blows,  which, 
under  ordinary  circumstances,  would  produce  no  effect,  now  give  rise 


152  THE    MUCOUS    MEMBRANE. 

to  extensive  ecchymosis.  Should  the  disease  contiuue,  all  the  symp- 
toms become  aggravated;  the  complexion  assumes  often,  with  its  pale- 
ness, a  livid  or  leaden  hue;  the  gums  swell  greatly,  and  put  forth  a 
blackish  fungous  growth,  so  as  sometimes  to  conceal  the  teeth ;  blood 
continually  oozes  from  them;  sloughing  occasionally  takes  place, 
laying  bare  the  necks  of  the  teeth,  and  extending,  in  very  bad  cases, 
even  to  the  cheek. 

'The  teeth  become  loose,  and  sometimes  fall  out;  the  patient  is  un- 
able to  chew  solid  food  in  consequence  of  the  state  of  his  gums.  The 
breath  becomes  intolerably  offensive;  hard  and  painful  tumefactions 
occur  in  the  calves  of  the  leg,  among  the  muscles  of  the  thigh,  upon 
the  tibiie  and  lower  jaw,  and  in  the  hand,  with  stiffness  and  contrac- 
tion of  the  joints,  especially  the  knee,  and  severe  pain  in  the  extremi- 
ties upon  every  attempt  at  movement ;  and  the  debility,  before  so 
prominent  a  feature  in  the  case,  now  becomes  excessive,  so  that  the 
least  exertion  is  dangerous,  and  the  patient  sometimes  dies  suddenly 
upon  rising  from  bed,  or  upon  being  conveyed,  without  great  caution, 
from  one  place  to  another.  Wounds,  even  slight  scratches,  degene- 
rate into  unhealthy  ulcers ;  old  cicatrices  break  out  afresh,  and  exist- 
ing ulcers  assume  a  new  and  much  worse  aspect.  The  bones  are  said 
to  be  softened,  united  fractures  are  again  opened,  and  in  the  young 
the  epiphyses  separate  sometimes  from  the  shaft. 

"  Throughout  the  complaint  the  tongue  is  usually  clean  and  moist ; 
and  the  appetite  and  digestion  remain  unimpaired  almost  to  the  last, 
unless  the  disease,  as  sometimes  happens,  should  be  complicated  with 
fever.  Indeed,  there  is  often  a  craving  for  food,  especially  for  fresh 
vegetables  and  fruits ;  occasionally,  however,  there  is  vomiting,  with 
epigastric  distress,  and  other  evidences  of  stomachic  disorder.  The 
bowels  are  mostly  costive,  and  in  some  cases  obstinately  so,  but  diar- 
rhoea not  unfrequently  intervenes,  with  black  or  bloody  and  offensive 
evacuations.  The  pulse  is  generally  small,  feeble,  and  slow ;  but  cases 
occur  in  which  it  becomes  very  frequent,  and  the  surface  of  the  skin 
febrile,  probably  from  |he  sympathy  of  the  system  with  various  local 
irritative  congestions. 

"Great  emaciation  usually  attends  the  disease  when  severe  or  last- 
ing, but  not  invariably.  Little  cerebral  disturbance  is  ordinarily  ob- 
servable, and  the  patient  often  retains  full  possession  of  his  senses  and 
intellect  to  the  last." 

In  regard  to  the  cause  of  scurvy,  it  is  the  general  belief  that  it 
results  from  the  absence  of  fresh  vegetables  and  fruits.  Prof  Hamil- 
ton says,  In  regard  to  the  pathology  of  scurvy,  the  belief  prevails 
that  it  is  due  essentially  to  the  absence  of  certain  staminal  prin- 
ciples from  the  blood,  and  especially  potash  ;  as  all,  or  nearly  all,  the 


THE    GUMS.  153 

remedies  whicli  have  been  employed  successfully  in  the  prevention  or 
cure  of  scurvy,  contain  potash,  such  as  potatoes,  cabbage,  celery, 
lettuce,  lime,  lemon,  and  orange  juice.  As  regards  the  treatment, 
both  local  and  constitutional  are  required.  The  local  treatment  being 
the  same  as  is  recommended  for  "mercurial  stomatitis,"  need  not  be 
repeated.  The  constitutional  treatment  consists  in  the  administration 
of  the  vegetable  acids,  such  as  lemonade,  for  example.  Turner's  an- 
tidote, composed  of  potassse  nitratis  3ij.  and  acidi  acetici,  Sviij.  in 
table-spoonful  doses,  three  times  a  day,  is  a  favorite  remedy.  In  con- 
nection with  this.  Dr.  Garretson  recommends  saturating  a  sheet  with 
water  modei-ately  warm  and  moderately  salt,  which  Ls  thrown  arouna 
the  body  each  morning  immediately  on  rising,  and  rubbed  against  the 
flesh  until  a  ruddy  glow  is  excited. 


CHAPTER  IV. 

THE    GUMS. 


LITTLE  can  be  ascertained  concerning  the  innate  constitution  from 
an  inspection  of  the  gums.  Subject  to  the  laws  of  the  general 
economy,  their  aj^pearance  varies  with  the  state  of  the  general  health 
and  the  condition  and  arrangement  of  the  teeth.  Although  the  proxi- 
mate cause  of  disease  in  them  may  be  specified  as  local  irritation  — 
produced  by  depositions  of  tartar  upon  the  teeth,  or  decayed,  dead, 
loose  or  irregularly  arranged  teeth,  or  by  a  vitiated  state  of  the  fluids 
of  the  mouth,  resulting  from  general  organic  derangement,  or  any  or 
all  of  the  first-mentioned  causes  —  their  susceptibility  to  morbid  im- 
pressions is  influenced  to  a  considerable  extent  by  the  constitutional 
health ;  and  the  state  of  this  determines,  too,  the  character  of  the 
morbid  effects  produced  upon  them  by  local  irritants.  For  example, 
the  deposition  of  a  small  quantity  of  tartar  upon  the  teeth,  or  a  dead 
or  loose  tooth,  would  not,  in  a  healthy  person  of  a  good  constitution, 
give  rise  to  anything  more  than  slight  increased  vascular  action  in  the 
margin  of  the  gums  in  contact  with  it;  while  in  a  scorbutic  subject,  it 
would  cause  them  to  assume  a  dark  purf)le  appearance  for  a  consider- 
able distance  around,  to  become  swollen  and  flabby,  to  separate  and 
retire  from  the  necks  of  the  teeth,  or  to  grow  down  upon  their  crowns, 
to  ulcerate  and  bleed  from  the  slightest  injury,  and  to  exhale  a  fetid 
odor.  In  proportion  as  this  disposition  of  body  exists,  their  liability 
to  be  thus  affected  is  increased ;  and  it  is  only  among  constitutions  of 
this  kind  that  that  peculiar  preternatural  morbid  growth  takes  place 


154  THE    GUMS. 

by  which  tlic  wliole  of  the  crowns  of  the  teeth  sometimes  become 
ahuost  entirely  imbedded  in  their  substance. 

But,  notwithstanding  the  dependence  of  the  condition  of  the  gums 
upon  the  state  of  the  constitutional  health,  they  are  occasionally 
atfected  with  sponginess  and  inflammation  in  the  best  temperaments, 
and  in  individuals  of  uninterrupted  good  health.  The  wrong  position 
of  a  tooth,  by  causing  continued  tension  of  the  gums  investing  its 
alveolus,  sooner  or  later  gives  rise  to  chronic  inflammation  in  them 
and  the  alveolo-dental  periosteum,  and  gradual  wasting  of  their  sub- 
stance about  the  mal-placed  organ.  The  causes  of  toothache,  too, 
often  produce  the  same  effects  ;  the  accumulation  of  salivary  calculus 
upon  teeth,  however  small  the  quantity,  is  likewise  prejudicial. 

All  of  these  may  occur  independently  of  the  state  of  the  general 
health.  A  bad  arrangement  of  the  best  constituted  teeth,  and  toothache 
may  be  produced  by  a  multitude  of  accidental  causes  disconnected 
Avith  the  functional  operations  of  other  parts  of  the  body. 

While,  therefore,  the  appearance  and  physical  condition  of  this 
peculiar  and  highly  vascular  structure  are  influenced  in  a  great  degree 
by  habit  of  body,  they  are  not  diagnostics  that  always,  and  with 
unerring  certainty,  indicate  the  pathological  state  of  the  general  sys- 
tem. It  can,  however,  in  by  far  the  larger  number  of  cases,  where  the 
gums  are  in  an  unhealthy  condition,  be  readily  ascertained  wKether 
the  disease  is  altogether  the  result  of  local  irritation,  or  whether  it  is 
favored  by  constitutional  tendencies. 

In  childhood,  or  during  adolescence,  when  the  formative  forces  of 
the  body  are  all  in  active  operation,  and  the  nervous  susceptibilities 
of  every  part  of  the  organism  highly  acute,  the  sympathy  between  the 
gums  and  other  parts  of  the  system,  and  particularly  the  stomach,  is, 
perhaps,  greater  than  at  any  other  period  of  life.  The  general  health, 
too,  at  this  time  is  more  fluctuating,  and  with  all  the  changes  this 
undergoes,  the  appearances  of  the  gums  vary.  Moreover,  there  are 
operations  carried  on  beneath  and  within  their  substance,  which  are 
almost  constantly  altering  their  appearance  and  physical  condition  ; 
and  which,  being  additionally  influenced  by  various  states  of  health 
and  habits  of  body,  it  may  readily  be  conceived  that  those  met  with 
in  one  case  might  be  looked  for  in  vain  in  another. 

Having  arrived  at  that  age  when  all  the  organs  of  the  body  are  in 
full  vigor  of  maturity,  and  not  under  the  debilitating  influences  to 
which  they  are  subject  during  the  earlier  periods  of  life,  the  gums 
participate  in  the  happy  change,  and,  as  a  consequence,  present  less 
variety  in  their  characteristics.  The  general  irritability  of  the  system 
is  not  now  so  great,  the  gums  are  less  susceptible  to  the  action  of  irri- 
tating agents,  and,  as  a  consequence,  less  frequently  affected  with  dis- 


THE    GTJMS.  155 

ease ;  buL  as  age  advances,  and  the  vital  energies  begin  to  diminisli, 
the  latent  tendencies  of  the  body  are  re-awakened,  and  they  are  again 
easily  excited  to  morbid  action. 

In  the  most  perfect  constitutions,  and  during  adolescence,  they  pre- 
sent the  following  appearances :  they  have  a  pale  rose-red  color,  a 
firm  consistence,  a  slightly  uneven  surflice,  their  margins  form  along 
the  outer  surfaces  of  the  dental  circle  beautiful  and  regular  festoons, 
and  the  mucous  membrane  here,  as  well  as  in  other  parts  of  the 
mouth,  has  a  fresh,  lively,  roseate  hue. 

The  time  for  the  moulting  of  a  primary  tooth  is  announced  some 
weeks  before  it  takes  place,  by  increased  redness  and  slight  tumefac- 
tion of  the  edges  and  apices  of  the  gums  surrounding  it.  The  eruption 
of  a  tooth,  whether  of  the  first  or  second  set,  is  also  preceded  by  simi- 
lar phenomena  in  the  gums  through  which  it  is  forcing  its  way,  and 
these  will  be  more  marked  as  the  condition  of  the  system  is  unhealthy, 
or  as  the  habit  of  body  is  bad. 

If  the  health  of  the  subject  continues  good,  and  the  teeth  are  well 
arranged,  and  the  necessary  attention  to  their  cleanliness  be  strictly 
observed,  the  characteristics  just  enumerated  will  be  preserved  through 
life,  except  there  will  be  a  slight  diminution  of  color  in  them  after  the 
age  of  puberty  until  that  of  the  climacteric  period  of  life,  when  they 
will  again  assume  a  somew^hat  redder  appearance.  But  if  the  health 
of  the  subject  becomes  impaired,  or  the  teeth  be  not  regularly  arranged, 
or  wear  oflfj  or  are  not  kept  free  from  all  lodgment  of  extraneous  mat- 
ter, their  edges,  and  particularly  their  apices,  will  inflame,  swell,  and 
become  more  than  ordinarily  sensitive. 

The  gradual  wasting  or  destruction  of  the  margins  of  the  gums 
around  the  necks  of  the  teeth,  which  sometimes  takes  place  in  the  best 
constitutions,  and  is  supposed  by  some  to  be  the  result  of  general  atro- 
phy, is  ascribable,  we  have  no  doubt,  to  some  one  or  other  of  these 
causes,  favored,  perhaps,  by  a  diminution  of  vitality  in  the  teeth, 
whereby  they  are  rendered  more  obnoxious  to  the  more  sensitive  and 
vascular  parts  within  which  their  roots  are  situated.  That  these  are 
the  causes  of  the  affection  (for  it  is  evidently  the  result  of  diseased 
action  in  the  gums ),  is  rendered  more  than  probable  by  the  fact  that 
it  rarely  occurs  with  those  who,  from  early  childhood,  have  been  in 
the  regular  and  constant  habit  of  thoroughly  cleansing  their  teeth 
from  four  to  five  times  a  day. 

Although  possessed  of  a  good  constitution,  a  person  may,  by  intem^ 
perance,  debauchery,  or  long  privation  of  the  necessary  comforts  of 
life,  or  by  protracted  febrile  or  other  severe  kinds  of  disease,  have  his 
assimilative  and  all  the  other  organs  of  the  body  so  enervated  as  to 
render  every  part  of  the  system  highly  susceptible  to  morbid  impres- 


156  THE    GUMS. 

sions  of  every  sort;  but  still  this  general  functional  derangement 
rarely  predisposes  the  structure  now  under  consideration  to  any  of  the 
more  malignant  forms  of  disease  occasionally  known  to  attack  it  in 
subjects  of  less  favorable  constitutions.  The  margins  of  the  gums 
may  inflame,  become  turgid,  ulcerate,  and  recede  from  the  necks  of 
the  teeth,  and  the  whole  of  their  substance  be  involved  in  an  unhealthy 
condition;  but  they  will  seldom  be  attacked  with  scirrhous  or  fungous 
tumors,  or  bad-conditioned  ulcers,  or  affected  with  preternatural  moi'- 
bid  growths ;  and  in  the  treatment  of  their  diseases  we  can  always 
form  a  more  favorable  prognosis  in  persons  of  this  description  than 
those  coming  into  the  world  with  some  specific  morbid  tendency. 

But  the  occurrence  of  severe  constitutional  disease, '  even  in  these 
subjects,  is  followed  by  increased  irritability  of  the  gums,  so  that  the 
slightest  cause  of  local  irritation  gives  rise  to  an  afflux  of  blood  to, 
and  stasis  of  this  fluid  in,  their  capillaries. 

The  teeth  of  persons  thus  happily  constituted  are  endowed  with 
characteristics  such  as  have  been  represented  as  belonging  to  those 
of  the  best  quality.  They  are  of  a  medium  size,  both  in  length  and 
volume,  white,  compact  in  their  structure,  generally  well  arranged, 
and  seldom  afiected  with  caries. 

Another  constitution  is  observed,  in  which  the  gums,  though  partak- 
ing somewhat  of  the  characteristics  just  described,  differ  from  them  in 
some  particulars.  Their  color  is  of  a  deeper  vermilion ;  their  edges 
rather  thicker,  their  structure  less  firm,  and  their  surface  not  so  rough, 
but  more  humid.  The  mucous  membrane  has  a  more  lively  and  ani- 
mated appearance.  They  are  more  sensitive  and  more  susceptible  to 
the  action  of  local  irritants,  with  morbid  tendencies  more  increased  by 
general  organic  derangement,  than  when  possessed  of  the  appearances 
first  mentioned. 

"When  in  a  morbid  condition,  the  disease,  though  easily  cured  by 
proper  treatment,  is,  nevertheless,  more  obstinate,  and  when  favored 
by  constitutional  derangement,  assumes  a  still  more  aggravated  form. 
Their  predisposition  to  disease  is  so  much  increased  by  long-continued 
disturbance  of  the  general  system,  and  especially  during  youth,  and 
by  febrile  or  inflammatory  aflTections,  that  not  only  their  margins,  but 
their  whole  substance,  sometimes  become  involved  in  inflammation  and 
sponginess,  followed  by  ulceration  of  their  edges,  and  recession  from 
the  necks  of  the  teeth,  which,  in  consequence,  loosen,  and  often  drop 
out.  But  gums  of  this  kind,  like  those  first  described,  seldom  grow 
down  upon  the  crowns  of  the  teeth.  Neither  are  they  very  liable  to 
be  attacked  with  scirrhous  or  fungous  tumors,  or  any  form  of  disease 
resulting  in  sanious  or  other  malignant-conditioned  ulcers.  Indeed, 
with  diseases  of  this  kind,  they  are  not,  perhaps,  ever  afiected,  except 


THE    GUMS.  •  157 

in  those  cases  where  every  part  of  the  body  has  become  exceedingly 
depraved  by  interaperance,  debauchery,  or  some  other  cause. 

The  teeth  of  those  whose  gums  are  of  this  description,  if  well 
arranged  and  kept  constantly  clean,  and  if  the  secretions  of  the  mouth 
he  not  vitiated  by  general  disease,  will,  in  most  cases,  remain  healthy 
through  life. 

It  is  only  among  sanguineous  persons  that  this  description  of  gums 
is  met  with,  and  the  teeth  of  subjects  of  this  kind  are  generally  of 
excellent  quality,  and  though  more  liable  to  be  attacked  by  caries 
than  those  first  noticed,  they  are  seldom  afiected  with  it. 

In  sangulneo-serous  and  strumous  subjects,  the  gums  are  pale,  and 
though  their  margins  are  thin  and  well  festooned,  often  exude,  after 
the  twenty-fifth  and  thirtieth  year,  a  small  quantity  of  muco-purulent 
matter,  which,  on  pressure,  oozes  from  betAveen  them  and  the  necks  of 
the  teeth.  Their  texture  is  usually  firm,  and  they  are  not  very  liable 
to  become  turgid.  They  often  remain  in  this  condition  to  a  late  period 
of  life,  without  undergoing  any  very  perceptible  change.  Their  con- 
nection with  the  necks  of  the  teeth  and  alveolar  processes  appears 
weak,  but  they  rarely  separate  from  them. 

In  individuals,  having  such  constitutions,  dyspepsia,  chronic  hepa- 
titis, and  diseases  in  which  the  prirnce  vice  generally  are  more  or  less 
involved,  are  not  unfrequent,  and  are  indicated  by  increased  irrita- 
bility, and  sometimes  a  pale,  yellowish  appearance  of  the  gums.  In 
jaundice,  the  yellowish  serosity  of  the  blood  is  very  apparent  in  the 
capillaries  of  this  structure. 

These  constitutions  are  more  common  in  females  than  males,  in  the 
rich  than  the  poor,  and  in  persons  of  sedentary  habits  than  in  those 
who  use  invigorating  exercise.  If  at  any  time  during  life  the  health 
is  ameliorated,  the  gums  assume  a  fresher  and  redder  appearance,  and 
the  exudation  of  muco-purulent  matter  from  between  them  and  the 
necks  of  the  teeth  ceases. 

In  mucous  dispositions,  the  gums  have  a  smooth,  shining  appear- 
ance, and  are  rather  more  highly  colored  than  the  preceding.  Their 
margins,  also,  are  thicker,  more  flabby,  and  not  so  deeply  festooned ; 
they  are  more  irritable,  and,  consequently,  more  susceptible  to  morbid 
impressions. 

If,  with  this  disposition,  there  be  combined  a  scorbutic  or  scrofulous 
tendency,  the  gums  during  early  childhood,  in  subjects  which,  from 
scanty  and  unwholesome  diet,  have  become  greatly  debilitated,  are 
liable,  besides  the  ordinary  forms  of  disease,  to  another —  characterized 
by  their  separation  from,  and  exfoliation  of,  the  alveolar  processes, 
accompanied  by  a  constant  discharge  of  sanies.     This  form  of  disease, 


158  THE    GUMS. 

however,  though  peculiar  to  childhood,  and  wholly  confined  to  the 
indigent,  is  by  no  means  common. 

These  constitutions  are  rarely  met  with,  except  among  persons  who 
live  in  cellars,  and  damp  and  closely  confined  rooms  in  large  cities, 
and  in  low,  damp,  and  sickly  districts  of  country.  The  mucous  mem- 
brane, in  subjects  of  this  kind  is  exceedingly  irritable,  and  secretes  a 
large  quantity  of  mucus. 

»\M-sons  even  tluis  unhappily  constituted  do,  sometimes,  by  change 
of  residence  and  judicious  regimen,  acquire  tolerably  good  constitu- 
tions. Little  advantage,  however,  is  derived  from  these,  unless  they 
are  had  recourse  to  before  the  twenty-fifth  or  thirtieth  year  of  age, 
though  they  may  prove  beneficial  at  a  much  later  period. 

The  gums,  in  scorbutic  persons,  have  a  reddish-brown  color ;  their 
margins  are  imperfectly  festooned  and  thick  ;  their  structure  rather 
disposed  to  become  turgid,  and  ever  ready,  on  the  presence  of  the 
slightest  cause  of  local  irritation,  to  take  on  a  morbid  action.  When 
thus  excited,  the  blood  accumulates  in  their  vessels,  where,  from  its 
highly  carbonized  state,  it  gives  to  the  gums  a  dark,  purple,  or  brown 
appearance ;  they  swell,  and  become  spongy  and  flabby,  and  bleed 
from  the  slightest  touch.  To  these  symptoms  supervene  the  exhala- 
tion of  a  fetid  odor,  the  destruction  of  the  bond  of  union  between 
them  and  the  necks  of  the  teeth,  suppuration  and  recession  of  their 
margins  from  the  same,  gradual  Avasting  of  the  alveolar  cavities, 
loosening,  and,  not  unfrequently,  the  loss  of  several  or  the  whole  of 
the  teeth.  These  are  the  most  common  results,  but,  sometimes,  they 
take  on  other  and  more  aggravated  forms  of  diseased  action.  Preter- 
natural prurient  growths  of  their  substance,  fungous  and  scirrhous 
tumors,  ichorous  and  other  malignant,  ill-conditioned  ulcers,  etc. 

The  occurrence  of  alveolar  abscess  in  dispositions  of  this  kind  is 
often  followed  by  necrosis  and  exfoliation  of  portions  of  the  maxillary 
bone,  and  the  effects  which  result  to  the  gums  are  always  more  perni- 
cious than  in  habits  less  depraved. 

The  development  of  the  morbid  changes  which  take  place  in  this 
structure,  even  in  subjects  of  this  kind,  while  the  character  of  the 
disease  is  influenced,  if  not  determined,  by  a  specific  constitutional 
tendency,  is,  nevertheless,  referable  to  local  irritation  as  the  immediate 
or  proximate  cause,  and  were  this  the  proper  place,  we  could  cite 
numerous  cases  tending  to  establish  the  truth  of  this  opinion. 

In  scrofulous  habits,  the  gums  have  a  pale  bluish  appearance,  and 
when  subjected  to  local  irritation,  they  become  flabby,  exhale  a  nau- 
seating odor,  detach  themselves  from  the  necks  of  the  teeth,  and  their 
apices  grow  down  between  these  organs.  The  blood  circulates  in  them 
languidly,   and  debility  seems   to   pervade    their   whole    substance. 


THE    GUMS.  159 

They  are  exceedingly  irritable,  and  not  unfrequently  take  on  aggra- 
vated forms  of  disease,  and,  as  often  happens  to  this  as  well  as  to  the 
preceding  habit,  there  are  combined  tendencies  which  favor  the  pro- 
duction of  ill  conditioned  tumors  and  ulcers. 

The  indications  furnished  by  the  gums  during  the  existence  of  a 
mercurial  diathesis  of  the  system  are  morbid  sensibility,  increased 
vascular  and  glandular  action,  foulness,  bleeding  from  the  most  trifling 
injuries,  pale  bluish  appearance  of  their  substances,  turgidity  of  their 
apices,  and  sloughing.  The  effects,  however,  resulting  to  these  parts 
from  the  employment  of  mercury  differ  in  different  individuals  accord- 
ing to  the  general  constitutional  susceptibility,  the  quantity  taken  into 
the  system,  and  the  length  of  time*  its  use  has  been  continued.  In 
persons  of  very  irritable  habits,  a  single  dose  will  sometimes  produce 
ptyalism,  and  so  increase  the  susceptibility  of  the  gums  that  the  secre- 
tions of  the  mouth,  in  their  altered  state,  will  at  once  rouse  up  a  mor- 
bid action  in  them. 

The  effects  of  a  mercurial  diathesis  upon  these  parts  is  not  unfre- 
quently so  great  as  to  result  in  the  loss  of  the  whole  of  the  teeth. 
But  with  these  effects  both  the  dental  and  medical  practitioner  are  too 
familiar  to  require  any  further  description. 

Finally,  we  would  observe,  that  the  indications  of  the  several  char- 
acteristics to  which  we  have  now  briefly  alluded  may  not  be  correct  in 
every  particular,  and  there  are  others  which  we  have  not  mentioned ; 
yet  we  think  they  will  commonly  be  found  true.  As  a  general  rule, 
persons  of  a  full  habit,  though  possessed  of  mixed  temperaments  and 
in  the  enjoyment  of  what  is  usually  called  good  health,  have  gums  well 
colored,  with  rather  thick  margins,  and  very  susceptible  to  local  irri- 
tation. With  this  description  of  individuals,  inflammation,  turgidity, 
and  suppuration  of  the  gums  are  very  common.  To  prevent  these 
effects,  constant  attention  to  the  cleanliness  of  the  teeth  is  indispensable. 

Prof  Schill  says,  the  "gum  is  pale  in  chlorosis  ansemia ;  of  a 
purple  red  color  before  an  active  hemorrhoidal  discharge  and  in  cases 
of  dysraenorrhoea ;  of  a  dark  red  color,  spongy,  and  bleeding  readily, 
in  scurvy  and  diabetes  mellitus,  and  after  the  use  of  mercury.  Spongy 
growths  indicate  caries  of  the  subjacent  bone." 

Regular  periodical  bleedings  of  the  gums  in  dysmenorrhoea,  and 
particularly  in  scorbutic  and  mucous  subjects,  are  not  unfrequent,  nor 
in  any  case  where  they  are  in  a  turgid  condition. 

Spongy  growths  of  the  gums  in  scorbutic  and  scrofulous  persons 
often  result  from  irritation  produced  by  decayed  teeth,  and  are  not, 
therefore,  always  to  be  regarded  as  an  indication  of  caries  of  the  sub- 
jacent bone. 

Dr.  T.  Thompson,  of  London,  says  that  the  reflected  margin  of  the 


160  THE    GUMS.     ■ 

gums  of  a  large  majority  of  phthisical  patients  is  deeper  iu  color  than 
the  other  portions  usually  presenting  a  vermilion  tint. 

Mr.  George  Waite  says,  "  A  change  of  residence  to  a  damp  climate 
will  often  rouse  up  in  the  gums  a  great  degree  of  vascularity.  In  the 
damp  places  of  England  and  Ireland  the  appearances  which  the  gums 
present  are  of  a  turgid  and  vascular  nature.  In  the  damp  countries 
of  France,  these  conditions  of  the  gums  run  a  much  greater  length 
from  the  circumstance  of  the  difference  in  the  constitutions  of  the  two 
nations.  In  the  damps  of  Germany  and  Switzerland  persons  also  lose 
their  teeth  early  in  life;  the  climate  engenders  malaria  and  low  fevers, 
enfeebles  the  power  of  digestion,  and  brings  on  rheumatic  affections, 
with  languor  and  general  constitutional  debility." 

Of  tlie  correctness  of  Mr.  Waite's  observations  there  can  be  no 
question,  and  they  go  to  establish  what  has  been  said  in  regard  to  the 
predisposing  cause  of  disease  in  the  gums ;  namely,  that  the  enervation 
of  the  vital  powers  of  the  body,  from  whatever  cause  produced, 
increases  their  susceptibility  to  morbid  impressions. 

INFLAMMATION  OF  THE  GUMS. 

The  gums  and  alveolar  processes,  from  apparently  the  same  cause, 
frequently  assume  various  morbid  conditions.  An  unhealthy  action 
in  one  is  almost  certain  to  be  followed  by  disease  in  the  other.  The 
most  common  form  of  disease  to  which  these  parts  are  subject  is  usually, 
though  very  improperly,  denominated  scurvy,  from  its  supposed  re- 
semblance to  scorbutus,  a  disease  to  which,  however,  it  bears  no  resem- 
blance. Instead,  therefore,  of  continuing  the  use  of  this  term,  we 
propose  to  treat  the  disease  under  the  name  of  chronic  wflamviation 
and  tumefaction  of  the  gums,  attended  by  recession  of  their  margins  from 
the  necks  of  the  teeth,  which  seems  to  express  more  clearly  the  condition 
of  the  parts  and  the  natui'e  of  the  disease.  The  gums  sometimes, 
though  less  frequently,  become  the  seat  of  acute  inflammation.  The 
other  affections  to  which  they  are  liable  will  be  noticed  in  their  ap- 
propriate place. 

The  diseases  of  the  gums  and  alveolar  processes  are  divided  by  Mr. 
Bell  into  two  classes :  those  which  are  the  result  of  local  irritation, 
and  those  which  arise  from  constitutional  causes. 

Were  it  not  for  local  irritation  in  these  parts,  the  constitutional 
tendencies  to  disease  would  rarely  manifest  themselves ;  and,  on  the 
other  hand,  were  it  not  for  constitutional  tendencies^  the  effects  of 
local  irritation  w^ould  seldom  be  of  a  serious  character.  "  Thus,"  says 
Mr.  Bell,  "the  same  cause  of  irritation  which,  in  a  healthy  person, 
would  occasion  a  simple  abscess,  might,  in  a  different  constitution,  re- 


THE    GUMS.  161 

suit  in  ulceration  of  a  decidedly  cancerous  type,  or  in  the  production 
of  fungous  tumors,  or  the  formation  of  scrofulous  abscesses." 

Each  constitution  has  its  peculiar  tendency ;  or,  in  other  -^ords,  is 
more  favorable  to  the  development  of  some  forms  of  disease  than 
others ;  and  this  tendency  is  always  increased  or  diminished  accord- 
ing to  the  healthy  or  unhealthy  performance  of  the  functional  opera- 
tions of  the  body  generally.  Thus,  derangement  of  the  digestive 
organs  increases  the  tendency,  in  an  individual  of  a  mucous  habit,  to 
certain  forms  of  diseased  action  in  particular  organs,  and  especially  in 
the  gums.  A  local  irritant,  which  would  otherwise  produce  only  a 
slight  inflammation  of  the  margins  of  the  gums,  would  now  give  rise 
to  turgidity  and  sponginess  of  their  whole  structure.  The  same  may 
be  said  with  regard  to  a  person  of  a  scrofulous  or  scorbutic  habit. 

The  susceptibility  of  the  gums  to  the  action  of  morbid  irritants  is 
always  increased  by  enfeeblement  of  the  vital  powers  of  the  body. 
Hence,  persons  laboring  under  excessive  grief,  melancholy,  or  any 
other  affection  of  the  mind,  or  under  constitutional  disease  tending  to 
enervate  the  vital  energies  of  the  system,  are  exceedingly  subject  to 
inflammation,  sponginess,  and  ulceration  of  the  gums.  But,  notwith- 
standing the  increase  of  susceptibility  which  the  gums  derive  from 
certain  constitutional  causes  and  states  of  the  general  health,  these 
influences  may,  in  the  majority  of  cases,  be  counteracted  by  a  strict 
observance  of  the  rules  of  dental  hygiene ;  or,  in  other  words,  by  con- 
stant and  regular  attention  to  the  cleanliness  of  the  teeth. 

A  local  disease,  situated  in  a  remote  part,  often  has  the  effect  of 
diminishing  the  tendency  in  the  gums  to  disease ;  but  when,  from  its- 
violence  or  long  continuance,  the  general  health  becomes  implicated, 
the  susceptibility  of  these  parts  is  augmented. 

Although  deriving  their  predisposition  to  disease  from  a  specific,, 
morbid  constitutional  tendency,  they,  nevertheless,  when  diseased, 
contribute  in  no  small  degree  to  derange  the  whole  organism.  Their 
unhealthy  action  vitiates  the  fluids  of  the  mouth,  and  renders  them 
unfit  for  the  purposes  for  which  they  are  designed  ;  hence,  when  these 
pai'ts  are  restored  to  health,  whether  from  the  loss  of  diseased  teeth, 
or  the  treatment  to  which  they  may  have  been  subjected,  the  con- 
dition of  the  general  health  is  always  immediately  improved. 

Thus,  while  the  susceptibility  of  the  gums  to  morbid  impressions  is 
influenced  by  the  state  of  the  general  health,  the  latter  is  equally  in- 
fluenced by  the  condition  of  the  former.  And  not  only  is  a  healthy 
condition  of  the  gums  essential  to  the  general  health,  but  it  is  also 
essential  to  the  health  of  the  teeth  and  alveolar  processes.  From  the 
intimate  relation  that  subsists  between  the  former  and  the  latter,  dis- 
ease cannot  exist  in  one  without  in  some  degree  affecting  the  other. 
11 


162  THE    GUMS. 

Caries  of  the  teeth,  for  example,  often  gives  rise  to  inflammation  of 
the  gums  and  alveolo-dental  periosteum ;  on  the  other  hand,  inflam- 
mation of  these  parts  vitiates  the  fluids  of  the  mouth  and  causes 
them  to  exert  a  deleterious  action  upon  the  teeth,  and  also  excites 
more  or  less  constitutional  derangement. 


ACUTE   INFLAMMATION   OF   THE   GUMS. 

Acute  inflammation  of  the  gums  frequently  occurs  in  connection 
with  stomatitis,  or  general  inflammation  of  the  mucous  membrane  of 
the  buccal  cavity,  which  appears  under  a  great  variety  of  forms.  In 
this  case  the  inflammatory  action  does  not  always  extend  to  the  sub- 
jacent fibro-cartilaginous  structure;  but  the  local  disease  is  often 
complicated  with  other  disorders,  the  treatment  of  which  comes  more 
properly  within  the  province  of  the  medical  than  that  of  the  dental 
practitioner.  Ulitis,  or  acute  inflammation  of  the  gums,  is,  in  most 
cases,  a  purely  local  disease,  arising  usually  from  the  irritation  of 
dentition,  or  as  a  consequence  of  periodontitis.  It  often  extends  to  the 
submaxillary  glands  and  muscles  of  the  face,  and  is  attended  by 
swelling  and  other  morbid  phenomena.  But  as  this  form  of  inflam- 
mation of  the  gums  is  treated  of  in  connection  with  other  subjects,  it 
will  not  be  necessary  to  repeat  what  we  have  said  elsewhere  concern- 
ing it. 

CHRONIC  INFLAMMATION  AND  TUMEFACTION   OF  THE  GUMS  ATTENDED 
BY   RECESSION   OF   THEIR   MARGINS   FROM   THE   TEETH. 

The  affection  which  we  are  now  about  to  consider  has  been  variously 
designated.  Jourdain  and  other  French  writers  term  it,  in  its  more 
advanced  stages,  conjoined  mjypuration;  because  it  is  then  complicated 
with  a  discharge  of  purulent  matter  from  between  the  edges  of  the 
gums  and  the  necks  of  the  teeth,  and  with  a  gradual  destruction  of 
the  alveolar  processes.  Dr.  Koecker  calls  it  the  devastating  process, 
because  it  is  attended  by  wasting  of  the  gums  and  alveoli.  But  it  is 
more  frequently  treated  of  under  the  appellation  of  scurvy  than  under 
any  other  name. 

Chronic  inflammation  of  the  gums  may  exist  for  years  without  being 
attended  with  suppuration  or  recession  of  their  margins  from  the 
necks  of  the  teeth ;  but  these  phenomena  are  sooner  or  later  developed, 
according  to  the  amount  of  local  irritation  and  the  state  of  the  consti- 
tutional health  and  habit  of  body.  With  the  occurrence  of  inflamma- 
tion the  margins  of  the  gums  gradually  lose  their  festooned  appearance, 
become  thick,  spongy,  and  rounded,  and  ultimately,  on  being  pressed, 
purulent  matter  is  discharged  from  between  them  and  the  necks  of 


THE    GUMS. 


163 


the  teeth.     Their  sensibility  is  increased,  and  they  bleed  from  the  most 
trifling  injury. 

The  diseased  action  usually  first  develops  itself  in  the  gums  around 
the  lower  front  teeth  and  the  upper  molars,  opposite  the  mouths  of  the 
salivary  ducts,  also  in  the  immediate  vicinity  of  aching,  decayed,  dead, 
loose,  or  irregularly  arranged  teeth,  or  in  the  neighborhood  of  roots 
of  teeth  ;  from  thence  it  extends  to  the  other  teeth.  The  rapidity  of 
its  progress  depends  on  the  age,  state  of  the  general  health,  tempera- 
ment and  habit  of  body  of  the  individual,  and  the  character  of  the 
local  irritants  which  has  given  rise  to  it.  It  is  always  more  rapid  in 
persons  addicted  to  the  free  use  of  spirituous  liquors,  and  in  individ- 
uals in  whom  there  exists  a  scorbutic  tendency,  or  who  have  suffered 
from  venereal  disease,  or  from  the  constitutional  eflects  of  a  mercurial 
treatment  used  to  cure  this  or  other  diseases. 

The  inflammation  may  be  confined  to  the  gums  of  two  or  three 
teeth,  or  it  may  extend  to  the  gums  Fig.  40. 

of  all  the  teeth,  in  one  or  both  jaws. 

As  the  disease  advances,  the  gums 
begin  to  recede  from  the  necks  of 
the  teeth,  and  the  alveoli  to  waste, 
and  the  teeth,  as  they  lose  their 
support,  loosen  and  ultimately  drop 
out.  In  Fig.  40  is  represented  a 
case  in  which  nearly  one-half  of 
the  roots  of  the  lower  incisors  have  become  exposed  by  this  devastating 
process. 

But  the  loss  of  the  teeth,  though  it  puts  a  stop  to  the  local  disease, 
is  not  the  only  bad  efiect  that  results  from  it.  Constitutional  symptoms 
often  supervene,  more  vi'tal  organs  become  implicated,  and  the  health 
of  the  general  system  is  sometimes  very  seriously  impaired.  Hence, 
the  improvement  often  observed  after  the  loss  of  the  teeth,  in  the 
general  health  of  persons  whose  mouths  have  for  a  long  time  been 
affected  with  this  disease.  I^o  condition  of  the  mouth  has  a  greater 
tendency  to  deteriorate  its  secretions  and  impair  the  functions  of  masti- 
cation and  digestion  than  the  one  now  under  consideration. 

In  forming  an  opinion  of  the  injury  likely  to  result  from  the  dis- 
ease, the  dentist  should  be  governed  not  only  by  the  health  and  age  of 
the  patient,  and  the  local  causes  concerned  in  its  production,  but  he 
should  also  endeavor  to  ascertain  whether  it  is  connected  with  a  con- 
stitutional tendency,  or  is  purely  a  local  affection.  Some  have  been 
led  to  believe  that  the  wasting  of  the  gums  and  alveolar  processes 
may  sometimes  take  place  without  being  connected  with  any  special, 
local,  or  constitutional  cause ;  that  it  is  identical  with  that  process  by 


164  THE    GUMS. 

^vhich  the  teeth  of  aged  persons  are  removed,  and  that  when  it  occurs 
in  persons  not  past  the  meridian  of  life,  it  is  symptomatic  of  a  kind  of 
premature  old  age. 

Mr.  Bell,  on  this  subject  remarks:  "In  forming  a  judgment  upon 
eases  of  this  description,  however,  and  even  upon  those  in  which  the 
loss  of  substance  is  associated  with  more  or  less  of  diseased  action,  it 
is  necessary  to  recollect  that  the  teeth  are  generally  removed  iii  old 
age  by  this  identical  mode ;  namely,  the  destruction  of  their  support, 
l)v  the  absorption  of  the  gums  and  alveolar  processes;  and  as  this  step 
toward  general  decay  commences  at  very  different  periods  in  different 
constitutions,  it  may,  doubtless,  in  many  cases,  even  in  persons  not  past 
tiie  middle  period  of  life,  be  considered  as  an  indication  of  a  sort  of 
premature  old  age,  or  an  anticipation,  at  least,  of  senile  decay,  as  far 
as  regards  these  parts  of  the  body. 

The  loss  of  the  teeth,  from  the  wasting  of  the  gums  and  alveolar 
processes,  although  occurring  frequently  in  advanced  life,  is  not  a 
necessary  consequence  of  senility,  for  we  occasionally  see  persons  of 
seventy,  and  even  eighty  years  of  age,  whose  teeth  are  as  firmly  fixed 
iu  their  sockets,and  their  gums  as  little  impaired,  as  in  individuals  at 
twenty.  We  do  not  recollect  ever  to  have  seen  a  case  of  this  kind  in 
which  there  was  not  evidently  some  diseased  action  in  the  gums.  But 
it  is  of  little  importance  whether  it  be  the  result  of  old  age,  a  consti- 
tutional tendency,  functional  derangement  of  some  other  part,  or  local 
irritation,  since  the  consequences  resulting  from  such  loss  are  always 
the  same. 

The  gums,  after  having  been  once  the  seat  of  chronic  inflammation, 
are  ever  after  more  susceptible  to  the  action  of  morbid  irritants. 

CAUSES. 

The  immediate  or  exciting  cause  of  inflammation  of  the  gums,  is 
local  irritation,  produced  by  salivary  calculus,  by  carious,  dead,  loose 
or  aching  teeth,  or  roots  of  teeth,  or  by  teeth  which  occupy  a  wrong 
position,  or  that  are  crowded  in  their  arrangement.  It  may  also  be 
produced  by  very  hard  teeth,  which,  in  consequence  of  their  density, 
possess  only  a  very  low  degree  of  vitality;  for  cases  of  recession  of  the 
gums,  in  which  a  very  slight  inflammatory  action  exists,  are  frequently 
met  with  in  individuals  having  teeth  of  this  description.  This  can 
only  be  explained,  by  supposing  a  w^ant  of  congeniality  between  these 
organs  and  the  more  sensitive  and  highly  vitalized  parts  with  which 
they  are  in  immediate  contact.  The  same  thing  is  observed  when  the 
vitality  of  the  teeth  is  weakened  by  age,  which  Mr.  Bell  regards  as  an 
indication  of  senile  decay. 

The  secretions  of  the  mouth,  especially  the  mucus,  are  often  ren- 


THE    GUMS.  165 

dered,  by  certain  conditions  of  the  general  system,  so  acrid  as  to  be- 
come a  source  of  irritation  to  the  gums. 

Dr.  Koecker,  who  has  had  the  most  ample  opportunities  of  observing 
this  afiection  in  all  its  various  forms,  says  that  he  has  never  seen  a  case 
in  which  tartar  was  not  present.  That  this  is  so  in  a  large  majority  of 
the  cases,  there  is  no  question ;  but  that  it  is  in  all,  is  certainly  a  mis- 
take. The  author  has  met  with  many  in  which  not  the  smallest  deposit 
could  be  detected. 

The  disease  attacks  persons  of  every  age,  rank,  and  condition;  and 
in  every  country,  climate,  and  nation.  "  I  have  observed,"  says  Dr. 
Koecker,  "the  inhabitants  of  the  most  widely  separated  countries, 
Russians,  French,  Italians,  Spaniards,  Portuguese,  English,  Africans, 
East  and  "West  Indians,  and  those  of  the  United  States,  to  be  all  more 
or  less  liable  to  it." 

It  is,  however,  more  frequently  met  with  in  the  lower  than  in  the 
higher  classes  of  society.  Persons  who  pay  no  attention  to  the  clean- 
liness and  health  of  their  teeth  are  particularly  subject  to  it.  With 
sailors,  and  those  who  live  principally  on  salt  provisions,  it  is  very 
common.  "  Persons  of  robust  constitution,"  says  Dr.  Koecker,  "  are 
much  more  liable  to  this  affection  of  the  gums  than  those  of  delicate 
habit ;  and  it  shows  itself  in  its  worst  form  after  the  age  of  thirty 
oftener  than  at  any  earlier  period." 

To  the  causes  of  irritation  which  have  already  been  enumerated, 
may  be  added,  accumulation  of  extraneous  matter  on  the  teeth  and 
along  the  edges  of  the  gums ;  peritonitis ;  mercurial  poisoning ;  scurvy ; 
^^yphilis  ;  a  crowded  dental  arch  ;  malignant  impressions ;  artificial 
teeth  badly  inserted,  or  made  of  improper  material;  and  dental  opera- 
tions badly  performed.  The  use  of  improper  tooth-brushes  and  pow- 
tlers,  especially  charcoal,  may  be  reckoned  among  its  exciting  causes. 
The  irritability  of  the  gums  is  sometimes  increased  by  the  use  of 
acids ;  at  other  times  it  is  diminished. 

Every  condition  of  the  general  system  tending  to  increase  the  sus- 
ceptibility of  the  gums  to  the  action  of  local  irritants  favors  the  pro- 
duction of  the  disease.  Everything  that  tends  to  induce  such  con- 
ditions may  be  regarded  as  a  predisposing  cause  ;  such  as  bilious  and 
inflammatory  fevers,  the  excessive  use  of  mercurial  medicines,  the 
venereal  virus,  intemperance,  and  debauchery.  Any  deterioration  of 
the  fluids  of  the  body  is  peculiarly  conducive  to  it.  Persons  of 
cachectic  habit  are  far  more  subject  to  it.  and  generally  in  its  worst 
forms,  than  those  individuals  in  the  enjoyment  of  good  health. 

Strumous  individuals  sometimes  have  an  affection  of  the  gums 
which  differs  in  many  respects  from  the  one  just  described.  The  gums, 
instead  of  being  purple  and  swollen,  are  pale  and  harder  than  ordinary, 


166  THE    GUMS. 

and,  on  being  pressed,  discharge  muco-purulent  matter  of  a  dingy 
white  color.  They  often  remain  in  this  condition  for  years,  without 
appearing  to  undergo  any  structural  alteration,  or  to  affect  the  alveo- 
lar processes.  The  form  of  the  disease  is  principally  confined  to  per- 
sons who  have  very  white  teeth ;  it  is  much  less  likely  to  attack  males 
than  females ;  and  has  never,  so  far  as  we  have  been  able  to  ascertain, 
been  mentioned  by  any  dental  writer.  Mr.  Fox  speaks  of  ulceration 
of  the  gums  in  scrofulous  children  ;  but  that  is  of  frequent  occurrence, 
and  is  characterized  by  the  usual  phenomena  of  infianimation.  This 
disease  now  spoken  of  rarely  occurs  before  the  age  of  eighteen  or 
twenty  ;  and  it  seems  to  be  the  result  of  impaired  nutrition.  The 
gums  exhibit  no  signs  of  inflammatory  action  ;  on  the  coutraiy,  they 
are  paler,  less  sensitive,  and  possess  less  warmth  than  usual.  It  is 
never  attended  with  tumefaction  or  absorption,  except  in  its  advanced 
stages ;  whereas,  the  affection  of  which  Mr.  Fox  speaks  is  always  ac- 
companied by  both. 

TREATMENT. 

In  the  treatment  of  inflamed,  sj)ongy,  and  ulcerated  gums,  the  first 
thing  claiming  attention  is  the  removal  of  the  exciting  causes.  If 
there  are  dead  or  loose  teeth  in  the  mouth,  or  teeth  which,  from  their 
position,  act  as  mechanical  irritants,  they  should  be  at  once  extracted. 
The  remaining  teeth  should,  at  the  same  time,  be  freed  from  tartar, 
and  all  other  irritating  depositions. 

Dr.  Koecker  goes  so  far  as  to  recommend  the  extraction  of  any 
molar  tooth,  particularly  in  the  upper  jaw,  which  has  lost  its  antago- 
nist, believing  that  a  tooth  under  such  circumstances  is  a  source  of 
irritation  to  the  alveolo-dental  periosteum  and  gums.  He  says,  "  In 
this  manner  the  loss  of  one  molar  tooth  produces  the  destruction  of 
its  remaining  antagonist.  This  is  effected,  however,  after  a  struggle 
of  nature,  of  a  very  long  duration,  which  always  involves,  in  some 
degree,  all  the  other  teeth  in  a  like  diseased  condition.  It  is  necessary, 
therefore,  to  prevent  this  morbid  condition,  particularly  pernicious  in 
this  disease,  by  the  extraction  of  the  tooth,  or  any  molar  so  situated." 

Although  a  molar  tooth,  after  having  lost  its  antagonist,  is  some- 
times a  source  of  irritation,  it  may  often  remain  with  impunity.  Its 
removal  is  necessary  only  when  it  acts  as  an  irritant  to  the  gums ;  and 
it  may,  in  a  majority  of  cases,  be  prevented  from  doing  this  by  keep- 
ing it  constantly  clean. 

It  is  essential,  in  the  treatment  of  the  disease  under  consideration, 
that  a  decided  impression  be  made  upon  it  at  once ;  consequently,  no 
time  should  be  lost  in  the  removal  of  local  exciting  causes.  "The 
advantage  derived  from  this  operation  "  (extraction  of  dead,  loose,  or 


THE    GUMS.  167 

irritating  teeth),  says  Dr.  Koecker,  "  would  be  either  partly  or  wholly 
lost,  were  it  performed  at  different  periods.'*  This  observation  has 
been  verified  by  the  author  more  than  once.  When  he  has  been  pre- 
vented by  the  timidity  of  his  patient  from  extracting  all  the  offending 
teeth  at  the  first  sitting,  he  has  always  found  the  cure  much  retarded, 
and,  in  some  instances,  almost  entirely  defeated. 

Having  extracted  such  teeth  as  it  may  be  necessary  to  remove,  Dr. 
Koecker  thinks  it  better  to  wait  ten  or  fifteen  days  before  the  tartar  is 
removed.  The  author  has  never  been  able  to  discover  any  advantage 
in  such  delay;  on  the  contrary,  he  regards  it  as  important  that  as 
much  as  possible  should  be  taken  from  the  teeth  at  the  time  of  the 
extraction.  Several  sittings,  however,  are  often  required  for  its  com- 
plete removal. 

The  bleeding  from  the  gums  and  sockets,  occasioned  by  these  several 
operations,  should  be  promoted  by  frequently  washing  the  mouth  with 
warm  water ;  and  when  the  gums  are  much  swollen,  advantage  will  be 
derived  from  scarifying  them  freely  every  three  or  four  days  with  a 
sharp  lancet.  This  last  operation  is  highly  recommended  by  Hunter, 
Fox,  and  Bell,  and,  indeed,  its  good  effects  are  so  apparent  that  it 
should  never  be  neglected. 

The  cure  may  be  hastened  by  washing  the  mouth  several  times  a 
day  with  some  tonic  and  astringent  lotion.  The  author  has  found  the 
following  to  be  very  serviceable : 

R.  Powdered  nutgalls, 

"        Peruvian  bark,       each,  2  drachms. 
"         Orris  root,  1  drachm. 

Infusion  of  roses,  4  fluidounces. 

The  infusion  to  stand  for  a  day  or  so  upon  the  powders,  with  frequent  stirring; 
then  decant  and  filter. 

In  mild  cases  of  inflammation  of  the  gums  and  mucous  membrane 
of  the  mouth,  iodine  in  glycerine  —  saturated  solution  —  is  an  excellent 
application.  For  acute  inflammation  of  the  mucous  membrane,  the 
following  recipes  will  prove  very  serviceable  as  gargles : 


R. 

Potassse  chloras, 

Sodae  boras. 

aa 

3i- 

Aquae, 

§ij.-M. 

B- 

Potassse  chloras, 

Alumina  sulphas, 

aa 

■  7is- 

Aquae, 

giv.  —  M 

B. 

Acidum  tannicum, 

33- 

Potassse  chloras, 

•m 

Mel.  rosa, 

li- 

Aqua  bulliens, 

Oj.  — M. 

168 


THE 

GUMS. 

.  Aqua  cologn, 

IJ. 

Tincture  capsici  comp., 

33- 

Sodae  boras, 

3U- 

Tinct.  cinchonse, 

Su- 

Tinct.  pyrethri, 

li- 

Aqua, 

S''J- 

—  M. 

—  Garretson. 

We  have,  in  cases  where  there  was  much  soreness  and  ulceration  of 
the  gums,  prescribed  the  following : 

R.  Borax,  2  scruples. 

Honey,  1  fluidounce. 

Sage  tea,  4  fluiJounces. 

This  is  a  favorite  and  very  general  domestic  remedy,  and  will  be  found  very 
soothing  and  healing. 

For  ulceration  of  the  gums  and  mucous  membrane  of  the  mouth, 
the  following  will  prove  excellent  applications: 

R.  Acid  carbolic,  ^ss. 

Glycerina,  3^^- — ^I- 

R.  Sodfe  boras,  gij. 

Glycerina,  gj. 

Aquae,  ^^iv.  —  M. 

R.  Acid  carbolic,  gtt.v. 

Glycerina,  §j.  . 

01.  caryophylli,  gtt.v.  —  M. 

R.  Sodffi  sulphis,  ^j. 

Glycerina,  3J.  —  M. 

As  a  wash  for  the  mouth.  Dr.  Fitch  recommends  a  decoction  of  the 
green  inner  bark  of  white  oak,  which  we  have  found  beneficial.  The 
following  are  recommended  by  Dr.  Koecker  as  being  very  serviceable : 

"  Take  of  clarified  honey,  three  ounces,  and  of  vinegar  one  ounce. 
This,  diluted  in  the  proportion  of  three  table-spoonfuls  to  a  pint  of 
warm  sage  tea,  or  water,  may  be  used  frequently  during  the  day.    -. 

"  Take  of  clarified  honey,  and  of  the  tincture  of  bark,  two  ounces 
each.     Mix  and  dilute  as  above. 

"  Take  of  honey,  and  of  the  tincture  of  myrrh,  two  ounces  each. 
Mix  and  use  as  above." 

Mr.  Bell  recommends  the  following : 

R.  Alum,  2  drachms. 

Decoction  of  Peruvian  bark,        2  fluidounces. 
Infusion  of  roses,  2     "  " 

But  when  the  last  prescription  is  used,  the  mouth,  immediately 


THE    GUMS.  169 

after,  should  be  thoroughly  washed  with  water  and  a  soft  brush,  to 
prevent  the  sulphuric  acid  of  the  alum  from  exercising  a  hurtful 
effect  upon  the  teeth. 

For  soft,  swollen,  and  spongy  gums,  the  French  preparation  known 
as  Ph^nole  Sodique —  phenate  of  soda  —  a  teaspoonful  to  a  tumbler  of 
water,  will  prove  beneficial. 

The  pleasantest,  and  at  the  same  time  the  most  efficacious,  mouth- 
wash which  the  author  has  ever  employed  is  the  following : 


South  American  soap  bark, 

8  ounces, 

Pyrethrum, 

Orris  root, 

-r,         .         ■  I    y  each, 

Benzoic  acid,              ' 

1  ounce. 

Cinnamon, 

Tannic  acid. 

4  drachms. 

Borax, 

4  scruples. 

Oil  of  wintergreen, 

2  fluiddrachms. 

Oil  of  peppermint, 

4 

Cochineal, 

3  drachms. 

White  sugar, 

1  pound. 

Alcohol, 

3  pints. 

Pure  water, 

5      " 

Mix  the  ingredients  thoroughly  ;  digest  for  six  days,  and  filter. 

If,  notwithstanding  the  use  of  the  means  here  recommended,  matter 
still  be  discharged  from  around  the  necks  of  the  teeth,  and  should  the 
gums  continue  spongy,  and  manifest  no-  disposition  to  heal,  their  edges 
may  be  touched  with  a  strong  solution  of  the  nitrate  of  silver.  This 
will  seldom  fail  to  impart  to  them  a  healthy  action.  It  may  be  used 
in  the  proportion  of  from  three  to  twelve  grains  to  one  ounce  of  water. 
The  most  convenient  mode  of  applying  it,  is  with  a  carael's-hair  pencil. 
Its  use  is  recommended  by  Mr.  Fox,  and  will  often  succeed  when  other 
remedies  fail.  In  those  cases  where  the  matter  discharged  from  tbe 
edge  of  the  gum  has  a  nauseating  and  disagreeable  odor,  "  a  weak 
solution,"  says  he,  "is  an  excellent  remedy  for  rendering  the  mouth 
sweet  and  comfortable ; "  but  in  using  it  in  this  way,  precaution  is 
necessary  to  prevent  it  from  getting  into  the  fauces,  as,  in  this  case,  it 
will  cause  disagreeable  nausea.  An  excellent  disinfectant,  in  such 
cases,  is  a  gargle  made  by  diluting  a  teaspoonful  of  chlorinated  soda 
(Labarraque's  solution)  in  four  or  eight  ounces  of  water.  Or  it  may 
be  used  much  stronger,  and  applied  with  a  small  mop  to  the  diseased 
parts;  the  silver  nitrate  may  be  applied  in  the  same  wav. 

While  the  means  here  directed  for  the  cure  of  the  disease  are  being 
employed,  a  recurrence  of  its  exciting  causes  must  be  studiously 
guarded  against.  Tartar  and  foreign  matter  of  every  kind  should  be 
prevented  from  accumulating  on  the  teeth,  by  a  free  and  frequent  use 


170  THE    GUMS, 

of  a  suitable  brush  and  waxed  floss-silk,  until  a  healthy  action  be 
imparted  to  the  gums  ;  these  should  be  used  at  least  five  times  a  day. 
immediately  after  rising  in  the  morning,  after  each  meal,  and  before 
retiring  at  night.  The  aj)plication  of  the  brush  may  at  first  occasion 
some  pain  ;  but  its  use  should  nevertheless  be  persisted  in,  for,  without 
it,  all  the  other  remedies  will  be  of  little  avail.  The  friction  produced 
by  it,  besides  keeping  the  teeth  clean,  is  of  great  service  to  the  gums, 
in  imparting  to  them  a  healthy  action. 

Treatment,  different  from  that  here  described,  is  necessary  in  that 
form  of  disease  which  we  noticed  as  being  characterized  by  preter- 
natural paleness  and  discharge  of  muco-purulent  matter  from  between 
the  edge  of  the  gum  and  the  neck  of  the  tooth.  In  the  first  case  of 
this  disease  treated  by  the  author,  he  directed  astringent  and  detergent 
lotions  to  be  used ;  but  these  did  not  produce  the  desired  effect. 
Having  been  led  from  his  observation  in  this  case,  to  suspect  that  the 
disease  was  connected  with  some  constitutional  derangement,  and  was 
probably  the  result  of  a  debilitated  condition  of  the  general  system, 
he  recommended,  in  the  next  case,  the  use  of  tonics  and  free  exercise 
in  the  open  air.  This  course,  though  attended  with  evident  improve- 
ment of  the  general  health,  seemed  to  be  productive  of  no  benefit  to 
the  gums.  They  still  appeared  debilitated,  and  on  being  pressed  dis- 
charged matter  from  beneath  their  edges.  He  advised  a  continuance 
of  the  tonics  and  exercise,  and,  with  a  view  of  exciting  inflammation, 
touched  the  edges  of  the  gums  with  nitrate  of  silver.  This  had  the 
desired  eflTect,  and,  as  he  had  anticipated,  a  new  disease  was  substituted 
for  the  old  one ;  for  the  cure  of  which  he  directed  the  mouth  to  be 
washed,  five  or  six  times  a  day,  with  the  mixture  of  sage  tea,  alum,  and 
honey,  and  at  night  and  morning  with  salt  water. 

This  treatment  was  perfectly  successful.  In  about  three  weeks  the 
gums  assumed  a  healthy  appearance,  acquired  their  natural  color,  and 
the  discharge  of  muco-purulent  matter  entirely  ceased.  He  has  since 
had  occasion  to  treat  several  other  cases,  in  all  of  which  he  adopted 
the  same  treatment,  and  -with  like  success. 

HYPERTROPHY,  OR  MORBID  GROWTH  OF  THE  GUMS. 

The  structural  changes  which  take  place  in  the  gums,  as  a  con- 
sequence of  increased  vascular  action,  are  almost  as  various  as  are  the 
constitutional  tendencies  of  diflferent  individuals.  Those  characterizing 
the  affection  last  noticed  consist,  for  the  most  part,  in  increased  thick- 
ness and  recession  of  their  edges  from  the  necks  of  the  teeth ;  but  in 
the  one  of  which  we  are  now  about  to  treat,  there  is  morbid  growth, 
which  is  sometimes  so  considerable,  that  it  almost  covers  the  crowns 
of  the  teeth,  thus  interfering  very  seriously  with  the  function  of  masti- 


THE    GUMS. 


171 


cation.  When  thus  affected,  the  gums  have  a  dark  purj^le  color,  with 
thick,  smooth  and  rounded  margins ;  and  discharge  almost  constantly 
from  their  inner  surface  a  thin,  purulent  matter,  which  exhales  an 
exceedingly  offensive  odor.  They  bleed  profusely  from  the  slightest  in- 
jury, and  are  so  sensitive  that  the  pressure  even  of  the  lips  is  sometimes 
attended  with  pain.  They  are  also  affected  with  a  peculiar  itching 
sensation,  which  at  times  is  a  source  of  great  annoyance. 

The  accompanying  engraving  (Fig.  41)  will  convey  to  the  reader  a 
more  correct  idea  of.  the  ap- 
pearance of  the  gums,  when  *^" 
thus  affected,  than  any  de- 
scription which  can  be  given. 
It  will  be  perceived  from  this 
that  the  morbid  growth  extends 
to  the  gums  of  all  the  teeth,  as 
it  usually  does  in  this  varietj' 
of  diseased  action. 

Among  the  local  and  consti- 
tutional effects  arising  from  the 
disease  are  offensive  breath, 
vitiated   saliva,  destruction  of 

the  alveoli,  with  loosening  and  ultimate  loss  of  the  teeth,  impaired 
digestion,  with  all  its  disagi-eeable  concomitants,  enlargement  of  the 
tonsils,  and  bronchitis,  together  with  a  long  train  of  other  phenomena. 


CAUSES. 

The  exciting  cause  of  this  peculiar  affection  is  local  irritation,  pro- 
duced by  salivary  calculus,  dead,  diseased,  or  irregularly  arranged 
teeth ;  but  the  character  of  thfe  structural  alteration  is  evidently  de- 
termined by  some  cachectic  habit  of  body  or  constitutional  ten- 
dency. It  often  attacks  the  gums  of  individuals  whose  teeth  are 
sound  and  well  arranged ;  but  the  author  has  never  met  with  a  case  in 
which  tartar  was  not  present ;  though,  in  some  instances,  the  quantity 
was  so  small  as  almost  to  lead  one  to  doubt  whether  it  could  have  had 
much  agency  in  the  production  of  the  disease.  But  the  susceptibility 
of  the  gums  to  morbid  impressions,  in  individuals  liable  to  this  affec- 
tion, is  usually  so  great,  that  an  irritant,  which  under  other  circum- 
stances would  scarcely  excite  an  increase  of  vascular  action,  gives  rise, 
in  cases  of  this  sort,  to  the  rapid  development  of  an  aggravated  form 
of  disease. 

TREATMENT. 

The  first  thing  to  be  attended  to  in  the  treatment  of  the  disease  is 
the  removal  of  all  dead  teeth,  and  such  others  as  may  in  any  way  irri- 


172  THE    GUMS. 

tate  the  gums.  The  morbid  growtli  should  be  next  removed,  by 
making  an  horizontal  incision  entirely  through  the  diseased  gums  to 
the  crowns  of  the  teeth.  This  should  be  carried  so  far  back  as  the 
morbid  growth  extends.  After  this,  the  gums  should  be  freely  scari- 
fied by  passing  a  lancet  between  the  teeth  down  to  the  alveoli,  in  order 
that  the  vessels  may  be  completely  divided,  and  discharge  their  accu- 
mulated blood.  This  should  be  repeated  several  times,  at  intervals 
of  four  or  five  days.  Meanwhile  the  mouth  may  be  washed  three  or 
four  times  a  day  with  some  astringent  and  detergent  lotion,  and  oc- 
casionally mopped  with  a  weak  solution  of  nitrate  of  silver.  Phenol 
Sodique  — Phenate  of  Soda  —  either  in  its  full  strength  or  diluted  with 
from  one  to  twelve  times  its  bulk  of  water,  according  to  indications, 
proves  very  serviceable  as  a  lotion,  causing  the  rapid  absorption  of  the 
extravasated  blood,  preventing  fetor,  and  speedily  healing  and  harden- 
ing the  gums.  The  tartar  should  be  removed  as  soon  as  the  gums  have 
sufiiciently  collapsed  to  admit  of  the  operation. 

The  progress  of  the  disease  may  be  arrested,  but  a  cure  cannot  be 
eflTected  by  local  treatment  alone.  Particular  attention  should  be  paid 
to  the  regimen  of  the  patient,  and  such  general  remedies  prescribed  as 
the  peculiar  nature  of  the  case  may  indicate.  Excess  and  intemper- 
ance of  every  kind  must  be  avoided.  In  cases  of  an  inflammatory 
type,  the  diet  should  be  chiefly  vegetable ;  but  where  there  is  debility, 
or  other  cachexia,  animal  food  should  be  used,  taking  care  to  avoid  all 
young  meats,  as  veal  or  lamb,  all  gross  meats,  such  as  pork,  and  all 
salt  meats  or  shell-fish.  Fruits  and  acid  beverages,  such  as  infusions 
of  malt  and  vinegar,  lemon-juice,  spruce  beer,  etc.,  may  be  used  with 
advantage. 

The  teeth  should  be  kept  perfectly  and  constantly  clean.  Not  a 
particle  of  foreign  matter  should  be  permitted  to  remain  between  them 
or  along  the  edges  of  the  gums.  A  scrupulous  attention  to  this  pre- 
caution is  indispensably  necessary,  as  it  constitutes  one  of  the  most 
important  remedial  indications. 

MERCURIAL   INFLAMMATION   OF   THE   GUMS. 

Small  and  repeated  doses  of  mercury,  when  carried  to  the  point  of 
salivation,  frequently  give  rise  to  the  development  of  peculiar  morbid 
phenomena  in  the  gums  and  other  parts  of  the  mouth.  The  first 
indication  of  the  specific  action  of  this  powerful  medicinal  agent  upon 
the  animal  economy  consists  in  a  slightly  increased  redness  and  tume- 
faction of  the  free  edge  of  the  gums  around  the  necks  of  the  inferior 
incisors.  There  is  a  characteristic  bluish  color  along  the  edge  of  the 
gums,  while  the  investing  mucous  membrane  of  the  adherent  portion, 
a  little  lower  down,  often  assumes  a  white  color,  owing  to  the  opacity 


THE    GUMS.  173 

of  the  epithelium.  These  appearances  are  followed  by  increased 
secretion  of  saliva  ;  a  strong  metallic  taste  ;  soreness  of  the  teeth  and 
gums;  inflammation  and  swelling  of  the  mucous  membrane  of  the  roof 
of  the  mouth,  fauces  and  cheeks,  and  the  salivary  glands ;  swelling  of 
the  tongue,  with  increased  redness  of  its  edges,  and  a  peculiarly  oifen- 
sive  odor  of  breath.  In  the  mean  time,  the  edges  of  the  gums  about 
the  necks  of  the  teeth  swell  and  assume  an  increase  of  redness ;  the 
saliva  becomes  viscid,  and  is  secreted  in  such  abundance  as  to  flow  from 
the  mouth,  and  the  movements  of  the  jaws  are  attended  with  pain. 
The  alveolo-dental  periosteum  is  thickened,  and  the  teeth  raised  from 
their  sockets  and  loosened.  A  vesicular  eruption  sometimes  appears, 
followed  by  ulceration  and  sloughing  of  the  gums,  and  very  frequently 
by  necrosis  of  large  portions  of  the  alveolar  process  and  maxilla.  We 
were  showu,  a  few  years  since,  the  entire  alveolar  border  of  both  jaws, 
the  necrosis  and  exfoliation  of  which  had  been  occasioned  by  severe 
mercurial  salivation;  and  we  have  frequently  had  occasion  to  remove 
portions  both  of  the  superior  and  inferior  maxillary  bones  —  the  nec- 
rosis having  been  occasioned  by  the  use  of  this  medicine. 

By  the  prudent  administi'ation  of  mercury,  salivation  may  be  in- 
duced, without  causing  the  deplorable  effects  just  described.  But  the 
specific  action  of  this  agent  upon  the  constitution  is  always  attended 
by  more  or  less  tumefaction  and  sponginess  of  the  gums,  and  when 
once  brought  under  its  influence,  however  perfectly  its  effects  may 
have  subsided,  they  are  ever  after  more  susceptible  to  morbid  impres- 
sions. Again,  it  should  be  remembered  that  very  many  of  these  de- 
plorable symptoms  follow  the  use  of  mercurials  even  where  there  is  no 
intention  to  salivate.  It  is  a  powerful  agent,  capable  of  much  good ; 
but  one  which  has  been  productive  of  untold  mischief,  especially  upon 
the  mouth  and  teeth.  Doubtless  life  must  be  saved  at  the  expense,  if 
necessary,  of  the  teeth.  But  the  peculiar  specific  action  of  this  medi- 
cine should  forbid  its  constant  and  indiscriminate  employment. 

TREATMENT. 

It  is  scarcely  necessary  to  say,  that  until  the  use  of  the  mercury  is 
discontinued,  it  will  be  impossible  to  control  or  even  counteract  its 
effects  upon  the  gums;  but  in  mild  cases  these  usually  soon  disappear 
after  the  action  which  it  has  produced  on  the  general  system  has  com- 
pletely subsided.  When  the  gums  continue  spongy,  the  bowels  should 
be  kept  open  with  Seidlitz  powders  or  other  saline  cathartics,  the 
patient  restricted  to  a  fluid  farinaceous  diet,  and  the  mouth  gargled 
several  times  a  day  with  mild  astringent  lotions,  to  which  it  may  some- 
times be  advisable  to  add  a  little  laudanum.  Benefit  may  be  derived 
from  the  application  of  the  officinal  tincture  of  iodine  in  a  solution 


174  THE    GUMS. 

composed  of  one-half  water.  For  internal  use,  chlorate  of  potash  and 
iodide  of  potassium  are  considered  the  best  remedies  in  mercurial  poi- 
soning. 

The  chlorate  of  potash  is  also  of  very  great  service  as  a  lotion  in  the 
strength  of  one  drachm  to  the  ounce  of  water. 

For  internal  use,  ten  grains  of  the  chlorate  of  potash  may  be  dis- 
solved in  a  half  ounce  of  water,  and  administered  in  four  or  five  doses 
during  the  day.  For  an  adult,  Dr.  Garretson  recommends  the  following 
lotion  as  very  beneficial  in  cases  where  the  tumefaction  is  very  great 
and  indolent  looking : 

R.   Potassoe  chloras,  3SS. 
Sod-je  boras, 

Alumen  pulv.,  aa  ^ij. 

Potass,  permang  ,  grs.  xxv. 

Aqua  cologn.,  ^ss. 

Tinct.  cinchonte,  5!.]. 

Tinct.  niyrrhoe,  5J. 
Infus.  quercus  (fort.),  ^iv. — M. 
Sig.     Gargle  the  mouth  pro  re  nata. 

The  iodide  of  potassium  may  be  given  in  doses  of  from  three  to  five 
grains,  three  times  a  day,  in  some  bitter  infusion. 

The  following  gargle  will  be  found  very  serviceable  in  mercurial 
salivation : 

R.  Tinct.  iodinii,  giij  to  vj. 

PotasssB  iodidi,  grs.  xv.  to  xxx. 

Aquae,  Oss. — M. 

After  the  action  of  the  medicine  upon  the  system  has  subsided,  and 
the  disease  assumes  a  chronic  form,  the  gums,  as  directed  by  Mr. 
Thomas  Bell,  should  be  freely  scarified  by  passing  a  lancet  entirely 
through  their  substance  between  the  teeth  ;  and  this  operation  should 
be  repeated  as  often  as  every  few  days,  until  they  are  completely 
restored.  The  use  of  astringent  washes  should  at  the  same  time  be 
continued,  and  if  there  are  any  teeth  which,  from  the  loss  of  their 
vitality,  or  from  having  become  very  much  loosened  by  the  j^artial 
destruction  of  their  sockets,  act  as  irritants,  they  should  be  removed. 

For  correcting  the  fetor  arising  from  the  ulcerated  surfaces,  a  gargle 
may  be  used  composed  of  two  or  three  drachms  of  charcoal  suspended 
by  agitation  in  a  tuml)ler  of  water.  After  retaining  a  portion  of  this 
gargle  for  a  short  time,  the  mouth  should  be  rinsed  with  warm  water 
to  remove  the  particles  of  charcoal. 

A  solution  of  the  permanganate  of  potash,  in  the  strength  of  from  two 
to  ten  grains  to  the  ounce  of  water,  is  also  highly  recommended  as  a 


THE    GUMS.  175 

gargle  for  the  removal  of  the  fetor ;  also  washes  made  from  chlorin- 
ated soda  or  lime. 

ULCERATION   OF   THE   GUMS    OF    CHILDREN    ATTENDED   WITH    EXFOLI- 
ATION  OF   THE    ALVEOLAR   PROCESSES. 

The  gums  and  alveolar  processes  of  children  are  occasionally  at- 
tacked by  a  very  peculiar  form  of  disease,  which  occurs  more  fre- 
quently during  the  shedding  of  the  temporary  and  the  eruption  of 
the  permanent  teeth  than  at  any  other  period  of  childhood.  We  have 
never  known  adults  to  be  affected  with  it,  and  to  the  ordinary  spongy, 
inflamed,  and  ulcerated  gums  it  does  not  appear  to  be  at  all  analogous. 
It  bears  a  much  closer  resemblance  to  cancrum  oris,  yet  differs  in  many 
particulars  from  this  disease. 

Among  the  symptoms  which  characterize  the  affection,  are  itching 
and  ulceration  of  the  gums  and  their  separation  from  the  necks  of  the 
teeth  and  alveoliar  processes  ;  there  is,  at  first,  a  discharge  of  muco- 
purulent matter  from  between  the  gums  and  necks  of  the  teeth,  which 
ultimately  becomes  ichorous  and  fetid.  The  teeth  loosen,  and  the 
alveoli  lose  their  vitality  and  exfoliate.  Ulcers  are  formed  in  various 
parts  of  the  mouth,  and  the  gums  and  lips  assume  a  deep  red  or  purple 
color.  In  the  exfoliation  of  the  alveolar  processes,  the  temporary,  and 
sometimes  the  crowns  of  the  permanent  teeth  are  carried  away.  The 
constitutional  symptoms  are:  skin,  for  the  most  part,  dry;  pulse,  small 
and  quick ;  the  bowels  generally  constipated,  though  sometimes  there 
is  diarrhoea ;  and  to  these  symptoms  may  be  added  lassitude  and  a 
disposition  to  sleep. 

These  may  be  regarded  as  the  prominent  phenomena  of  the  disease 
in  its  most  aggravated  form.  When  exfoliation  of  the  alveolar  pro- 
cesses takes  place,  the  symptoms  usually  abate,  and  sometimes  wholly 
disappear.  Delabarre  says:  "Among  the  great  number  of  children 
that  are  brought  to  the  orphan  asylum,  he  has  had  frequent  occasion 
to  notice  singular  complications  of  the  affection,  as  modified  by  the 
strength,  sex,  and  idiosyncrasies  of  the  different  subjects."  The  gums 
and  lips,  in  some,  he  describes  as  being  of  a  beautiful  red  color ;  in 
others,  the  lips  are  rosy  and  the  gums  pale,  and  sometimes  very  much 
swollen.  He  also  enumerates  among  the  symptoms,  burning  pain  in 
the  mucous  membrane  of  the  cheeks,  and  ulceration,  pain,  and  swell- 
ing in  the  submaxillary  glands. 

In  the  majority  of  cases,  the  disease  is  confined  to  one  jaw  and  to 
one  side,  though  sometimes  both  are  affected  by  it.  The  effect  on  the 
permanent  teeth,  in  all  the  cases  which  have  fallen  under  the  notice 
of  the  author,  was  injurious,  though  Delabarre  says,  that  in  children 
who  have  reached  their  seventh  or  eighth  year,  the  teeth  are  not  in- 


176  THE    GUMS. 

jured,  except  that  they  may  be  badly  arranged,  in  consequence  of  the 
want  of  a  proper  development  of  the  jaw. 

The  author  enumerates  the  following  symptoms  of  a  very  aggravated 
form  of  this  disease :  inordinate  appetite,  burning  thirst,  a  small  spot 
on  the  cheek,  or  about  the  lips,  resembling  an  anthrax,  which  rapidly 
increases  in  size,  turns  black,  separates,  discharges  an  ichorous  fluid, 
and  its  edges  roll  themselves  up  like  flesh  exposed  to  the  action  of  a 
brisk  fire  ;  the  flesh  separates  froui  the  face,  the  bones  become  exposed, 
hectic  fever  ensues,  and  in  the  course  of  fifteen  or  twenty  days  death 
puts  au  end  to  the  sufferings  of  the  child.  Delabarre  asserts  that  this 
affection  is  more  common  among  females  than  males,  and  that  the 
bones  of  the  jaw  are  so  much  softened  that  they  may  be  easily  cut 
Avith  a  knife. 

CAUSES. 

The  disease  seems  to  be  the  result  of  general  debility  or  defective 
nutrition  and  a  cachectic  habit  of  body.  It  never  occurs  among  the 
wealthy,  but  is  always  confined  to  children  of  the  poor  and  destitute, 
and,  so  far  as  the  author's  observations  extend,  to  those  who  reside  in 
cellars  or  small  and  confined  apartments.  Children  of  scorbutic  habit 
seem  to  be  the  most  subject  to  it.  Delabarre,  however,  says  he  has 
met  with  it  in  children  who  appear  robust,  and  in  other  respects  well. 
He  locates  the  seat  of  the  disease  in  the  organs  of  nutrition,  and  in 
the  fluids  that  are  conveyed  to  them.  The  disposition  of  body  which 
gives  rise  to  it  he  mentions  as  being  sometimes  innate,  sometimes  the 
result  of  a  want  of  proper  nourishment.  He  does  not  think  it  arises 
from  the  specific  affection  of  any  separate  organ. 

From  the  great  debility  of  all  the  organs  of  the  body,  their  functions 
are  languidly  and  imperfectly  performed.  That  the  disease  is  deter- 
mined by  general  enfeeblement  of  the  functions  of  the  body,  there  is, 
we  think,  little  doubt ;  but  whether  it  would  develop  itself  indepen- 
dently of  any  local  cause,  is  a  question  which  we  do  not  feel  ourself  able 
satisfactorily  to  answer.  It  is  not  at  all  improbable  that  local  irritants 
are  the  exciting  cause ;  and  we  are  the  more  inclined  to  this  belief 
from  the  fact,  that  in  all  the  cases  which  have  fallen  under  our  obser- 
vation, the  teeth  were  considerably  decayed,  and  had  previously  given 
rise  to  pain  ;  and  in  some  instances  they  were  coated  with  tartar. 
While,  therefore,  the  character  of  the  affection  is  determined  by  some 
peculiar  constitutional  tendency  and  general  enfeeblement  of  the  vital 
powers  of  the  body,  it  is  not  unlikely  that  local  irritation  is  the  imme- 
diate cause  of  its  development. 


THE    GUMS.  177 

TREATMENT. 

As  the  treatment  of  this  affection  comes  more  immediately  within 
the  province  of  the  medical  than  of  the  dental  practitioner,  we  shall 
not  dwell  long  upon  the  subject. 

The  local  treatment  should  consist  of  acidulated  and  astringent 
gargles,  and  a  chlorinated  solution  of  lime  or  soda.  The  ulcerated 
parts  may  be  occasionally  touched  with  a  strong  solution  of  the  nitrate 
of  silver,  and  Delabarre  says  he  has  in  some  cases  derived  great  ad- 
vantage from  touching  them  with  the  actual  cautery.  As  soon  as  the 
alveolar  process  exfoliates,  it  should  be  removed.  After  this  takes 
place,  a  cure  is  generally  speedily  effected  under  proper  constitutional 
treatment.  This  last  may  consist  of  mild  alteratives,  a  generous  nu 
tritive  diet,  consisting  of  succulent  vegetables,  and,  in  the  absence  of 
fever,  wholesome  meats,  tonics,  and  exercise  in  the  open  air.  (See 
"  Ulcerative  Stomatitis.") 

ADHESION   OF   THE   GUMS   TO   THE    CHEEKS. 

The  gums  and  inner  walls  of  the  cheeks  sometimes  contract  adhe- 
sions which  interfere  seriously  with  the  functions  of  the  mouth.  The 
affection  may  be  congenital,  but  in  the  majority  of  the  cases  it  occurs 
subsequently  to  birth.  The  extent  of  the  adhesion  may  be  small,  or  it 
may  occupy  the  gums  of  the  entire  alveolar  border  of  one  or  both 
sides  of  the  mouth,  and  of  one  or  both  jaws.  Desirabode  relates  the 
case  of  a  young  man,  who,  in  consequence  of  a  venereal  ulcer,  had 
his  upper  lip  united  to  the  gums  of  the  four  incisors  in  such  a  Avay  as 
to  form  a  sort  of  loop  above  the  teeth,  which,  by  the  retraction  of  the- 
lip,  were  caused  to  project  outward.* 

Adhesion  of  the  gums  to  the  cheeks  or  lips  results  from  ulceration 
caused  either  by  constitutional  disease  or  local  lesions.  But  that  it 
arises  more  frequently  as  a  consequence  of  the  immoderate  use  of 
mercury  than  from  any  other  cause,  is  a  universally  admitted  fact. 
The  author  has  met  with  several  cases,  however,  in  which  the  affection 
had  resulted  from  ulceration  of  the  gums  around  necrosed  temporary 
teeth,  and  of  the  corresponding  wall  of  the  cheek,  caused  by  excoria- 
tion of  the  mucous  membrane,  produced  by  the  sharp  points  of  the 
proti'uding  roots.  But  the  extent  of  the  adhesion,  in  cases  of  this 
sort,  is  never  very  considerable. 

The  proper  remedy  is  to  separate  the  parts  which  have  grown 
together  with  a  sharp  bistoury.  This  done,  reunion  should  be  pre- 
vented by  keeping  a  pledget  of  cotton  or  lint  in  the  wound,  until  the 
process  of  cicatrization  is  completed. 

*  Author's  trnnslation  of  Desirabode's  "Complete  Elements  of  the  Science  and- 
Art  of  the  Dentist,"  p.  227. 
12 


178  THE    GUMS. 

TUMORS   OF   THE   GUMS   AND   JAWS. 

Tumors  of  the  gums  are  of  various  kinds ;  some  interesting  cases 
of  simple  hypertrophy  are  reported  by  Dr.  Gross  and  Mr.  Salter  and 
Mr.  Erichsen,  which  are  reproduced  by  Mr.  Heath  in  his  admirable 
"  Essay."  Mr.  Salter's  case  was  found  to  consist  of  a  pinkish,  corru- 
gated, and  lobcd  mas^s,  composed  of  an  expansion  of  the  alveolus, 
with  "immense  hypertrophy  of  the  fibrous  gum,  and  an  exuberant 
growth  of  the  papillae  of  the  mucous  membrane."  Dr.  Gross'  case 
was  somewhat  similar.  Mr.  Erichsen's  was  found  "  on  section  to  con- 
sist of  a  firm,  fibrous  stroma,  containing  much  glandular  tissue  in  its 
interstices,  and  covered  on  its  surface  by  very  large  and  vascular 
papillie.  The  epithelial  layer  was  of  unusual  thickness,  but  no  abnor- 
mal epithelial  structures  were  found  in  the  growth,  which  was  an 
example  of  true  hypertrophy."     (Heath's  "  Jacksonian  Essay,"  190.) 

A  peculiarity  of  this  case  was  that  the  teeth  were  also  hypertrophied. 
In  each  of  these  cases  the  diseased  tissue  was  removed  and  the  ex- 
posed surface  cauterized. 

Polypus  is  a  simple  hypertrojihy  of  the  interdental  gum,  or  dental 
pulp,  and  is  generally  occasioned  by  the  irritation  of  a  worn-out  or 
broken  tooth  with  a  ragged  edge.  In  structure  they  are  like  the  gum 
from  which  they  arise.  They  seldom  give  much  pain,  excejit  ulcera- 
tion should  take  place.  If  simply  cut  away,  they  are  very  likely  to 
return ;  but  if  the  tooth  is  removed,  and  astringent  or  cauterant  ap- 
plications be  made,  they  give  but  little  trouble. 

Continuous  pressure,  by  gutta  percha  or  other  means,  will  also  con- 
trol them. 

Mr.  Salter  reports  two  cases  of  "  Papillary  Tumors  of  the  Gums," 
consisting  almost  entirely  of  epithelium,  arranged  in  filiform  papillae 
resembling  those  of  the  tongue.  It  is  described  as  "a  curious  white 
mass,  consisting  of  coarse,  detached  fibres,  pointed  and  free  at  one  ex- 
tremity and  attached  at  the  other ;  in  fact,  it  was  a  mass  of  papillae, 
many  of  them  nearly  an  inch  long,  and  similar  in  shape  to  the  '  fili- 
form' papillae  of  the  tongue;  their  surface  was  shreddy  and  broken; 
among  the  elongated  processes  were  a  few  rounded  eminences  like 
'fungiform'  papillae,  and  these  had  a  smooth  and  broken  surface." 

The  term  Epulis  is  usually  applied  to  tumors  springing  from  the 
margin  of  the  gums,  whatever  their  structural  character.  They  most 
commonly  spring  from  the  gum  between  two  teeth ;  as  they  continue 
to  grow,  the  base  may  increase  also  in  size,  till  it  covers  the  alveolar 
bone,  or  it  may  undergo  superficial  development,  the  point  of  attach- 
ment undergoing  but  little  change ;  in  other  words,  it  may  possess  a 
broad,  flattened  base  or  a  narrow  pedicle.  In  structure  it  bears  a 
close  resemblance  to  the  gum,  and  sometimes  has  imbedded  in  it  spi- 


THE    GUMS.  179 

culse  of  bone,  whicli  may  have  been  detached  from  the  alveolar  bone, 
constituting  the  source  of  irritation  which  gave  rise  to  the  morbid 
growth ;  or  it  may  have  been  a  true  osseous  development,  a  portion  of 
germinal  matter,  having  escaped  from  its  true  osseous  relation,  has 
been  here  arrested,  established  a  false  centre  of  growth,  and  undergone 
development,  in  obedience  to  the  primitive  impulse  of  the  parent  cell 
from  which  it  was  derived. 

The  accompanying  figure,  from  Mr.  Heath,  is  a  typical  epulis  of  the 
most  common  variety.     It  is  seen  to  Fig.  42. 

be  a  "firm,  fibrous  tumor,"  with  "  some  (Fig.  90  of  "  Heath  on  the  Jaws.") 
fibro-plastic  cells  intermingled."  This 
variety  of  epulis  is  not  unusually  at- 
tached to  the  periosteum  of  the  alve- 
olus, with  projecting  spicules  of  bone 
entering  it  from  the  maxilla. 

Left  to  themselves,  these  tumors  will 
often  continue  to  grow,  encroaching 
upon  the  tongue,  hard  palate,  and 
teeth.     They  are  thus   made  liable  to 

injury  by  the  teeth,  and  an  ulcerated  surface  is  in  this  way  established, 
which  discharges  freely,  occasions  considerable  pain,  and  may  become 
the  seat  of  hemorrhage. 

A  softer  and  more  vascular  variety  is  described  by  Mr.  Hutchinson 
as  consisting  of  fibrous  tissue,  in  which  are  imbedded  a  large  number  of 
polynucleated  cells  of  the  myeloid  variety.  In  the  "  Transactions  of 
the  Pathological  Society,"  he  thus  describes  them:  "The  epulis  pre- 
sented all  the  characters  of  myeloid  growth  in  a  most  remarkable 
degree.  Its  section  was  very  vascular,  and  showed  hues  varying  from 
a  deep  red  to  buflf,  and  a  peculiar  light-greenish  tint  of  yellow  (xan- 
thoid  of  Lebert).  Scattered  in  its  structures  were  some  detached 
masses  of  soft,  spongy  bone.  Under  the  microscope  were  seen  abun- 
dance of  the  large  polynucleated  bodies  characteristic  of  these  growths, 
many  of  them  being  very  irregular  in  shape  and  much  branched." 
This  form  of  epulis  is  most  frequently  connected  with  the  interior  of 
the  alveolus,  and  hence  more  closely  resembles  the  endosteal  structures. 
When  presenting  an  ill-conditioned  and  ulcerated  surface,  it  closely  re- 
sembles a  malignant  growth,  but  does  not,  as  has  been  thought  by  some 
writers,  pass  into  cancer. 

Mr.  Heath  also  describes  a  variety  which  he  calls  "  Giant-celled 
Epulis,"  consisting  of  "large,  irregular,  disc-like  cells  containing  nu- 
merous beard-like  nuclei  interspersed  among  the  fibrous  tissue."  It 
presents  a  surface  of  uniform  smoothness,  of  a  dark-gray  color,  with 
numerous  purple  spots  upon  it.     He  considers  it  as  holding  a  position 


180  THE    GUMS. 

intennediate  betweca  "fibro-cellular  and  myeloid  tumors,"  and  of  a 
similar  nature  to  the  gro.wths  described  by  Otto  Weber  as  "giant-celled 
sarcoma,"  and  as  a  "  fibrous  form  of  cancer  arising  from  bone,"  by 
Wedl. 

Another  form  of  epulis,  resembling  epithelioma,  and  of  interest,  as 
showing  that  epitliclioina  may  be  developed  in  the  gum  as  elsewhei'e, 
is  thus  desc-rilied  in  a  report  by  Mr.  Bruce  to  Mr.  Heath  : 

"  The  surface  of  the  tumor  is  covered  with  healthy  mucous  mem- 
brane. The  interior  of  the  tumor  is  whiter,  firmer,  and  more  compact 
than  the  surface,  but  there  is  no  line  of  demarcation  between  the  tumor 
and  its  mucous  covering.  The  structure  of  the  growth  is  distinctly 
glandular,  very  much  resembling  some  form  of  compact  adenoid  tumor 
of  the  breast. 

"  At  the  point  of  attachment  of  the  tumor  to  the  parts  beneath,  a 
remarkable  transformation  of  the  glandular  into  the  epitheliomatous 
structure  is  seen.  In  one  part  of  the  section  may  be  seen  the  cut  ends 
of  gland  tubules,  whilst  in  their  immediate  neighborhood  are  most  dis- 
tinct nests  of  true  epithelioma,  consisting  evidently  of  concentrically 
arranged  cells  compressed  from  the  centre  upward." 

Mr.  Adams  reports  a  similar  case  which  resulted  in  death,  the  dis- 
ease having  reappeared  in  the  skin  after  its.  removal. 

It  is  often  difficult  to  determine  the  causation  of  epulis,  but  they 
mav  often  be  referred  to  the  irritation  of  broken  or  unsound  teeth,  or 
to  fragments  of  the  alveolar  bone  which  become  detached,  or  to  out- 
growths from  the  alveolus;  most  frequently,  however,  to  roots  of 
decayed  teeth ;  hence  ]\Ir.  Heath  thinks  the  greater  frequency  of  these 
tumors  in  women  —  five  to  three, — they,  having  a  greater  dread  of  all 
surgical  operations,  are  more  likely  to  permit  useless  roots  to  remain 
in  their  mouths. 

It  is  rarely  fotal,  but  sometimes  attains  such  size  as  to  produce  great 
deformity,  pain,  and  embarrassment  of  the  functions  of  mastication 
and  deglutition. 

TREATMENT. 

For  the  treatment  of  epulis,  nothing  short  of  the  entire  removal  of 
the  tumor  with  its  periosteal  attachments,  together  Avith  all  decayed 
teeth,  or  even  sound  ones  —  when  the  disease  seems  inclined  to  repro- 
duce itself —  promises  any  good  result.  After  excision,  the  actual 
cautery  should  be  freely  applied  for  the  double  purpose  of  destroying 
all  trace  of  the  disease  and  of  arresting  hemorrhage. 

Tumors  of  the  hard  palate  are  closely  related  to  epulis,  and  papil- 
lary and  epithelial  forms  are  reported  —  the  former  presenting  but  little 
tliflerence  from  tumors  of  the  same  character  arisinsr  on  the  gum. 


THE    GUMS.  181 

An  epithelial  tumor  occurring  on  the  hard  palate  is  reported  by  Dr. 
Andrew  Clark,  which  was  described  as  "  soft,  elastic,  and  vascular. 
The  cut  surface  is  of  a  dead-white  color,  distinctly  granular,  like  rough 
honey,  crumbly-looking,  and  studded  with  red  or  pink  blotched  parts 
sunk  below  the  general  level.  On  further  examination,  it  appears 
to  be  permeated  by  a  kind  of  glairy  substance  (colloid  matter),  which 
helps,  seemingly,  to  give  coherence  to  the  tumor.  To  the  naked  eye 
the  tumor  resembles  in  some  respects  a  cephaloidor  myeloid  mass.  To 
the  latter  it  bears  the  greatest  resemblance  in  general  character,  seat, 
and  structure.  The  microscopic  characters  are  those  of  epithelia,l  can- 
cer, epithelial  cells  in  all  stages  of  development  and  of  the  most 
various  forms,  together  with  a  few  nest-cells  and  fat.  The  mucous 
membrane  over  the  tumor,  though  not  continuous  with  it,  presents  the 
same  structural  characters.  This  decides  the  doubt  between  the  epi- 
thelioma and  myeloma." — (Heath's  "  Jacksonian  Essay,"  p.  208.) 

Encysted  tumors  of  the  hard  palate  are  also  sometimes  found,  but  they 
are  rare,  and  require  no  special  description  in  a  work  of  this  character. 

These  tumors,  when  epuloid  in  character,  are  to  be  treated  in  the 
manner  already  described.  When  the  bone  becomes  affected,  it  also 
must  be  removed  to  such  an  extent  as  will  leave  an  entirely  healthy 
surface. 

CYSTIC   DISEASES   OF   THE   ANTRUM   AND   TEETH. 

It  must  be  remembered,  in  connection  with  diseases  of  the  antrum, 
that  it  is  of  variable  size,  with  walls  of  variable  tbickness.  In  youth 
the  walls  are  thick  and  the  cavity  small.  After  attainingits  maximum 
size  in  the  adult,  it  is  found  ae:ain  to  diminish  with  old  age:  it  is  larg-er 
(a  males  than  in  females.  But  in  adult  life  its  capacity  varies  in  dif- 
ferent subjects  from  one  drachm  to  eight  drachms,  the  average  c-apacity 
being  about  two  and  a  half  drachms. 

Suppurative  inflammation,  or  abscess  of  the  antrum,  is  commonly 
due  to  extension  of  inflammatiom  from  the  teeth  to  the  lining  mem- 
brane of  its  cavity.  The  roots  of  the  first  and  second  molars  not  infre- 
quently present  prominences  at  the  antrum,  and  sometimes  the  first 
molar  roots  are  found  extending  into  this  cavity  entirely  uncovered 
by  bone.  It  will,  therefore,  be  readily  seen  how  disease  of  the  roots 
may  prove  a  source  of  irritation  and  inflammation  to  the  lining  mem- 
brane of  this  cavity;  but  such  direct  communication  is  not  necessary ; 
and  disease  beginning  in  alveoli  not  in  immediate  relation  with  the 
antrum  may  extend  through  intervening  bone  and  establish  commu- 
nication. Direct  blows  upon  the  face  may  also  induce  suppurative  " 
inflammation  of  its  membrane,  and  it  may  also  arise  from  "  pressure 
during  birth." 


182  THE    GUMS. 

The  symptoms  arc,  pain  of  a  dull  character  shooting  up  the  side  of 
the  face  and  head,  rigors  succeeded  by  irritative  fever,  with  tenderness 
and  swelling  of  the  cheek.  As  the  pus  accumulates,  the  pressure  to 
which  it  subjects  the  walls  of  the  cavity,  together  with  the  vitiated 
nutrition  occasioned  by  its  presence,  determines  absorption  of  the  bone 
and  the  discharge  of  the  contained  fluid  through  the  opening  thus 
established  either  into  the  orbit  or  by  the  side  of  teeth.  Before  an 
opening  is  established,  however,  the  orbital  wall  may  become  so  dilated 
as  to  occasion  partial  blindness  by  disjolacement  of  the  eye,  or  it  may 
even  induce  an  amaurosis  which  shall  result  in  permanent  blindness. 
Sometimes  extensive  necrosis  is  occasioned,  afl'ecting  all  the  adjacent 
bones,  as  in  the  case  reported  by  Mr.  Salter,  in  which  the  "  floor  of 
the  orbit,  the  upper-cheek  portion  of  the  superior  maxilla,  and  the 
infra-orbital,  and  a  large  plate  of  bone  from  the  inner  (nasal)  wall  of 
the  antrum  were  involved."  Dr.  Mair,  of  Madras,  reports  a  case  in 
which  death  resulted  in  sixteen  days,  though  ap])arently  beginning  as 
a  simple  ozoeua.  The  post-mortem  examination  in  this  case  revealed  a 
condition  of  things  that  led  Dr.  Mair  to  conclude  that  it  began  as  a 
"  disease  of  the  antrum,  originating  in  degeneration  of  the  mucous 
membrane  lining  its  cavity,  or,  perhaps,  connected  with  the  soft  tumors 
which  grow  from  the  apex  of  the  tooth  and  from  the  lining  membrane 
of  the  root ;  secondarily,  involving  the  ethmoid,  lachrymal,  palatine, 
and  inferior  turbinated  bones  of  the  left  side,  causing  suppuration  and 
disintegration,  the  purulent  matter  filling  the  cavity  of  the  antrum,  ex- 
tending toward  the  left  nostril,  causing  ozcena,  and  upward  into  the 
orbit,  behind  the  globe  of  the  eye,  pushing  the  eye  outward  and  for- 
ward, the  matter  finding  its  way  through  the  optic  foramen  to  the  ante- 
rior surface  of  the  left  hemisphere  of  the  brain,  there  acting  as  a  foreign 
body,  exciting  inflammatory  action,  terminating  in  cerebral  abscess, 
causing  convulsions,  coma,  and  death."  —  (Edinburg  INIedical  Journal, 
May,  1866.)  Cases  of  such  severity  are,  fortunately,  rare ;  but  they 
indicate  the  possibilities  of  the  apparently  most  simple  cases,  as  well 
as  the  line  of  treatment  most  likely  to  obviate  such  conditions  and 
result. 

TREATMENT. 

In  the  simplest  cases  in  which  suppuration  of  the  antrum  is  strongly 
suspected,  we  should  at  once  remove  all  decayed  teeth  or  roots,  and  ' 
even  sound  teeth,  when  found  to  be  tender.  If  matter  has  not  yet 
formed,  the  disease  may  then  subside  under  the  use  of  simple  fomenta- 
tions. It  is  safer,  however,  in  most  cases,  to  penetrate  the  antrum,  pre- 
ferably through  the  socket  "of  the  first  molar,  because  of  the  greater 
depth  of  the  socket ;  and  this,  too,  without  delay,  care  being  taken  to 


THE    GUMS.  183 

regulate  the  force  so  as  not,  by  too  great  violence,  to  injure  the  floor  of 
the  orbit.  Should  the  teeth  be  sound,  and  it  be  desired  to  save  them, 
an  opening  may  be  made  through  the  alveolus  above  the  gum.  The 
cavity  should  be  freely  injected  with  tepid  water,  and  subsequently 
with  some  slightly  stimulating  and  antiseptic  lotion  ;  and  care  must 
afterward  be  taken  to  prevent  the  admission  uf  foreign  substances  into 
the  cavity. 

In  the  more  chronic  forms  of  this  disease,  the  purulent  accumulation 
takes  place  so  slowly,  and  the  consequent  expansion  is  so  gradual,  that 
it  is  often  mistaken  for  solid  growths  ;  and  in  many  cases  the  diagnosis 
is  of  extreme  difficulty ;  surgeons  of  distinction,  having  begun  an  ope- 
ration for  the  removal  of  a  solid  growth,  have  been  surprised  to  find 
their  hands  bathed  in  pus  whilst  the  supposed  tumor  disappeared  from 
beneath  them.  In  all  cases  in  which  the  diagnosis  is  not  perfectly 
clear,  an  exploratory  puncture  should  be  made,  and  thus  the  difficulty 
is  at  once  resolved. 

Sometimes  the  pus  is  inclosed  in  a  second  bony  investment,  due  to 
the  ossification  of  the  antral  jDeriosteum.  When  this  occurs,  it  occa- 
sionally happens  that  the  bone  remains  thickened  long  after  the  evacu- 
ation of  the  pus  and  the  entire  cure  of  the  abscess,  the  deformity,  of 
course,  remaining  unaltered.  It  then  becomes  necessary  to  open  the 
antrum  and  remove  this  ossified  periosteum. 

A  clear  or  yellowish  serous  fluid  is  not  unfrequently  found  in  the 
antrum,  which  the  older  writers  took  to  be  a  secretion  of  mucus, 
which,  having  failed  to  make  its  escape  by  the  aperture  between  the 
antrum  and  the  nostril,  accumulated  in  such  quantity  as  to  occasion 
wasting  of  antral  walls  to  such  an  extent  as  to  permit  the  fluctuating 
mass  to  be  felt  at  certain  points.  This  fluid  was  found  on  examination 
to  contain  numerous  flakes  of  cholesterine,  as  is  the  case  in  well-defined 
cystic  growths,  and,  as  it  in  no  respect  resembled  mucus,  recent  writers 
have  referred  this  form  of  disease  to  cystic  formations. 

The  most  recent  and  able  writer  on  this  subject,  Mr.  Heath,  thus 
.describes  their  mode  of  origin:  "It  is  certain,  however,  that  some  of 
these  cases,  and  very  probably  all  of  them,  originate  in  the  growth  of 
a  cyst,  or  cysts,  within  the  antrum,  or  ir^  connection  with  the  fangs  of 
the  teeth,  which  either  grow  to  ?uch  a  size  as  to  be  mistaken  for  the 
cavity  of  the  antrum  when  opened,  or  break  into  the  antrum  by  ab- 
sorption of  the  cyst-wall,  so  that  on  subsequent  examination  no  evidence 
of  the  cyst  formation  can  be  discovered." 

These  cyst  formations  are  also  occasionally  mistaken  for  solid 
growths ;  and  Mr.  Heath  relates  an  instance  in  which  "  a  very  able 
surgeon  removed  the  upper  jaw  before  the  mistake  was  discovered." 
And  Sir  William  Fergusson  relates  a  case   in  which  a  similar  error 


184  THE    GUMS. 

was  avoided  by  an  exploratory  puncture,  which  should  in  no  case  he 
omitted. 

They  may  be  single  or  multiple ;  sometimes  there  appears  to  be  a 
"  cystic  regeneration  of  the  entire  mucous  membrane."  Mr.  Giraldes, 
who  was  the  first  writer  on  this  subject,  thinks  they  are  due  to  "  dilation 
of  the  glandular  follicles  of  the  mucous  membrane,  and  that,  in  such 
cases,  it  will  be  necessary  to  open  the  antrum,  so  as  to  remove  the  entire 
mass ;  it  being  useless  in  such  cases  to  pursue  the  customary  plan  of 
tapping  the  antrum." 

Cysts  of  teeth  are  divided  by  Mr.  Heath  into  two  classes:  "First, 
cysts  connected  with  the  roots  of  fully  developed  teeth;  and,  secondly, 
cysts  connected  with  imperfectly  developed  teeth  —  to  which  the  term 
'  Dentigerous  Cysts '  has  been  applied  in  modern  times."  They  occur 
indifi'erently  in  either  jaw ;  in  the  upper,  however,  are  sometimes  com- 
plicated with  collections  of  fluid  in  the  antrum,  which  they  have  sec- 
ondarily affected.  "When  of  very  small  size  they  give  but  little  trouble, 
and  are  frequently  found  attached  to  the  roots  of  teeth  after  extraction 
where  their  existence  had  not  before  been  suspected.  They  seem  to 
occur  most  frequently  in  connection  with  the  incisor  teeth,  and  some- 
times attain  a  very  large  size  even  when  not  communicating  with  the 
antrum.  They  are  commonly  associated  wdth  the  disease  of  the  root 
about  which  they  are  formed,  whether  as  cause  or  effect,  it  is  difficult 
to  determine;  the  majority  of  observers  holding  the  latter  opinion. 
Mr.  Paget  relates  a  case  in  which  the  cyst  contained  as  much  as  an 
ounce  of  fluid,  and  was  received  in  a  deep  depression  in  the  alveolar 
border  of  the  jaw.  And  Delpech  reports  one  containing  so  much  as 
three  ounces,  without  ccmnection  with  the  antrum.  They  consist 
essentially  of  a  serous  bag  growing  from  the  dental  periosteum  at  the 
extremity  of  the  root  filled  with  a  clear  or  yellowish  fluid  with  bright 
shining  particles  of  cholesterine  floating  about  in  it. 

Dentigerous  cysts  occur  in  connection  with  teeth,  most  commonly 
permanent  teeth,  in  which  the  process  of  evolution  has  been  arrested ; 
and  is  due,  Mr.  Tomes  thinks,  to  the  accumulation  of  fluid  between 
the  enamel  and  soft  outer  tissue  at  the  time  when  the  enamel  is  com- 
pleted, which  fluid  is  usuallv  discharged  when  the  tooth  is  cut;  but 
when  the  tooth  remains  within  the  jaw,  this  discharge  cannot  take 
place,  and  it  continues  to  increase  in  quantity  until  a  cyst  is  established. 
We  are  thus  enabled  to  account  for  the  presence  of  cysts  in  those  cases 
in  which  neither  the  tooth  nor  adjacent  bone  presents  any  appearance 
of  disease.  In  illustration  of  this  theory,  Mr.  Jones  relates  a  case  in 
which,  "  instead  of  having  the  two  fangs  common  to  second  molars  of 
the  lower  jaw,  the  implanted  portion  of  the  tooth  was  dilated  into  one 
large  concavity,  in  which  was  placed  the  crown  of  a  second  tooth,  per- 


THE    GUMS.  185 

fectly  invested  with  well  developed  enamel,  and  with  the  masticating 
surface  directed  toward  the  jaw.  The  two  teeth  appear  to  be  united 
by  dentine  at  one  point,  and  to  have  one  common  pulp  cavity.  .  .  . 
I  consider  that  in  the  case  cited,  fluid  collected  between  the  enamel  of 
the  inverted  tooth  and  the  remains  of  the  enamel  organ,  situated 
within  the  socket  of  the  second  molar.  As  the  cyst  enlarged,  the  con- 
tiguous bone  was  absorbed  to  make  room  for  it,  and  new  tissue  was 
concurrently  developed  on  the  outer  walls  of  the  socket  till,  at  last, 
a  large  cup  of  bone  was  formed."  ("  Dental  Surgery,"  244.) 

When  cysts  of  this  kind  occur  in  the  lower  jaw,  they  present  more 
obvious  deformity.  Sometimes  the  cyst  undergoes  calcification,  and  is 
exceedingly  difficult  to  diagnose  from  a  solid  tumor. 

Many  errors  of  diagnosis,  leading  to  the  operations  for  the  removal 
of  supposed  tumors,  have  been  made  by  able  and  distinguished  sur- 
geons, who  have  had  the  courage  and  candor  to  confess  their  mistakes, 
among  whom  may  be  mentioned  Gensoul,  Syme,  Feavu,  and  Lisfranc. 
The  two  latter  gentlemen  each  removed  half  the  jaw.  It  is  only  when 
the  osseous  walls  have  become  so  wasted  as  to  give  under  pressure  a 
parchment-like  crackling  that  the  diagnosis  may  be  made  with  any 
approach  to  certainty.  In  every  case  an  exploratory  puncture  should 
be  insisted  on  before  proceeding  to  operate.  The  existence  of  a  cyst 
determined,  and  communication  with  the  antrum  suspected,  the  first 
molar  tooth  should  be  removed  and  the  wall  of  the  antrum  be  per- 
forated through  the  socket,  and  if  a  supernumerary  tooth  is  found  in 
the  cavity,  it  should,  of  course,  be  removed.  In  many  cases  it  is 
necessary  to  remove  the  front  v»'all  of  the  antrum  and  stufi*  the  cavity 
with  lint,  thus  inducing  granulations,  before  a  cure  can  be  effected. 
This  can  generally  be  effected  without  incision  of  the  integument. 
When  feasible,  the  plate  of  bone  removed  should  be  left  attached  to 
the  periosteum,  and  be  replaced  after  removal  of  the  cyst. 

Cysts  in  the  lower  jaw  present  some  peculiarities  which  make  a 
separate  description  necessary.  They  may  occur  in  connection  with 
fully  developed  teeth,  or  without  any  direct  connection  with  the  teeth. 
They  may  be  multilocular,  and  in  rare  instances  may  contain  one 
within  another.  Mr.  Coote  reports  a  case  in  an  infant  of  six  months  — 
which  resulted  in  death  from  exhaustion  occasioned  by  continued  dis- 
charge after  an  operation — in  which,  covered  by  a  thin  shell  of  bone, 
a  perfect  nest  of  cysts  connected  Avith  the  antrum  have  been  shown 
to  arise  in  th«  glandular  structure  of  its  lining  membrane,  but 
in  the  lower  jaw  we  have  no  such  membrane.  Instead  thereof,  we 
have  two  layers  of  laminated  bone  enclosing  a  cancellated  structure 
lined  by  the  endosteum  alone.  Mr.  Heath  is  of  opinion  that  it  is  in 
these  cancelli  the  disease  is  developed.     "A  cancellus  expanding  and 


186  THE    GUMS. 

producing  gradual  alisorption  and  obliteration  of  its  neighbors  until 
a  cyst  of  considerable  size  is  produced."  The  causation  of  cystic 
formations  in  the  lower  jaw  is  very  obscure,  though  they  are  probably 
associated  in  some  way  -with  the  irritation  from  adjacent  roots.  They 
may  continue  to  rei)roduce  themselves,  from  time  to  time,  until  the 
cancellated  tissue  is  entirely  destroyed. 

Multilocular  cysts  are  found  in  the  lower  jaw,  consisting  of  cells 
varying  in  size  from  that  of  a  pea  to  others  occupying  the  entire 
thickness  of  the  bone.  Unilocular  cysts  are  to  be  treated  simply  by 
extracting  adjacent  teeth,  and,  after  evacuating  its  contents,  when  the 
walls  are  thin,  crushing  them  in  so  as  to  diminish  the  size  of  the 
cavity.  Multilocular  cysts  in  the  first  stages  may  be  treated  in  the 
same  manner  ;  but  after  the  bone  has  become  largely  excavated,  it  is 
usually  necessary  to  remove  it  entire. 

Uncut  teeth  may  also  give  rise  to  osseous  tumors,  requiring  "sur- 
gical interference.  This  is  more  peculiarly  the  case  with  the  wisdom 
tooth  for  a  reason  easily  understood,  the  space  nominally  allotted  it 
between  the  second  molar  and  the  terminal  point  of  the  alveolar  ridge 
is  often  too  limited  for  its  eruption  ;  endeavoring  to  make  its  way 
through  the  bone,  under  such  circumstances,  the  opposition  it  encoun- 
ters is  often  sufficient  to  occasion  great  irritation  and  pain,  and  occa- 
sionally to  entirely  prevent  its  eruption.  The  retained  tooth  thus 
becomes  a  centre  of  irritative  action,  and  may  serve,  not  only  to 
determine  the  site,  but  the  fact  of  such  tumors.  Mr.  Tomes  also  re- 
lates a  case  in  which  the  wisdom  tooth  was  bound  down  by  a  "mass  of 
enamel,  dentine,  and  cementum  thrown  together  without  any  definite 
arrangement,"  which  occupied  the  place  of  the  second  molar.  Mr. 
Heath  also  records  a  case,  reported  by  Dr  Forget,  in  which  a  tumor 
about  the  "consistence  of  ivory,"  covered  everywhere  with  enamel, 
and  about  the  size  of  an  egg,  occupied  that  portion  of  the  jaw  between 
the  ramus  and  the  first  bicuspid.  It  was  composed  chiefly  of  enamel 
and  dentine,  with  portions  of  cementum  "dipping  into  the  crevices" 
here  and  there,  and  was  regarded  by  Dr.  Forget  as  a  "fusion  and 
hypertrophy  of  the  last  tAvo  molars." 

Again,  one  of  the  anatomical  elements  of  the  tooth  may  become 
so  hypertrophied  as  to  constitute  a  troublesome  disease,  and  call  for 
surgical  interference.  The  cementum  is  most  likely  to  undergo  such 
change.  M.  Maisonneuve  reports  a  case,  cited  by  Mr.  Heath,  in 
which  the  hypertrophied  cementum  attained  the  size  of  a  pigeon's 

It  is  desirable,  if  possible,  to  remove  all  such  morbid  growths  with- 
out injury  to  the  bone  in  w'hich  they  are  implanted ;  but  it  may  be- 
come necessary  to  excise  that  part  of  the  jaw  in  w^hich  it  is.    AU 


THE    GUMS.  187 

neighboring  teeth,  which  may  possibly  be  associated  with  it  should  be 
removed. 

Tumors  of  the  antrum  and  upper  jaw  may  be  appropriately  de- 
scribed together,  the  distinguishing  characteristics  being  pointed  out. 

Polypus.  Growths  of  this  character  occasionally  occur  iu  the 
antrum,  and  are  closely  allied  to  the  small  cysts  occurring  in  its 
mucous  membrane;  both  are  essentially  a  "hypertrophy  of  some  ele- 
ment of  the  mucous  or  sub-mucous  tissue.  When  the  connective  or 
areolar  tissue  predominates,  the  fleshy  polypus  is  produced ;  when  the 
glandular  element  is  especially  afl'ected,  we  have  the  cystic  form  pro- 
duced. Intermediately,  when  the  fibrous  element  is  very  loose,  and  we 
have  some  glandular  hypertrophy,  the  semi-gelatinous  polypus  is  pro- 
duced, which  closely  resembles  the  nasal  polypus."  ("Jacksonian 
■Essay,"  p.  210.) 

Antral  polyps  are  very  vascular,  and  are  sometimes  the  ushers  of 
malignant  disease.  The  diagnosis  is  exceedingly  difficult  until  they 
Lave  advanced  sufficiently  to  break  down  the  osseous  wall  somewhere ; 
this  most .  frequently  takes  place  into  the  nose  through  the  thin  nasal 
wall. 

They  should  be  removed  as  soon  as  ascertained  to  exist,  and  the 
troublesome  hemorrhage,  which  is  likely  to  occur,  should  be  arrested 
by  injections  of  the  persulphate  of  iron,  which  is  not  likely  to  give 
rise  to  trouble  in  any  strength,  if  the  opening  is  sufficiently  large  to 
permit  its  ready  escape. 

A  single  instance  of  a  peculiar  form  of  fibroid  growth  of  the 
antrum  is  recorded  by  Mr.  Heath,  from  whose  work  we  take  the  fol- 
lowing description  by  Mr.  Bruce  : 

"  It  appears  to  consist  of  a  fine,  soft,  fibrous  stroma,  in  which  very 
numerous  nuclear  bodies,  and  a  few  elongated  fibre-cells  are  dis- 
tributed. Its  structure  resembles  that  of  the  upper  strata  of  a 
mucous  membrane,  from  which  it  is  probably  an  outgrowth.  It  con- 
sists of  newly-formed  fibrous  tissue,  and  of  the  elements  from  which 
fibrous  tissue  is  developed,  and  may,  therefore,  be  classed  among  the 
simple  fibro-plastic  growths  as  distinguished  from  the  true  myeloid 
tumors." 

Fibrous  tumors  of  the  upper  jaw  are  not  unlike  fibrous  tumors 
found  elsewhere.  They  are  of  slow  growth,  dense  structure,  with  in- 
terlacing, slender  bundles  of  fibres,  and  are  frequently  lobulated. 
They  commonly  spring  from  the  interior  of  the  antrum,  or  from  the 
alveolus,  and  sometimes  attain  to  an  enormous  size,  crushing  in  the 
antrum  or  obliterating  its  walls  by  absorption,  encroaching  upon  the 
orbit,  destroying  its  floor,  penetrating  the  nasal  cavity,  and,  extending 
outward,  conceal  the  teeth  on  the  same  side  from  view.     Mr.  Liston 


188  THE    GUMS. 

removed  a  tumor  of  this  kind  from  the  face  of  a  hidy,  \Yhore  it  had 
arisen  six  years  before,  apparently  from  a  blow  received  on  the  face, 
and  had  attained  to  an  enormous  size,  covering  the  whole  of  that  side 
of  the  face.  Its  smallest  diameter  was  six  inches.  This  tumor  became 
of  increased  vascularity  after  the  cessation  of  the  catamenia  at  the 
regular  monthly  period,  and  bled  slightly  at  these  times  from  the  ad- 
jacent parts  of  the  gum.  They  are  usually  of  an  oval  or  i-ounded 
form,  freely  movable,  and  painless.  When  laid  open  they  present  a 
white,  shining,  ligamentous  structure,  and  are  composed  of  nucleated 
fibres.  If  left  to  themselves  they  may  become  softened  in  the  centre 
and  under  disintegration,  though  Mr.  Heath  thinks  they  never  sujj- 
purate,  except  where  they  have  been  punctured  in  establishing  a 
diagnosis.  They  may  also  undergo  calcareous  degeneration,  but  are 
never  ossified. 

Mr.  Paget  reports  a  case  in  which  distinct  pulsation,  synchronous 
with  the  radial  pulse,  was  felt.  They  rarely  recur  after  removal, 
perhaps  never  when  entirely  removed.  ]\Ir.  "Weber  thinks  "  they  are 
usually  connected  with  the  lining  of  the  Haversian  canals,"  and  ad- 
vises that  a  portion  of  the  bone  be  removed  in  all  operations.  Their 
origin  is  usually  referred  to  the  irritation  of  decayed  teeth,  or  to 
direct  violence. 

Fibro-cellular  tumor,  or  osteo-sarcoma,  is  of  softer  consistence  than 
the  simple  fibrous  tumor ;  they  are  smooth,  round,  elastic  tumors,  of 
a  yellowish  color,  and  are  infiltrated  w'ith  a  serous  fluid.  Unlike  the 
simple  fibrous  tumor,  they  exhibit  a  strong  tendency  to  ulceration, 
which  sometimes  serves  to  confound  them  with  malignant  growths, 
from  which  they  are  to  be  distinguished  by  the  history  of  the  case, 
and  the  non-implication  of  the  lymphatic  glands.  They  are  thus  de- 
scribed by  Sir  Philip  Crampton:  "In  the  earlier  stages  of  the  disease, 
the  tumor  consists  of  a  dense,  elastic  substance  resembling  fibro-car- 
tilaginous  structure,  but  the  resemblance  is  more  in  color  than  con- 
sistency, for  it  is  not  nearly  so  hard,  and  is  granular  rather  than 
fibrous,  so  that  it  *  breaks  short'  On  cutting  into  the  tumor,  the  edge 
of  the  knife  grates  against  spicula,  or  small  grains  of  earthy  matter, 
with  which  its .  substance  is  beset."  Fibro-cellular  tumors  may  un- 
dergo fatty  or  calcareous  degeneration. 

Kecurring  fibroid  tumors  occur,  if  at  all,  so  rarely  in  the  upper 
jaw,  that  any  description  is  unnecessary  in  a  work  of  this  kind.  The 
same  may  be  said  of  vascular  tumors. 

Myeloid  tumors  are  described  by  Mr.  Paget  as  occupying  an  inter- 
mediate position  between  fibrous  and  fibro-cellular  tumors.  They  are 
composed  of  parallel  fibres  with  fibro-plastic  cells,  and  bear  a  close 
resemblance  to  "granulation  cells  in  process  of  development  into  fibro- 


THE    GUMS. 


189 


cellular  tissue."  On  section  they  present  a  smooth,  shiny,  semi-trans- 
parent appearance  ;  are  of  a  pinkish  or  bluish  color  and  of  brittle 
texture.  They  usually  occur  in  the  young ;  are  painless,  and  seldom 
recur.  Externally,  they  present  a  dark  maroon  color,  quite  character- 
istic. An  excellent  description  of  a  tumor  of  this  class  is  furnished 
Mr.  Heath  by  Dr.  Tonge,  from  which  we  make  the  following  extract : 
"It  was  of  firm  consistence  throughout,  and  on  section  presented  a 
whitish  appearance,  with  a  small  pink  patch  or  two,  and  a  whitish, 

creamy  looking  juice  could  be  scraped  from  the  cut  surface 

The  fibrous  element  was  much  less  abundant  than  the  cellular,  and 
consisted  of  white  fibrous  tissue,  with  numerous  fine  curling  fibres  of 
yellow  elastic  tissue,  and  many  small  oval  and  rounded  nuclei  were 
imbedded  in  the  fibrous  structure.  The  greater  portion  of  the  tumor 
seemed  to  be  composed  of  cells.  »These  were  mostly  of  an  irregularly 
rounded  form,  often  with  pointed  processes,  and  some  shuttle-shaped  and 
spindle-shaped,  of  a  somewhat  trapezoidal  form,  were  not  uncommon, 
while  a  few  cells  presented  the  character  of  those  distinctive  of  myeloid 
tumors.  All  the  cells  contained  one,  and  often  two,  very  large,  and 
generally  oval  nuclei,  with  one,  two,  or  three  nucleoli,  and  a  variable 
number  of  oil  globules.  The  myeloid  cells  observed  were  of  irregular 
outline,  and  contained  from  three  to  five  nuclei,  with  single  or  double 
nucleoli ;  one  very  large  cell  contained  six  nuclei." 

Their  formation  takes  place  slowly,  after  the  manner  of  cyst  forma- 
tion, or  other  simple  tumors.  When  the  bone  has  been  removed  by 
absorption  or  otherAvise,  they  may  be  recognized  by  their  characteristic 
color,  and  when  a  cyst  forms  within  them,  as  sometimes  happens,  mye- 
loid cells  may  be  found  in  the  fluid  that  escapes  when  it  has  been  punc- 
tured ;  thus  distinguishing  it  from  other  cystic  formations. 

Cartilaginous  tumors  are  of  two  kinds  :  simple,  innocent  or  benig- 
nant tumors  ;  and  tumors  presenting  a  malignant  appearance.  Those 
of  the  first  class  present  a  round  or  ovoidal  form,  are  smooth,  hard,  of 
slow  growth,  and  painless.  Those  of  the  second  class  grow  with  great 
rapidity  to  a  large  size,  and  are  of  a  malignant  appearance. 

Cartilaginous  tumors  occur  on  the  upper  jaw,  but  may  afiect  it  sec- 
ondarily by  extension  from  other  parts. 

Mr.  Heath  describes  several  specimens  taken  from  St.  George's  and 
St.  Bartholomew's  Hospitals ;  in  one  of  which  the  disease  occurred  or 
the  inner  side  of  the  orbit,  and  two  years  later  had  pressed  the  superior 
maxillse  forward  nearly  an  inch  beyond  the  inferior,  whilst  the  "bones 
of  the  face  and  orbit  were  extensively  absorbed."  In  the  other,  the 
superior  maxillary  bones  were  entirely  absorbed,  the  cavity  of  skull  was 
invaded,  and  the  brain  pressed  aside ;  it  is  attached  to  the  soft  palate 
below,  and  presses  forward  the  walls  of  the  nose  in  front.     Mr.  Paget 


190  THE    GUMS. 

relates  a  case  in  which  the  disease  had  existed  nine  years,  was  removed, 
but  returned,  and  the  patient  died  seven  years  after.  "A  section  of 
the  tumor  showed  that  it  was  composed  of  an  outer,  hard,  thin  shell  of 
bone,  completely  inclosing  a  morbid  growth  of  spongy,  cancellated 
structure,  devoid  of  all  appearance  of  carcinomatous  or  spongy  dis- 
ease." These  growths  are  usually  very  slow,  and,  when  removed,  ex- 
hibit but  a  slight  tendency  to  recur.  Cases  are  reported  in  which  the 
free  local  use  of  iodine  has  effected  the  absorption  of  tumors  of  this 
kind  that  had  not  yet  attained  a  large  size.  They  sometimes  soften, 
disintegrate,  slough,  and  establish  fistulous  openings  through  which  a 
jelly-like  mass  escapes. 

Osseous  tumors,  in  their  simplest  form,  are  but  a  hypertrophy  of 
previously  existing  bone  tissue.  They  are  predisposed  to  by  syphilitic 
and  scrofulous  affections,  and  sometimes  their  immediate  origin  may 
be  traced  to  the  irritation  of  imperfect  teeth ;  in  general,  however,  it 
is  difficult  to  refer  them  to  a  determinate  cause.  They  are  of  slow 
growth,  painless,  and  closely  resemble  true  bone  in  structure.  Their 
slowness  of  growth,  hardness,  painlessness,  and  fixity,  are  the  charac- 
teristics on  which  a  diagnosis  may  be  based,  though  they  are  occasion- 
allv  movable.  Occasionally  they  ulcerate,  and  troublesome  fistulous 
openings  are  established.  When  of  large  size  they  may  invade  im- 
portant organs,  occasioning  great  trouble,  as  iu  the  case  reported  by 
Mr.  Hilton,  where  it  invaded  the  orbit,  and,  by  its  pressure,  burst 
the  ball  of  the  eye. 

Cancerous  tumors  of  the  upper  jaw  are,  in  Mr.  Heath's  experience, 
limited  to  the  medullary  form ;  other  observers  have,  however,  occa- 
sionally met  with  scirrhus.  Mr.  Hancock  advanced  the  view  that 
medullary  disease  does  not  begin  in  the  antrum,  but  in  the  bones  at 
the  base  of  the  skull.  This  view  is  refuted  by  the  observation  of  Mr. 
Listen  and  others,  who  have  shown  that  it  unquestionably  begins  in  the 
antrum  very  often.  They  are  characterized  by  rapid  development, 
softness  to  the  touch,  and,  when  fully  established,  by  a  jjeculiar  expres- 
sion and  sallow,  putty-like  appearance  of  the  skin.  In  this  situation  it 
is  seldom  accompanied  by  glandular  enlargement.  By  pressing  upon 
the  nasal  duct,  it  may  occasion  considerable  oedema  of  lower  eyelid, 
with  enlargement  of  the  facial  veins  from  obstructed  circulation. 

For  the  cure  of  all  solid  tumors  of  the  upper  jaw,  there  is  but  one 
remedy  on  which  we  can  rely  —  the  knife.  All  operative  procedures 
should  be  resorted  to  at  the  earliest  practicable  moment  before  the 
facial  structures  have  been  extensively  invaded  by  the  disease.  When 
the  disease  is  entirely  removed,  in  even  malignant  growths,  we  may 
sometimes  entertain  a  hope  of  permanent  relief.  To  eflfect  the  removal 
of  tumors  in  this  situation,  various  methods  have  been  devised.    Until 


THE    GUMS, 


191 


1826,  surgeons  usually  contented  themselves  with  the  removal  of  so 
much  of  the  disease  as  could  be  effected  with  the  gouge  and  chisel ; 
but  about  this  time,  Mr.  Lizars,  of  Edinburg,  proposed  the  removal  of 
the  entire  superior  maxilla,  having  previously  secured  the  carotid 
arteo-y.  An  opportunity  to  carry  out  his  suggestion  did  not  offer  until 
December  of  the  following  year,  when,  in  attempting  this  operation, 
the  hseraorrhage,  notwithstanding  the  ligation  of  the  carotid,  was  so 
great  as  to  necessitate  the  discontinuance  of  the  operation.  In  the 
mean  time,  without  any  knowledge  of  Mr.  Lizars'  suggestion,  Mr.  Gen- 
soul  successfully  removed  the  upper  jaw  without  securing  the  artery, 
and  with  but  little  hemorrhage.  Mr.  Lizars  afterward  operated  suc- 
cessfully, and  the  operation  is  now  an  established  one.  His  incision 
was  carried  from  the  angle  of  the  mouth  to  the  malar  bone,  where, 
when  more  space  was  required,  it  Avas  met  by  a  short,  vertical  incision, 
and  an  incision  was  also  made  from  the  middle  line  of  the  lip  to  the 
nostril.  Mr.  Gensoul  employed  a  vertical  incision  from  the  inner 
canthus  to  the  angle  of  the  motith,  which  was  met  midway  by 
another  at  right  angles  to  it,  letting  fall  on  its  outer  extremity  another 
vertical  incision.  The  bone  was  then  removed  with  the  mallet  and 
chisel.  An  obvious  objection  to  these  operations  was  the  great  deform- 
ity occasioned,  and  the  division  of  the  facial  nerve.  To  obviate  these 
difficulties.  Sir  William  Fergusson  suggested  a  plan,  which  has  since 
been  very  generally  adopted.  It  consisted  solely  in  an  incision  from  the 
middle  line  of  the  lip  to  the 
nostril,  when,  by  stretching 
the  integument,  sufficient 
space  was  usually  gained.  If 
more,  however,  was  required, 
the  incision  was  carried  up 
alongside  of  the  nose  to  the 
inner  canthus,  and  below  the 
eye  to  the  outer  canthus,  thus 
the  facial  nerve  and  artery 
were  divided  so  high  up  as  to 
give  but  little  trouble,  while 
the  scars  are  most  favorably 
situated.  (See  Fig  43.) 

After  deflecting  the  skin, 
a  small  saw  is  passed  into  the 
nostril,  with  which  the  hard 
palate  and  alveolus  are  di- 
vided. The  nasal  and  ma- 
lar processes  of  the  superior 


Fig.  43. 


192  THE    GUMS. 

maxilla  are  next  sawed  nearly  through,  the  division  completed  with 
bone  forceps.  The  bone  is  then  grasped  by  the  powerful  forceps 
devised  by  Sir  AVilliam  Fergusson,  and  forcibly  wrenched  from  its 
attachments  to  the  pterygoid  process  and  palate  bones.  The  infra- 
orbital nerve  is  then  divided,  the  soft  palate  carefully  dissected  from 
the  detached  bone,  which  is  now  ready  for  removal.  After  which 
honiorrhage  is  arrested  by  ligatures  and  the  actual  cautery,  and  the 
wound  closed  with  silver  sutures.  When  the  palate  bone  and  orbital 
jilate  are  not  involved,  they  may  be  spared  by  sawing  horizontally 
above  and  below  them  respectively.  Sir  William  Fergusson  now  pre- 
fers to  avoid  the  removal  of  all  healthy  tissue  by  attacking  the  disease 
from  centre  to  circumference  with  strong  curved  and  angular  bone 
forceps.  Both  superior  maxillae  have  occasionally  been  removed ;  but 
it  is  an  operation  so  seldom  required  that  a  description  of  it  is  not 
called  for  in  a  work  of  this  kind. 

Tumors  of  the  lower  jaw  do  not  differ  in  essential  particulars  from 
those  already  described.  They  are  more  readily  diagnosed  and  safelv 
removed  than  those  of  the  upper  jaw.  Deaths  are  comparatively  rare 
from  operative  procedures  here.  When  the  tumors  are  small,  they  may 
be  removed  without  incision  of  the  lip,  by  simply  dissecting  it  from  its 
attachment  to  the  bone,  turning  it  down,  and  removing  the  diseased 
portion  with  bone  forceps.  When  a  large  body  is  to  be  removed, 
the  incision  should  be  carried  beneath  the  margin  of  the  jaw,  whei-e 
the  scar  shall  afterward  be  concealed  from  view.  When  the  bone  is 
exposed,  we  should  endeavor  carefully  to  ascertain  if  the  disease  may 
not  be  removed  with  the  external  plate  of  bone  alone ;  if  this  may  not 
be  done,  the  saw  should  be  brought-  into  requisition,  and  the  diseased 
structure  removed.  Amputation  of  the  lower  jaw  is  far  more  readily 
effected  than  of  the  upper;  for  a  detailed  account  of  this  operation  the 
student  is  referred  to  more  exclusively  surgical  works. 


lALIVARY    CALCULUS.  193 


CHAPTEE  V. 

SALIYAEY   CALCULUS. 

THE  color,  consistence,  and  quantity  of  salivary  calculus,  or  tartar, 
as  it  is  most  commonly  called,  vary  in  different  temperaments, 
and  upon  all  of  them  the  state  of  the  general  health  exercises  consid- 
erable influence.  The  characteristics  of  this  substance,  therefore,  fur 
nish  diagnoses,  important  both  to  the  physician  and  dentist.  Their 
indications  are,  in  many  eases,  less  equivocal  than  the  appearances  of 
any  other  part  of  the  mouth ;  but,  like  those  of  the  gums,  should  not, 
perhaps,  be  alone  relied  upon.  It  is  necessary  to  interrogate  every 
part  from  which  information  can  be  derived  concerning  the  patholog- 
ical condition  of  the  several  organs  of  the  body. 

Salivary  calculus  is  composed  of  earthy  ijalts  and  animal  matter. 
Phosphate  of  lime  and  fibrine,  or  cartilage,  are  its  principal  ingredi- 
ents ;  a  small  quantity  of  animal  fat,  however,  enters  into  its  compo- 
sition, and  the  relative  proportions  of  its  constituents  vary  accordingly 
as  it  is  hard  or  soft,  or  as  the  temperament  of  the  individual  from 
whose  mouth  it  is  taken  is  favorable  or  unfavorable  to  health.  Hence 
it  is  that  the  analyses  that  have  been  made  of  it  by  different  chemists 
differ.     No  two  give  the  same  result. 

The  black,  dry  tartar  deposited  around  the  necks  of  the  teeth  of 
such  only  as  have  good  constitutions,  is  never  in  large  quantities ;  it  is 
dissolved  in  muriatic  acid  with  difficulty,  while  the  dry,  light-brown 
tartar  found  upon  the  teeth  of  bilious  persons  dissolves  more  readily 
in  it ;  but  the  soft,  white  tartar,  found  upon  the  teeth  of  individuals  of 
mucous  temperaments,  is  scarcely  at  all  soluble  in  the  acids,  but  is 
readily  dissolved  in  the  alkalies. 

All  persons  are  subject  to  salivary  calculus,  but  not  alike;  it  collects 
on  the  teeth  of  some  in  larger  quantities  than  on  those  of  others, 
and  its  chemical  and  physical  characteristics  are  exceedingly  variable. 
It  is,  sometimes,  almost  wholly  composed  of  calcareous  ingredients ; 
at  other  times  these  constitute  but  about  one-half,  or  little  more  than 
one-half,  of  its  substance,  the  remainder  being  made  up  of  animal 
matter.  IS"or  is  its  color  more  uniform.  Sometimes  it  is  black,  at 
other  times  it  is  of  a  dark,  pale,  or  yellowish  brown,  and  in  some  in- 
stances it  is  nearly  white.  It  also  differs  in  density.  In  the  mouths 
of  some  it  has  a  solidity  of  texture  nearly  equal  to  that  of  the  teeth 
13 


194  SALIVARY    CALCULUS. 

themselves  ;  in  others,  it  is  so  soft  that  it  can  be  scraped  from  the  teeth 
with  the  thumb-  or  finger-nail.  Tiie  bhick  kind  is  the  hardest,  the 
white  the  softest,  and  its  density  is  increased  or  diminished  as  it  ap- 
proaches the  one  or  the  other  of  these  colors. 

Salivary  calculus  collects  in  very  small  quantities  on  the  teeth  of 
persons  possessed  of  the  most  perfect  constitutions,  and  even  on  these 
it  is  seldom  found  except  on  the  inner  surfaces  of  the  lower  incisors 
next  the  gums.  It  is  then  black,  or  of  a  dark  brown,  very  dry,  and 
almost  as  hard  as  the  teeth,  to  which  it  adheres  with  great  tenacity. 

It  rarely  happens  that  any  unpleasant  effects  are  produced  by  the 
presence  of  this  kind  of  tartar  upon  the  teeth.  The  general  health  is 
never  affected  by  it,  and  the  only  local  injury  that  results  from  it  is 
slight  turgidity  of  the  edge  of  the  gums  in  immediate  contact  with  it. 

The  indications,  therefore,  of  this  description  of  tartar  are  favorable, 
both  with  regard  to  the  teeth,  gums,  and  organism  generally.  The 
teeth  upon  which  it  is  found  are  of  an  excellent  quality,  and  rarely 
affected  by  caries.  They  have  the  characteristics  represented  as  be- 
longing to  the  best  kind,  and  teeth  of  this  description  are  only  found 
among  persons  having  go^d  innate  constitutions. 

There  is  another  kind  of  black  tartar,  differing  from  this  in  many 
particulars.  It  is  found  in  the  mouths  of  those  having  good  constitu- 
tions, but  whose  physical  powers  have  been  enervated  by  privation  or 
disease,  or  intemperance  and  debauchery,  and  most  frequently  by  the 
last  named.  It  is  found  in  large  quantities  on  the  teeth  opjiosite  the 
mouths  of  the  salivary  ducts  ;  it  is  exceedingly  hai'd,  and  agglutinated 
so  firmly  to  the  organs  that  it  is  removed  Avith  great  difficulty ;  it  is 
very  black,  has  a  rough  and  uneven  surface,  and  is  covered  with  a 
glairy,  viscid,  and  almost  insufferably  offensive  mucus. 

The  presence  of  this  kind  of  salivary  calculus  is  attended  with 
very  hurtful  consequences,  not  only  to  the  gums,  alveolar  processes, 
and  teeth,  but  also  to  the  general  health.  It  causes  the  gums  to 
inflame,  swell,  suppurate,  and  recede  from  the  teeth,  the  alveoli  to 
waste,  and  the  teeth  to  loosen  and  frequently  to  drop  out.  The  secre- 
tions of  the  mouth  are  also  vitiated  by  it,  and  rendered  unfit  to  be 
taken  into  the  stomach.  Hence,  as  long  as  it  is  permitted  to  remain 
on  the  teeth,  neither  the  skill  of  the  physician  nor  the  best  regulated 
regimen,  though  they  may  afford  partial  and  tempoa-ary  relief,  will 
fully  restore  to  the  system  its  healthy  functions. 

As  this  kind  of  tartar  is  seldom  if  ever  met  with  except  in  consti- 
tutions naturally  excellent,  the  teeth  on  which  it  is  deposited  are  gen- 
erally sound,  but  they  are  often  caused,  by  the  disease  which  is  pro- 
duced in  the  gums  and  alveoli,  to  loosen  and  drop  out. 

The  dark -brown  tartar  is  not  so  hard  as  either  of  the  descriptions 


SALIVARY    CALCULUS.  195 

of  black.  It  sometimes  collects  iu  tolerably  large  quantities  on  the 
lower  front  teeth  and  on  the  first  and  second  superior  molars;  it  is  also 
often  found  on  all  the  teeth,  though  not  in  as  great  abundance  as  on 
these.  It  does  not  adhere  with  as  much  tenacity  as  either  of  the  pre- 
ceding kinds,  and  can  be  more  easily  detached  from  them.  It  exhales 
a  more  fetid  odor  than  the  first  variety,  but  is  less  offensive  than  the 
second. 

The  persons  most  subject  to  this  kind  of  tartar  are  of  mixed  tem- 
peraments, the  sanguineous,  however,  always  predominating.  They 
may  be  denominated  sanguineo-serous  and  bilious.  Their  physical 
organization,  though  not  the  strongest  and  most  perfect,  may,  never- 
theless, be  considered  very  good.  But,  being  more  susceptible  to  mor- 
bid impressions,  their  general  health  is  less  uniform  and  more  liable  to 
impairment  than  those  possessed  of  the  most  perfect  constitutions. 

The  effects  arising  from  the  accumulations  of  this  description  of 
salivary  calculus,  both  local  and  constitutional,  are  less  hurtful  than 
the  variety  last  noticed ;  but,  like  that,  it  causes  the  gums  to  inflame, 
swell,  suppurate,  and  to  retire  from  and  expose  the  necks  of  the  teeth, 
the  alveoli  to  waste,  the  teeth  to  loosen  and  sometimes  to  drop  out. 
It  also  gives  rise  to  a  vitiated  condition  of  the  fluids  of  the  mouth. 

Salivary  calculus  of  a  light  or  pale  yellowish-brown  color  is  of  a 
much  softer  consistence  than  the  darker  varieties,  and  is  seldom  found 
upon  the  teeth,  except  of  persons  of  bilious  temperament,  or  those  in 
Avhom  this  predominates.  It  has  a  rough  and,  for  the  most  part,  a  dry 
surface  ;  it  is  found  in  large  quantities  opposite  the  mouths  of  the  sali- 
vary ducts,  and  sometimes  every  tooth  in  the  mouth  is  completely 
imbedded  in  it.  It  contains  less  of  the  earthy  salts  and  more  of  the 
animal  matter  than  any  of  the  foregoing  descriptions,,  and  from  the 
quantity  of  vitiated  mucus  in  and  adhering  to  it,  has  an  exceedingly 
offensive  smell.  It  is  sometimes,  though  not  always,  so  soft  that  it 
may  be  crumbled  between  the  thumb  and  finger. 

.Inflammation,  turgescence,  and  suppuration  of  the  gums,  inflamma- 
tion of  the  alveolo-dental  periosteum,  the  destruction  of  the  sockets  and 
loss  of  the  teeth,  and  an  altered  condition  of  the  fluids  of  the  mouth, 
are  among  the  local  effects  produced  by  the  long  continued  presence 
of  large  collections  of  this  variety  of  tartar.  The  constitutional  effects 
are  not  much  less  pernicious.  Indigestion  and  general  derangement 
of  all  the  assimilative  functions  are  among  the  most  common.  "When 
the  deposit  is  not  large,  inflammation  and  sponginess  of  such  parts  of 
the  gums  as  are  in  immediate  contact  with  it,  and  fetid  breath,  are  the 
principal  of  the  unpleasant  effects  produced  by  it. 

White  tartar  rarely  collects  in  very  large  quantities,  and  though 
most  abundant  on  the  outer  surfaces  of  the  first  and  second  superior 


196  SALIVARY    CALCULUS. 

molars  and  the  inner  surfaces  of  the  lower  incisors,  it  is  neverthelesa 
frequently  found  on  all  the  teeth.  Its  calcareous  ingredients  are  less 
abundant  than  those  of  any  of  the  preceding  descriptions.  Fibrine, 
animal  iht,  and  mucus  constitute  by  far  the  larger  portion  of  its  sub- 
stance. It  is  very  soft,  seldom  exceeding  in  consistence  common 
cheese-curd,  to  which  in  appearance  it  bears  considerable  resemblance. 
Although  it  exerts  but  little  mechanical  irritation  upon  the  gums,  it 
keeps  up  a  constant  morbid  action  in  them.  Its  effects,  however,  upon 
the  teeth  are  far  more  deleterious  than  any  other  description  of  tartar. 
It  corrodes  the  enamel,  and  causes  rapid  decay  of  the  organs.  The 
fluids  of  the  mouth  are  also  vitiated  by  it. 

It  is  only  upon  the.  teeth  of  persons  of  mucous  habit,  or  those  who 
have  suffered  from  diseases  of  the  mucous  membranes,  or  those  in 
whom  these  tissues  have  been  more  or  less  involved,  that  this  kind  of 
tartar  accumulates. 

There  is  one  other  kind  of  tartar  described  by  dental  writers.  It 
is  of  a  dark-green  color,  and  is  seen  more  frequently  on  the  anterior 
surfaces  of  the  upper  teeth  occupying  the  front  part  of  the  mouth, 
than  on  any  of  the  others.  It  resembles  more  closely  a  stain  on  the 
enamel  than  salivary  calculus.  Children  and  young  persons  are  more 
subject  to  it  than  adults,  though  it  is  occasionally  observed  on  the 
teeth  of  the  latter.  It  is  exceedingly  acrid,  and  has  the  effect  of  de- 
composing the  enamel ;  the  margins  of  the  gums  around  the  teeth 
having  it  on  them  are  inflamed,  and  the  sanguineous  capillaries  of  their 
whole  substance  appear  to  be  distended  and  more  than  ordinarily 
languid. 

This  kind  of  discoloration  of  the  enamel  is  indicative  of  an  irrita- 
ble condition  of  the  raucous  membranes  and  viscidity  of  the  fluids  of 
the  mouth.  Sour  eructations,  vomitings,  diarrhosa,  and  dysentery  are 
not  unfrequent  with  those  whose  teeth  are  thus  affected. 

Tartar  or  salivary  calculus  sometimes  accumulates  in  very  large 
quantities,  giving  to  the  mouth  a  most  disagreeable  and  repulsive 
aspect,  and  imparting  to  the  breath,  not  unfrequently,  an  almost  in- 
sufferably offensive  odor.  Fig.  44  represents  a  set  of  teeth  incrusted 
with  it,  and  Fig.  45  a  single  tooth,  presented  to  the  author  by  Dr.  W. 

Fig.  44.  Fig.  45. 


SALIVAEY    CALCULUS.  197 

Allen,  of  Massachusetts,  and  now  in  the  Museum  of  the  Baltimore 
College  of  Dental  Surgery,  Avith  the  largest  accumulation  of  this  sub- 
stance he  has  ever  seen  in  one  mass.  Its  longest  diameter  is  an  inch 
and  an  eighth,  its  shortest  seven-eighths,  and  its  thickest  five-eighths  of 
an  inch.  Imbedded  in  its  substance  is  the  entire  crown  and  neck  of  a 
lower  dens  sapientise,  which  was  removed  with  it.  It  is  of  a  light- 
brown  color,  and  weighs  two  drachms  and  seventeen  grains. 

Prof.  Austen  describes  a  remarkable  case  where  every  tooth,  above 
and  below,  had  been  loosened  by  alveolar  absorption  caused  by 
this  deposit ;  no  tooth  having  more  than  an  eighth  of  an  inch  depth 
of  socket,  and  some  of  them  held  only  by  an  exceedingly  tough  at- 
tachment to  the  gum  and  periosteum.  The  tartar  upon  the  lower  in- 
cisors was  equal  to  five  times  the  size  of  the  teeth,  most  of  it  being 
on  the  inside,  and  three-quarters  of  an  inch  thick  at  the  base.  A 
singular  peculiarity  in  this  case  was  the  excessive  pain  of  extraction. 
Small  as  was  the  attachment,  it  was  uncommonly  firm ;  and  the  patient, 
a  working-man,  was  laid  up  with  nervous  prostration  for  two  weeks 
after  the  operation. 

CHEMICAL   CONSTITUENTS    OF   SALIVARY   CALCULUS. 

Salivary  calculus  is  composed  of  phosphate  of  lime  and  animal 
matter,  combined  in  various  proportions,  accordingly  as  it  is  hard  or 
soft;  consequently  no  two  analyses  will  yield  the  same  result.     The 
following  is  the  analysis  made  by  Mr.  Peps  for  Mr.  Fox.     Fifty  parts 
yielded 

Phosphate  of  Lime, ......  85 

Fibrin,  or  cartilage,       ......  9 

Animal  fat,  or  oil,    .  .  .  .  .  .  3  . 

Loss,        ........         3 

50 

Berzelius  gives  the  following  analysis.  He  found  one  hundred 
parts  to  contain 

Phosphate  of  lime  and  magnesia,  .  .  .  79-0 

Salivary  mucus  and  salivine,  ....        13-5 

Animal  matter,       .  .  .  .  .  .  .7*5 


1000 


Dr.  Dwinelle,  of  ISTew  York,  furnishes  the  following : 

Phosphate  of  lime,     .             .             .       •      .             .             .  60 

Carbonate  of  lime,             .           .             .            .             ,  .14 

Animal  matter  and  mucus,     .....  16 

Water  and  loss,     .             .            .            .            .            ,  .10 

100 


198  SALIVARY    CALCULUS. 

The  last  named  gentleman  acknowledges  that  he  could  make  no 
two  analyses  agree.  Hard,  dry  tartar  contains  more  earthy  and  less 
animal  matter  than  the  soft,  humid  tartar. 

Chemical  analysis  reveals  a  large  proportion  of  mucus,  as  is  shown 
by  the  following  table  of  Vauquelin  and  Langier : 

Phosphate  of  lime  and  a  little  luagucsia,  .  .  .66 

Carbonate  of  lime,      ......  9 

Salivary  mucus  (including  ptyalin),        .  .  .  .13 

Animal  matter  soluble  in  hydrochloric  acid,  .  .  5 

Water  and  loss,      .......      7 

100 

An  analysis  of  saliva  reveals,  water,  ptyalin,  fat,  chloride  of  sodium, 
chloride  of  potassium,  phosphate  of  lime,  and  suljDhocyauide  of 
potassium. 

The  infusoria,  of  which  M.  Mandl  says  tartar  is  composed,  have 
their  origin  in  the  vitiated  mucus  which  is  always  mixed  with  it. 

Scherer  detected  with  a  microscope  infusoria,  in  large  numbers,  in 
the  saliva  of  a  girl  laboring  under  a  scorbutic  affection  of  the  mouth ; 
but  the  author  is  inclined  to  believe  that  they  had  their  origin  in  the 
mucous  secretions  of  this  cavity,  which  are  always  mixed  with  the 
former  fluid.  They  are  more  or  less  numerous,  as  the  tartar  is  hard 
or  soft,  or  in  proportion  to  the  quantity  of  mucus  that  enters  into  its 
composition.* 

ORIGIN   AND   DEPOSITION   OF   SALIVARY   CALCULUS. 

There  formerly  existed  much  diversity  of  opinion  as  to  the  source 
whence  salivary  calculus  is  derived ;  but  it  is  now  generally  conceded 
that  this  deleterious  concretion  is  a  deposit  chiefly  from  the  saliva, 
with  an  admixture  of  mucus,  as  the  analyses  of  both  these  secretions 
reveal  the  necessary  materials  in  suflficient  quantity  to  form  it.  Bidder 
and  Schmidt  make  the  phosphates  and  carbonates  amount  to  very  nearly 
one  per  cent,  in  the  saliva.  All  that  is  necessary,  therefore,  is  that 
the  surfaces  of  the  teeth  should  have  a  sufficient  affinity  for  the  sub- 
stance in  question  to  cause. a  nucleus,  which,  when  once  formed,  the 
secretion  continues  until  serious  secondary  effects  are  liable  to  result. 

In  most  varieties  of  salivary  calculus  there  is  a  notable  supera- 
bundance of  the  phosphates  and  carbonates,  while  in  others  there  is 
nearly  forty  per  cent,  of  purely  animal  matter.  Hence  the  difference 
in  action  upon  them  by  acids  and  alkalies.  Of  the  animal  matter 
entering  into  the  composition  of  salivary  calculus,  fibrin,  animal  fat, 
and  mucus  are  in  the  largest  proportion. 

*  Dr.  Dwinelle  gives  a  minute  description  of  their  appearance  in  the  first 
number  of  the  fifth  volume  of  the  American  Journal  of  Dental  Science. 


SALIVARY    CALCULUS.  199 

Of  the  existence  of  the  elements  of  the  composition  of  calculus  in 
the  saliva  there  can  be  no  question.  Chemical  analyses  of  this  fluid, 
direct  from  the  glands,  place  all  doubt  upon  the  subject  at  rest.  Tur- 
ner, in  enumerating  the  chemical  constituents  of  saliva,  mentions  bone- 
earth;*  and  Tiedemann,  Gmelin,  and  Scherer  have  detected  phosj^hate 
of  lime,  as  has  also  Enderlin,  and  other  chemists  who  have  analyzed 
this  fluid.  Thus  it  is  seen  that  the  chief  earthy  constituents  which 
enter  into  the  formation  of  this  substance  are  contained  in  the  saliva. 
It  may  also  exist  in  solution  in  the  mucous  fluid  of  the  mouth. 

That  the  deposition  of  tartar  may  take  place  on  one  side  of  the 
mouth  without  a  similar  deposit  on  the  opposite  side,  furnishes  no  evi- 
dence in  support  of  the  doctrine  which  has  been  advanced,  that  if  is 
an  exhalation  from  the  capillaries  of  the  mucous  membrane  of  the 
gums.  The  mastication  of  food  is,  with  most  persons,  performed  more 
on  one  side  of  the  mouth  than  on  the  other ;  that  this  function  pre- 
vents, in  a  great  degree,  the  accumulation  of  tartar  on  the  organs 
immediately  concerned,  is  a  fact  with  which  every  dentist  must  be 
familiar.  Hence  its  frequent  collection  on  the  teeth  of  one  side  and 
not  on  those  of  the  other.  And  that  it  is  ascribable  to  this  circum- 
stance is  susceptible  of  positive  proof.  If,  on  the  removal  of  the  tar- 
tar from  the  teeth  of  a  person,  in  whose  mouth  it  has  collected  only 
on  those  of  one  side,  mastication  be  afterward  altogether  performed  on 
this  side,  it  will  not  reaccumulate  on  them ;  and  if  requisite  attention 
to  the  cleanliness  of  the  teeth  on  the  other  side  be  not  observed,  it 
will  soon  collect  there,  although  these  teeth  had  before  remained  free 
from  it. 

Again,  it  often  happens  that  disease  of  a  severe  character  is  excited 
in  the  gums  by  the  use  of  mercurial  medicines  and  other  causes,  and 
yet  but  a  small  quantity  of  tartar  collects  on  the  teeth  ;  but  that  any 
condition  of  the  general  system,  or  of  the  mouth,  tending  to  make  the 
fluids  of  this  cavity  more  viscid,  promotes  its  formation  is  undeniable. 
There  are,  however,  some  temperaments  much  more  favorable  to  its 
production  than  others ;  and  it  is  a  well-established  fact,  that  the 
mucous  membrane  of  those  in  whose  mouths  it  accumulates  in  largest 
quantity  is  the  most  irritable,  and  the  buccal  fluids  most  viscid.  Again, 
if  it  were  deposited  by  the  mucous  fluids  of  the  mouth,  it  would  col- 
lect in  largest  quantities  on  those  teeth  which  are  less  abundantly 
bathed  in  the  saliva  ;  as,  for  example,  the  anterior  surfaces  of  the 
upper  incisors  and  cuspids,  while  those  opposite  to  the  mouths  of  the 
ducts,  which  discharge  this  fluid  into  the  mouth,  would  be  less  liable  to 
deposits  of  tartar  than  any  of  the  other  teeth  ;  whereas  the  contrary  is 
found  to  be  the  case. 

*  Turner's  Chemistry,  p.  756, 


200  SALIVARY    CALCULUS. 

The  conclusion,  therefore,  appears  to  us  irresistible,  that  this  earthy- 
matter  is  chiefly  a  salivary  deposit,  and  takes  place  in  the  following 
manner:  It  is  precipitated  from  the  saliva,  as  this  fluid  enters  the 
mouth  —  especially  when  the  secretion  is  sluggish  —  upon  the  surfaces 
of  the  teeth  opposite  the  openings  into  the  ducts  from  which  it  is  poured. 
To  these  its  particles  become  agglutinated  by  the  mucus  always  found, 
in  greater  or  less  quantity,  upon  them.  Particle  after  particle  is  depos- 
ited, until  it  sometimes  accumulates  in  such  quantities  that  nearly  all 
the  teeth  are  almost  entirely  iucrusted  with  it. 

As  regards  the  points  of  deposit  of  salivary  calculus,  the  greatest 
quantities  are  found  opposite  the  mouths  of  the  ducts  of  the  salivary 
glands  upon  the  lingual  surfaces  of  the  inferior  incisors,  cuspidati,  and 
bicuspids,  and  the  buccal  surfaces  of  the  superior  molars.  The  necks 
of  the  teetli,  about  the  free  margins  of  the  gums,  afford  favorable 
points  for  its  collection,  as  here  the  saliva  is  longer  retained  and  its 
calcareous  ingredients  precipitated,  than  upon  more  exposed  parts.  It 
first  collects  about  the  necks  of  the  teeth  in  serai-circular  or  crescent- 
like lines  close  to  the  enamel,  under  the  edge  of  the  gums,  and  a  nu- 
cleus being  once  formed,  it  rapidly  encroaches  upon  the  crown,  where 
it  is  deposited  more  abundantly.  Certain  varieties  of  salivary  calculus 
adhere  to  the  necks  of  the  teeth  with  great  tenacity,  and  often  progress 
as  far  as  the  apex  of  the  root,  until  the  teeth  are  deprived  of  their 
support,  and  their  roots  left  denuded  and  exposed.  Salivary  calculus 
is  never  deposited  on  the  flesh,  but  only  upon  such  substances  as  rep- 
resent the  teeth  or  form  nuclei,  as  artificial  teeth,  for  example.  It  is 
sometimes  deposited  in  the  ducts,  which  may  be  owing  to  a  sluggish 
condition  of  the  saliva,  in  a  form  known  as  ranula,  and  has  been  re- 
moved in  a  mass  as  large  as  a  hazel-nut. 

M.  Robert  presented  to  the  Anatomical  Society  of  Paris  a  hog's 
bristle,  which  had  been  forced  into  the  duct  of  Wharton,  densely  cov- 
ered with  a  thick  salivary  concretion. 

From  the  fiict  that  salivary  calculus  is  often  found  upon  parts  where 
the  saliva  cannot  be  retained  for  any  length  of  time,  it  is  evident  that 
it  is  sometunes  precipitated  as  soon  as  this  fluid  enters  the  mouth. 

EFFECTS     OF     SALIVARY     CALCULUS     UPON     THE    TEETH,    GUMS,    AND 
ALVEOLAR    PROCESSES. 

Although  salivary  calculus  does  not  directly  act  injuriously  upon  the 
substance  of  the  teeth,  but,  on  the  contrary,  preserves  the  part  it 
covers  from  the  action  of  chemical  agents,  yet  the  effects  of  the  presence 
of  this  substance  are  always  pernicious,  though  sometimes  more  so 
than  at  others.  An  altered  condition  of  the  fluids  of  the  mouth,  dis- 
eased gums,  and  not  uufrequently  the  gradual  destruction  of  the  alve- 


SALIVARY    CALCULUS.  201 

olar  processes,  and  the  loosening  and  loss  of  the  teeth,  are  among  the 
consequences  that  result  from  it.  But  besides  these,  other  effects  are 
occasionally  produced,  among  which  may  be  enumerated  tumors  and 
spongy  excrescences  of  the  gums  of  various  kinds,  necrosis  and  exfo- 
liation of  the  alveolar  processes  and  of  portions  of  the  maxillary 
bones,  hemorrhage  of  the  gums,  anorexia,  derangement  of  the  whole 
digestive  apparatus,  and  foul  breath,  catarrh,  cough,  diarrhoea,  diseases 
of  various  kinds  in  the  maxillary  antra  and  nose,  pain  in  the  ear, 
headache,  melancholy,  hypochondriasis,  etc.  So  irritating  is  its  pre- 
sence that,  wherever  it  comes  in  contact  with  the  gums  and  alveoli,  it 
causes  their  absorption,  which  in  some  cases  may,  at  first,  be  attended 
with  little  or  no  inconvenience  to  the  parties;  while  in  others  consider- 
able inflammation,  ending  in  suppuration  of  the  gums,  may  result,  ex- 
tending to  the  mucous  membrane  of  the  mouth.  Periostitis  and  necrosis 
of  the  alveolar  processes  are  also  results  of  the  irritating  action  of  this 
substance.  The  character  of  the  effects,  however,  both  local  and  con- 
stitutional, depends  upon  the  quantity  and  consistence  of  the  tartar, 
and  upon  the  temperament  of  the  individual  as  well  as  the  state  of  the 
general  health  ;  the  two  former  of  these  are  determined  by  the  two 
latter,  and  by  the  attention  paid  to  the  cleanliness  of  the  teeth.  If 
this  last  be  properly  attended  to,  salivary  calculus,  no  matter  how 
great  the  constitutional  tendency  to  its  formation,  will  not  collect  in 
large  quantity  upon  the  teeth.  The  importance,  therefore,  of  its  con- 
stant observance  cannot  be  too  strongly  impressed  upon  the  patient, 
especially  in  those  in  whom  there  exists  a  great  tendency  to  its  de- 
position. 

The  teeth  and  their  contiguous  parts  suffer  more  from  accumulations 
of  this  substance,  than  almost  any  other  cause.  Caries  is  not  much 
more  destructive  to  them.  When  permitted  to  accumulate  for  any 
great  length  of  time,  the  gums  become  so  morbidly  sensitive  that  a 
tooth-brush  cannot  be  used  without  causing  pain ;  consequently,  the 
cleanliness  of  the  mouth  is  not  attempted,  and  thus,  no  means  being 
taken  to  prevent  its  formation,  it  accumulates  with  increased  rapidity, 
until  the  teeth,  one  after  another,  fall  in  quick  succession  victims  to  its 
desolating  ravages. 

It  sometimes  not  only  undermines  the  constitution,  by  occasioning 
discharges  of  fetid  matter  from  the  gums,  and  corrupting  the  fluids  of 
the  mouth,  but  it  also  renders  the  breath  exceedingly  unpleasant  and 
offensive.  So  nauseating  and  disagreeable  is  the  odor  which  some 
descriptions  of  tartar  exhale,  that  the  atmosphere  of  a  whole  room  is 
contaminated  by  it  in  a  few  minutes. 


202 


SALIVAEY    CALCULUS. 


MANNER   OF    REMOVING    SALIVARY    CALCULUS. 

This  is  an  operation  of  great  importance  to  the  health  of  the  gums, 
alveolar  processes,  and  teeth.  But  from  a  misconception  of  its  nature, 
rather  than  from  fear  of  pain,  many  arc  much  opposed  to  it ;  and,  not- 
withstanding the  universal  admiration  in  which  clean  and  white  teeth 
are  held,  they  will  suffer  the  beauty  of  these  organs  to  be  destroyed 
rather  than  submit  to  its  performance.  There  are  some,  indeed,  who, 
though  scrupulously  particular  in  everything  that  regai-ds  dress,  seem 
nevertheless  to  consider  cleanliness  of  the  mouth  as  unworthy  of  notice. 

For  the  removal  of  tartar  from  the  teeth,  a  variety  of  instruments 
are  necessary,  which  should  be  so  constructed  that  they  may  be  easily 
applied  to  every  part  of  every  tooth.  Those  in  common  use  among 
dental  practitioners  are  so  very  similar  in  their  shape  and  so  well  know^n, 
that  we  do  not  deem  it  necessary  to  point  out  the  minute  differences  of 
construction,  or  even  to  give  a  general  description  of  the  instruments 
themselves.  The  instruments  should  be  light,  made  with  ivory,  ebony, 
or  cocoa  "handles,  and  tapering  from  a  little  above  the  ferule,  both 
ways ;  and  the  points  of  the  instruments  should  be  delicately  shaped, 
so  as  readily  to  pass  below  the  free  edge  of  the  gum.  The  success  of 
the  operation  depends  much  upon  the  careful  removal  of  every  particle 
of  deposit ;  for  which  a  heavy,  clumsy,  or  large-bladed  instrument  is 
wholly  unsuited.  If  any  particles  of  tartar  be  suffered  to  remain, 
they  will  irritate  the  gums,  and  serve  as  nuclei  for  immediate  re-accu- 
mulations. 

Dr.  Abbott's  scalers,  represented  in  the  following  figures,  are  well 
adapted  for  removing  salivary  calculus  from  all  parts  of  the  teeth. 

Fig.  46.  ' 


The  adhesion  of  tartar  to  the  teeth  is  sometimes  so  great  that  con- 
siderable force  is  required  for  its  removal,  even  when  the  sharpest  and 
best-tempered  instruments  are  employed  ;  but  ordinarily  it  may  be 


SALIVARY    CALCULUS.  203 

removed  with  ease.  Considerable  tact,  however,  is  necessary  to  per- 
form the  operation  in  a  skilful  manner ;  more  than  most  persons,  from 
its  apparent  simplicity,  imagine.  This  skill  can  only  be  acquired  by 
practice,  Tartar  may  be  taken  from  the  outer  and  inner  surfaces  of 
the  teeth  without  much  difficulty  ;  but  the  removal  of  it  from  between 
them  is  more  troublesome,  and  can  only  be  effected  by  means  of  very 
thin,  sharp-pointed  instruments. 

In  removing  this  substance  from  the  teeth,  the  point  or  edge  of  the 
scaling  instrument  should  be  applied  below  the  deposit,  between  it  and 
the  gum,  and  passed  well  under,  until  it  comes  in  contact  with  the  sur- 
face of  the  tooth,  and  the  mass  scaled  off  in  the  direction  of  the  cutting 
edge  or  grinding  surface. 

Care  is  necessary  that  the  edge  of  the  instrument  does  not  roughen 
the  tooth  substance,  especially  the  dentine,  beyond  the  enamel ;  and  to 
prevent  the  possibility  of  this,  some  recommend  the  use  of  instruments 
from  which  the  sharp  edge  has  been  removed.  After  the  removal  of 
the  greater  part  of  the  deposit,  the  instrument  should  be  lightly  passed 
over  the  surface  to  detach  any  particles  which  may  remain,  especially 
upon  the  approximal  surfaces.  After  the  use  of  the  scaling  instruments, 
finely  pulverized  pumice  or  silex  should  be  applied  on  a  piece  of 
orange  wood  so  shaped  as  to  reach  all  parts  on  which  the  deposit  has 
collected.  Where  the  surface  of  the  enamel  or  dentine  is  found  to  be 
rough  and  without  the  natural  polish,  after  the  use  of  the  pumice  or 
silex,  Arkansas  stone  and  the  burnisher  may  be  applied  with  advantage 
and  a  finely  polished  surface  obtained. 

Several  sittings  are  sometimes  necessary  for  the  completion  of  the 
operation,  especially  when  the  tartar  has  accumulated  in  very  large 
quantities.  In  all  cases  of  this  sort,  it  should  be  first  removed  from 
between  the  edges  of  the  gums  and  the  necks  of  the  teeth.  During  the 
intervals  between  the  several  operations  the  mouth  should  be  gar- 
gled, several  times  a  day,  with  some  cooling  and  astringent  wash ;  but 
on  this  subject  more  particular  directions  will  be  given  in  another 
chapter. 

During  the  removal  of  tartar  from  the  teeth,  the  gums  often  bleed 
very  freely ;  and  when  much  swollen  and  spongy,  it  may  be  well  to 
promote  it  by  holding  tepid*  water  in  the  mouth.  When  the  lower  in- 
cisors are  loose,  as  is  often  the  case,  the  operation  should  be  proceeded 
with  very  cautiously,  and  the  teeth  supported  by  the  fingers  of  the  left 
hand  holding  the  jaw,  especially  when  the  tartar  is  very  hard  and  ad- 
heres with  great  tenacity. 

Chemical  agents  are  sometimes  employed  for  the  removal  of  salivary 
calculus,  especially  such  of  the  vegetable  and  mineral  acids  as  are 
supposed  to  have  less  affinity  for  the  lime  of  the  teeth  than  the  phos- 


204  SALIVARY    CALCULUS. 

phoric  acid  with  -which  it  is  combined  ;  but  it  is  scarcely  necessary  to 
say  that  any  acid  capable  of  dissolving  tartar  will  act  upon  these 
organs.  The  use  of  all  such  agents  should  be  most  scrupulously 
avoided.  Nearly  all  acids,  both  mineral  and  vegetable,  as  has  been 
shown  in  another  part  of  this  work,  are  prejudicial  to  the  teeth. 
Their  careless  administration  by  physicians  is  a  fruitful  source  of 
injury  to  the  teeth.  And  they  certaiuly  should  form  no  part  of  any 
dentifrice,  or  be  in  auy  way  used  for  the  removal  of  stains  of  any  kind 
from  the  teeth. 

MUCUS   DEPOSIT   ON   THE   TEETH. 

While  persons  of  all  ages  are  subject  to  deposits  of  salivary  calculus, 
there  is  a  mucus  deposit,  to  which  the  teeth  of  children  are  especially 
liable,  in  the  form  of  a  brown  or  a  green  stain,  which  has  been  erroneously 
called  green  tartar.  This  deposit  is  generally  found  upon  the  labial 
surfaces  of  the  front  teeth,  more  especially  upon  those  of  the  upper 
jaw,  and  varies  in  color  from  a  light  brown  to  a  dark  green.  From  its 
not  collecting  upon  the  posterior  teeth  and  u]Don  the  lingual  surfaces  of 
the  inferior  front  teeth  opposite  the  mouths  of  the  ducts  leading  from 
the  salivary  glands,  there  is  every  reason  to  conclude  that  this  deposit 
is  not  precipitated  by  the  saliva,  and  hence  is  altogether  different  in  its 
origin  from  salivary  calculus.  It  is  generally  considered  to  be  a  de- 
posit from  the  mucus,  w'hen  this  secretion  is  in  a  more  acid  condition 
than  is  natural.  From  its  effects  upon  the  teeth,  when  it  is  alloAted  to 
remain  on  them  for  a  considerable  time,  and  also  from  the  fact  that  it 
is  most  abundant  when  the  mucus  is  secreted  in  large  quantities  and 
of  a  decidedly  acid  reaction,  there  is  little  doubt  as  to  its  origin  from 
this  secretion. 

That  it  is  not  deposited  on  all  parts  of  the  teeth,  is  no  reason  for  doubt- 
ing the  correctness  of  this  theory,  when  we  consider  that  the  parts  upon 
which  it  is  found  are  those  protected  from  the  friction  of  food  and  the 
movements  of  the  tongue  and  the  flow  of  the  saliva. 

In  regard  to  the  effects  of  this  mucus  deposit  upon  the  teeth,  while 
salivary  calculus  tends  to  preserve  the  portion  of  tooth  substance  on 
which  it  is  precipitated,  this  green  stain  so  erodes  the  enamel  that  de- 
cay advances  in  the  part  which  it  covers,  aaore  or  less  rapidly,  accord- 
ing to  the  quality  of  the  teeth  and  the  length  of  time  it  is  allowed  to 
remain.  The  removal  of  this  mucus  deposit  requires  more  skilful 
manipulation  than  that  of  salivary  calculus,  on  account  of  its  being  a 
thin  film  entering  into  the  substance  of  the  enamel,  rendering  it  diffi- 
cult to  detach  without  injury  to  the  tooth  substance ;  whereas  salivary 
calculus  is  deposited  in  such  quantities  as  to  leave  thick  incrustations, 
which  are  readily  scaled  off  from  an  uninjured  surface.     Where  the 


THE    FLUIDS    OF    THE    MOUTH.  205 

erosion  caused  by  this  mucus  deposit  is  but  slight,  it  may  be  removed 
by  Arkansas  or  Superior  stones,  or  by  finely  powdered  silex  or  pumice 
stone  and  water  applied  on  a  stick  of  hard,  fine  grained  wood,  such  as 
orange  wood  or  hickory ;  the  point  of  the  piece  of  wood  being  so  formed  as 
to  adapt  it  well  to  the  surface  on  which  it  is  to  be  used.  After  all  the 
discoloration  is  removed  by  the  means  just  referred  to,  the  surface 
should  be  well  burnished  with  a  steel  burnisher  and  a  solution  of  pure 
Castile  or  white  Windsor  soap.  When,  however,  the  effects  of  this  mu- 
cus deposit  are  more  serious,  the  enamel  not  only  being  discolored  but 
deeply  eroded,  it  is  necessary  to  make  use  of  the  enamel  chisel  or  file 
to  remove  the  injured  surface.  The  enamel  chisel  is  to  be  preferred  to 
the  file  in  all  cases  where  it  is  applicable ;  and  the  plain  surface  thus 
obtained  should  be  polished  with  fine  silex  or  pumice  stone,  Arkansas 
or  Superior  stones,  and  the  burnisher.  Care  is  necessary  in  the  use  of 
the  enamel  chisel  to  avoid  wounding  the  neighboring  soft  tissues.  To 
prevent  the  possibility  of  such  an  accident,  and  to  enable  the  operator 
to  have  control  over  his  instrument,  the  chisel  should  be  held  firmly 
with  the  hand  in  such  a  manner  as  to  allow  the  thumb  to  rest  on  an 
adjoining  tooth.  When  the  dentine  is  very  sensitive,  as  is  frequently 
the  case,  a  proper  agent  for  ^.Haying  the  sensitiveness  may  be  applied 
from  time  to  time  to  the  surjfkce,  as  the  operation  of  cutting  it  away 
proceeds.    (See  "  Treatment  of  Sensitive  Dentine.") 


CHAPTER  VI. 

THE   FLUIDS   OF  THE   MOUTH. 

IN  treating  upon  the  physical  characteristics  of  the  fluids  of  the 
mouth,  it  will  not  be  necessary  to  dwell  at  much  length  on  their 
effects,  when  in  a  morbid  condition,  on  this  cavity.  Concerning  their 
agency  in  the  production  of  caries  of  the  teeth,  we  shall  add  one  or 
two  remarks. 

Saliva,  in  healthy  persons  having  good  constitutions,  has  a  light 
frothy  appearance,  and  but  little  viscidity.  Inflammation  of  the  gums, 
from  whatever  cause  produced,  increases  its  viscidity,  and  causes  it  to 
be  less  frothy.  In  a  healthy  state,  it  is  inodorous,  floats  upon  and 
mixes  readily  with  water,  but  when  in  a  viscid  or  diseased  condition, 
it  sinks  and  mixes  with  it  Avith  difficulty. 

Irritation  in  the  mouth,  from  diseased  gums,  aphthous  ulcers,  in 
flammation  of  the  mucous  membrane,  the  introduction  of  mercury 


206  THE    FLUIDS    OF    THE    MOUTH. 

Into  the  system,  or  takins;  anything  pungent  into  the  mouth,  increases 
the  ilow  of  this  fluid,  and  causes  it  to  be  more  viscid  than  it  is  in  its 
natun.l  and  healtiiy  state. 

In  treating  on  the  symptomatology  of  saliva.  Prof.  Schill  says,  "The 
sympathetic  affection  of  the  stomach  in  pregnancy  is  sometimes  ac- 
companied by  salivation,  which,  in  this  case,  mostly  takes  place  after 
conception,  and  sometimes  continues  to  the  time  of  delivery.  It  is 
also  observed  to  occur  in  weakened  digestion,  in  gastric  catarrhs,  after 
the  use  of  emetics,  in  mania,  in  what  are  called  abdominal  obstruc- 
tions, in  hypochondriasis  and  hysteria;  salivation  occurs  during  the 
use  of  mercury  or  antimony. 

"  In  confluent  small-pox,  salivation  is  a  favorable  sign.  If  it  cease 
before  the  ninth  day,  the  prognosis  is  bad.  In  lingering  intermittents, 
salivation  is  sometimes  critical ;  more  frequently  in  these  afi'ections  it 
precedes  the  termination  in  dropsy. 

"Diminution  of  the  salivary  secretion,  and,  in  consequence  of  this, 
dryness  of  the  mouth,  is  peculiar  to  the  commencement  of  acute  dis- 
ease, as  also  to  the  hectic  fevers  occasioned  by  affections  of  the  ab- 
dominal organs.  If  the  flow  of  the  saliva  stop  suddenly,  there  is 
reason  to  apprehend  an  affection  of  the  brain. 

"Thick  viscid  saliva  occurs  under  the  same  circumstances  as  the 
diminution  of  the  salivary  secretion,  especially  in  small-pox,  typhus, 
and  in  hectic  fevers.  It  is  thin  in  ptyalism.  In  gastric  diseases,  where 
the  liver  participates,  it  becomes  yellow  or  green ;  by  the  admixture 
of  blood  it  may  assume  a  reddish  color ;  in  pregnant  or  lying-in 
women,  it  is  sometimes  milky;  an  icy  cold  saliva  was  observed  by  the 
author  in  faceache. 

"  Frothy  saliva  from  the  mouth  is  observed  in  apoplexy,  epilepsy, 
hydrophobia,  and  in  hysterical  paroxysms." 

Dr.  Bell,  of  Philadelphia,  in  a  note  to  the  work  from  which  we 
have  just  quoted,  says,  "Acid  saliva  is  regarded  by  M.  Donne  as  in- 
dicative of  gastritis  or  deranged  digestion.  Mr.  Laycock,"  he  ob- 
serves, "on  the  other  hand,  infers  from  numerous  experiments  on 
hospital  patients  that  the  saliva  may  be  acid,  alkaline,  or  neutral, 
when  the  gastric  ])henomena  are  the  same.  In  general,  Mr.  L.  re- 
marked that  it  was  alkaline  in  the  morning  and  acid  in  the  evening." 

We  have  had  occasion  to  observe  that  the  acid  quality  of  the 
saliva  was  more  apparent  and  more  common  in  lymphatic,  mucous,  and 
bilious  dispositions,  than  in  sanguineous  or  in  sanguineo-serous  persons, 
and  that  weakened  or  impaired  digestion  always  had  a  tendency  to  in- 
crease it. 

M.  Delabarre  says,  "When  this  fluid"  (the  saliva)  "has  remained 
in  the  mouth  some  moments,  it  there  obtains  new  properties,  accord- 


THE    LIPS.  207 

ing  to  each  individual's  constitution  and  the  integrity  of  the  mucous 
membrane,  or  some  of  the  parts  which  it  covers. 

"In  subjects  who  enjoy  the  best  health,  whose  stomach  and  lungs 
are  unimpaired,  the  saliva  appears  very  scarce,  but  this  is  because  it 
passes  into  the  stomach  almost  as  soon  as  it  is  furnished  by  the  Q:lands 
that  secrete  it.  It  only  remains  long  enough  in  the  mouth  to  mix 
with  a  small  quantity  of  mucus,  and  absorb  a  certain  portion  of 
atmospheric  air,  to  render  it  frothy. 

"  On  the  other  hand,  the  saliva  of  an  individual  whose  mucous 
system  furnishes  a  large  quantity  of  mucus,  is  stringy  and  heavy ;  is 
but  slightly  charged  with  oxygen,  contains  a  great  proportion  of  azote 
and  sulphur,  and  stains  silver." 

Increased  redness  and  irritability  of  the  mucous  membrane  of  the 
mouth  is  an  almost  invariable  accompaniment  of  general  acidity  of 
these  fluids.  Excoriation  and  aphthous  ulcers,  and  bleeding  of  the 
gums,  also,  frequently  result  from  this  condition  of  the  salivary  and 
mucous  secretions  of  this  cavity. 

Anorexia,  languor,  general  depression  of  spirits,  headache,  diarrhoea, 
and  rapid  decay  of  the  teeth,  ai-e  very  common  among  persons  habitu- 
ally subject  to  great  viscidity  of  the  buccal  fluids.  It  is  likewise 
among  subjects  of  this  kind,  and  particularly  when  the  viscidity  is  so 
great  as  to  cause  clamminess  of  these  secretions,  that  the  green  dis- 
coloration of  the  enamel  of  the  teeth  is  most  frequently  met  with. 


CHAPTER  VII. 

THE    LIPS. 


THE  indications  of  the  physical  characteristics  of  the  lips  are 
more  general  than  local,  and  the  observations  of  Laforgue  and 
Delabarre  on  this  subject  leave  little  to  be  added.  We  cannot,  there- 
fore, do  much  more  than  repeat  what  they  have  said. 

"  The  lips,"  says  Delabarre,  "  present  marked  difierences  in  different 
constitutions.  They  are  thick,  red,  rosy,  or  pale,  according  to  the 
qualities  of  the  blood  that  circulates  through  their  arteries." 

Firmness  of  the  lips,  and  a  pale  rose  color  of  the  mucous  membrane 
that  covers  them,  are,  according  to  Laforgue,  indicative  of  pure  blood, 
and,  as  a  consequence,  of  a  good  constitution.  Redness  of  the  lips, 
deeper  than  that  of  the  pale  rose,  is  also  mentioned  as  one  of  the  signs 
of  sanguineo-serous  blood.  Soft,  pale  lips  are  indicative  of  lym- 
phatico-serous  dispositions.     In  these  subjects  the  lips  are  almost  en- 


208  THE    LIPS. 

tirely  without  color.  "When  there  is  a  sufficiency  of  blood,  the  lips 
are  firm,  though  variable  in  color,  according  to  the  predominancy  of 
the  red  or  s^orous  parts  of  this  fluid. 

Both  hardness  and  redness  of  the  lips,  and  all  the  soft  parts  of  the 
mouth,  are  enumerated  among  the  signs  of  plethora.  Softness  of  the 
lips,  ^Yithout  change  of  color  in  their  mucous  membrane,  is  spoken  of 
by  the  last  author  as  indicative  of  deficiency  of  blood;  and  softness 
and  redness  of  the  mucous  membrane  of  the  lips  are  signs  that  the 
blood  is  small  in  quantity  and  sanguiueo-serous. 

Deficiency  in  the  red  corpuscles,  and  in  the  nutritive  qualities  of 
the  blood,  is  evidenced  by  the  want  of  color  and  softness  of  the  lips, 
and  general  paleness  of  the  mucous  membrane  of  the  whole  mouth. 
"The  fluids  contained  in  the  vessels,"  says  Laforgue,  "in  forms  of 
anremia,  vield  to  the  slightest  pressure,  and  leave  nothing  between  the 
fingers  but  the  skin  and  cellular  tissue." 

In  remai'king  upon  the  signs  of  the  diflferent  qualities  of  the  blood, 
the  above-mentioned  author  asserts  that  the  constitution  of  children, 
about  six  years  of  age,  cannot  be  distinguished  by  any  universal  char- 
acteristic ;  but  that  the  lips,  as  well  as  the  other  parts  of  the  mouth, 
constantly  betoken  "  the  quality  of  blood  and  that  of  the  flesh  ; " 
and,  "  consequently,  they  proclaim  health  or  disease,  or  the  approach 
of  asthenic  and  adynamic  disorders,  which  the  blood  either  causes  or 
aggravates." 

Again,  he  observes  that  the  blood  of  all  children  is  "superabund- 
antly serous,"  but  that  it  is  redder  in  those  of  the  second  constitution 
than  in  those  of  any  of  the  others,  and  that  this  is  more  distinctly 
indicated  by  the  color  of  the  lips.  "This  quality  of  the  blood,"  says 
he,  "  is  necessary  to  dispose  all  the  parts  to  elongate  in  their  growth. 
When  the  proportions  of  the  constituent  elements  of  the  blood  are 
just,  growth  is  accomplished  without  disease.  If  the  proportions  are 
otherwise  than  they  should  be  for  the  preservation  of  the  health,  or  if 
one  or  moi-e  of  its  elements  be  altered,  health  no  longer  exists,  growth 
is  arrested  altogether,  or  is  performed  irregularly.  The  nutritive 
matter  is  imperfect,  assimilation  is  prevented  or  impaired.  On  the 
other  hand,  its  disintegration  decomposes  the  patient;  if  death  does 
not  sooner  result,  it  will  consume  him  by  the  lesion  of  some  vital 
organ." 

The  changes  produced  in  the  color  of  the  blood  by  organic  derange- 
ment are  at  once  indicated  by  the  color  of  the' lips. 

The  accuracy  of  Laforgue's  observations  on  the  indications  of  the 
physical  characteristics  of  the  lips  has  been  fully  confirmed  by  subse- 
quent writers. 

"  The  secretion  of  the  lips,"   says   Prof.  Schill,    "  has   a   similar 


THE    TONGUE.  209 

diagnostic  and  prognostic  import  to  that  of  tlie  tongue  and  gums. 
They  become  dry  in  all  fevers  and  in  spasmodic  paroxysms.  A 
mucous  white  coating  is  a  sign  of  irritation  or  inflammation  of  the 
intestinal  canal ;  accordingly,  this  coating  is  found  in  mucous  ob- 
structions, in  gastric  and  intermittent  fevers,  in  mucous  fever,  and 
before  a  gouty  paroxysm.  A  dry,  brown  coating  of  the  lips  is  a  sign 
of  colliquation  in  consequence  of  typhus  afiections ;  it  is  accordingly 
observed  in  typhus,  in  putrid  fever,  in  acute  exanthemata,  and  inflam- 
mations which  have  become  nervous." 

The  lips,  however,  do  not  present  so  great  a  variety  of  appearance 
as  those  of  other  parts  of  the  mouth,  for  the  reason  that  they  are 
not  as  subject  to  local  diseases ;  but  their  general  pathological  indica- 
tions are,  perhaps,  quite  as  decided. 


CHAPTEE  VIII. 

THE   TOXGUE. 


THE  appearance  of  the  tongue,  both  in  health  and  disease,  is  re- 
garded by  physicians  as  furnishing  more  correct  indications  of  the 
state  of  the  constitution  and  general  health  than  any  of  the  other  parts 
of  the  mouth.  It  is  asserted,  however,  by  others,  and  by  those,  too, 
who  have  the  very  best  opportunities  for  inspecting  the  various  parts 
of  this  cavity,  that  the  lips  and  gums  furnish  as  marked  and  reliable 
indications  as  the  tongue.  That  the  state  and  quality  of  the  blood 
can  be  as  readily  ascertained  by  an  examination  of  these  parts  as  by 
that  of  the  tongue,  i?,  we  believe,  undeniable ;  but  that  the  patholog- 
ical condition  of  the  body  can  be  inferred  is  a  question  we  leave  for 
others  to  decide. 

So  far  as  the  quality  of  the  blood  and  the  temperament  of  the  sub- 
ject are  indicated  by  the  color  of  the  tongue,  the  preceding  remarks 
concerning  the  lips  will  be  found  applicable,  the  one  being  as  much 
influenced  by  them  as  the  other.  It  will,  therefore,  be  unnecessary  to 
recapitulate  what  we  have  before  said  upon  the  subject. 

The  effects  produced  upon  the  mucous  membrane  of  the  tongue  by 
disease  in  any  other  part,  are  said  to  be  analogous  to  those  produced 
on  the  general  integument.  So,  also,  are  the  changes  of  its  color,  con- 
sistence, humidity,  and  temperature  similar  to  those  of  the  skin.  We 
are  likewise  told  that  the  changes  of  its  coating  agree  with  the  analo- 
gous changes  of  the  perspiration,  and  that  these  phenomena  are  more 
decided  in  acute  than  in  chronic  affections. 
14 


210  THE    TOXGUE. 

But  the  diagnostic  and  prognostic  indications  of  the  tongue  vary 
according  to  the  temperament  and  constitutional  predisposition  of  the 
individual.  The  pliysician  should  acquaint  himself  with  its  appear- 
ances in  health,  to  be  able  to  determine  correctly  its  indications  in 
disease.  He  should  likewise  inform  himself  of  the  changes  produced 
in  its  appearance  by  certain  morbid  conditions  of  the  body.  In  some 
subjects  it  is  always  slightly  furred  and  rather  dry,  especially  near  its 
root;  in  others  it  is  always  clean  and  humid  ;  in  some,  again,  it  is 
always  red,  and  in  others  pale. 

Prof.  Schill  divides  the  signs  of  the  tongue  into  objective  and 
subjective.  "  To  the  objective  belong  the  changes  of  size,  form,  con- 
sistence, color,  temperature,  secretion,  and  of  power  and  direction  of 
motion;  and  to  the  subjective  belong  the  anomalous  sensations  of 
taste." 

In  enumerating  the  pathognomonic  signs  of  the  tongue,  this  author 
says  that  hypertrophy,  inflammation  or  congestion,  may  occasion  its 
enlargement;  and  that  inflammatory  swelling  of  it,  when  arising  from 
acute  diseases,  such  as  "angina,  pulmonary  inflammation,  measles, 
plague,  or  variola,  yields  an  unfavorable  prognosis.  Even  non-inflam- 
matory swelling  of  the  tongue  is  a  dangerous  phenomenon  in  acute 
diseases,  especially  cerebral,  which  are  combined  with  coma.  If  it  be 
the  consequence  of  mercury,  of  the  abuse  of  spirituous  drinks,  of  gas- 
tric inflammation,  of  chlorosis,  of  syphilis,  or  if  it  occur  in  hysteria 
or  epilepsy,  the  prognosis  is  not  dangerous ;  but  the  disease  is  always 
the  more  tedious  where  the  tongue  swells  than  where  it  does  not.  It 
is  enlarged,  also,  by  degenerescence  and  cancer. 

"  Diminution  of  the  size  of  the  tongue  takes  place  where  there  is 
considerable  emaciation.  In  this  case  it  continues  soft  and  movable. 
If,  in  acute  states,  the  tongue  becomes  small,  and  is,  at  the  same  time, 
hard,  retracted,  and  pointed,  the  irritation  is  very  great  and  the  prog- 
nosis bad.  This  sign  occurs  more  especially  in  typhus,  in  tbe  oriental 
cholera,  in  inflammation  of  the  lungs,  and  in  acute  cerebral  affections. 
In  hysteria  and  epilepsy  this  phenomenon  has  no  unfavorable  import." 

Internal  maladies,  he  says,  seldom  cause  the  form  of  the  tongue  to 
change ;  but  that  the  simplest  change  arising  from  chronic  irritations 
of  the  stomach,  chronic  dyspepsia,  and  acute  exanthemata,  is  enlarge- 
ment of  its  papillae.  In  cases  of  protracted  dyspepsia,  the  edges  of 
the  tongue  sometimes  crack,  and  in  paralysis  and  epilepsy  it  becomes 
elongated. 

In  acute  diseases,  a  soft  tongue  is  a  favorable  indication  ;  and  flac- 
cidity  of  it  is  symptomatic  of  debility. 

Humidity  of  the  tongue,  he  tells  us,  is  a  favorable  sign,  and  that 
•dryness  of  it  occurs  in  acute  or  violent  inflammations  and  irritations, 


THE    TONGUE.  211 

and  more  particularly  when  seated  in  the  intestinal  canal  and  respira- 
tory organs.  "This  also  happens  in  diarrhoea,  typhus,  pneumonia, 
gangrene  of  the  lung,  pleuritis,  peritonitis,  enteritis,  catarrhus  gas- 
tricus,  gastritis,  inflammation  of  joints,  etc.  Among  the  higher  degrees 
of  dryness  he  enumerates  the  rough,  the  fissured,  and  burnt  tongue,  as 
furnishing  still  more  unfavorable  indications,  informing  us,  at  the  same 
time,  that  if  these  be  not  accompanied  by  thirst,  they  prognosticate  a 
fatal  termination.  The  abatement  and  crisis  of  the  disease  is  indicated 
by  the  tongue  becoming  moist." 

Dr.  Bell,  of  Philadelphia,  in  a  note  to  Prof  Schill's  observations 
on  the  tongue,  says,  "A  rough  and  dry,  and  even  furred  tongue  is  seen 
in  some  dyspeptic  persons  "who  sleep  with  the  mouth  open;  and  al- 
though it  indicates  an  irritation  of  the  digestive  organs,  it  is  not  a  bad 
augury."  Bilious  persons,  not  unfrequently,  though  not  troubled  -with 
any  manifest  symptoms  of  gastric  or  intestinal  derangement,  or  any 
other  apparent  functional  disturbance,  have  a  furred  tongue  in  the 
morning. 

Paleness  of  the  tongue,  says  Prof  Schill,  is  a  sign  of  a  serous 
condition  of  the  blood,  of  chlorosis,  of  great  loss  of  blood,  of  chronic 
disorders,  of  sinking  of  the  strength  in  acute  maladies,  assuming  a 
"  nervous  form,  as  typhus  and  scarlatina  maligna.  It  is  also  found," 
says  he,  "  in  enteritis  and  dysentery,  when  but  little  fever  is  present." 
He  infers  from  this  that  paleness  of  the  tongue  is  caused  by  the 
"  drawing  of  the  fluids  downward  ; "  but  it  is  often  observed  in  persons 
who  enjoy  tolerably  good  health.  Lymphatic  dispositions,  as  has  been 
before  remarked,  are  peculiarly  subject  to  it. 

Again  he  observes,  that  a  very  red  tongue  is  indicative  of  ''  violent 
inflammation,  mostly  of  the  intestinal  canal,  but  also  of  the  lungs  and 
pharynx,  also  of  acute  exanthemata."  He  regards  the  prognosis  as 
bad,  when  a  furred  tongue,  "  in  acute  diseases  of  the  intestinal  canal, 
becomes  clean  and  very  red,"  if  the  change  is  not  accompanied  with 
the  return  of  the  patient's  strength.  "But,"  he  continues,  "if  the 
debility  is  not  considerable,  and  the  tongue  becomes  clean  and  very 
red,  while  other  febrile  symptoms  continue,  a  new  inflammation  may 
be  expected."  But  even  in  aflections  like  these,  the  redness  of  the 
tongue  is  always  more  considerable  in  sanguineous  than  in  lymphatic 
or  lymphatico-serous  subjects,  so  that  in  forming  a  prognosis  from  this 
sign,  the  temperament  of  the  individual  should  never  be  overlooked." 

Proceeding  with  the  description  of  the  signs  of  this  organ,  he  says, 
"  The  tongue  becomes  a  blackish  red  and  bluish  red  in  all  serious  disturb- 
ances of  the  circulation  and  respiration,  as  also  in  severe  diseases  of 
the  lungs  and  heart,  as  catarrhs,  sufibcations,  asthma,  extensive  inflam- 
mations of  the  lungs,  carditis,  Asiatic  cholera,  confluent  small-pox, 


212  THE    TONGUE. 

and  putrid  fevers.  It  becomes  black  and  livid  in  cases  of  vitiation  of 
the  blood,  more  especially  in  scurvy,  at  the  setting  in  of  gangrene, 
and  in  phthisis,  when  death  is  near  at  hand." 

Among  the  diseases  mentioned  as  giving  rise  to  an  increase  of  the 
temperature  of  the  tongue,  are  glossitis,  violent  internal  inflammation, 
and  tvphus  fever;  and  coldness  of  this  organ  is  observed  to  take  place 
in  Asiatic  cholera,  and  at  the  approach  of  death. 

The  signs  from  the  secretion  of  the  tongue  are  thus  enumerated  :  A 
clean  and  moist  tongue  are  favorable  indications,  but  a  clean,  dry,  and 
red  tongue,  as  seen  in  slow,  nervous  fevers,  acute  exanthemata  and 
plague,  are  bad  auguries.  A  furred  or  coated  tongue  is  said  to  occur 
chiefly  in  intestinal  disorders,  diseases  of  the  lungs,  skin,  and  in 
rheumatic  afiections.  The  coating  is  said  to  vary  in  "  color,  thickness, 
adherence,  and  extent,"  and  different  kinds  of  secretion  from  the 
mucous  membrane  of  this  organ  are  mentioned  as  occurring  in  differ- 
ent diseases,  and  it  should  have  been  added  in  the  same  disease  in 
different  temperaments. 

After  describing  the  various  kinds  of  coating  on  the  tongue,  to- 
gether with  their  respective  indications,  which  it  is  not  necessary  here 
to  enumerate,  the  occurrence  of  false  membranes  and  pustules,  result- 
ing from  peculiar  forms  of  mucous  secretion,  are  next  mentioned.  The 
former  show  themselves  either  as  small  white  points,  or  large  patches, 
and  sometimes  they  are  said  to  envelop  the  whole  tongue.  The  color 
is  "  sometimes  Avhite,  sometimes  yellow,  and  sometimes  red,"  and  the 
greater  the  surface  covered  by  them,  the  more  unfavorable  is  the 
prognosis  regarded.  "  Pustules  on  the  tongue,"  says  our  author,  "  are 
sometimes  idiopathic,  but  in  most  cases  symptomatic.  They  are  either 
distinct  or  confluent ;  the  confluent  are  the  worst.  Those  which  are 
hardish  and  dry,  and  also  those  which  are  blue,  and  those  of  a  blackish 
appearance,  which  sometimes  occur  in  acute  diseases,  are  of  an  un- 
favorable import."  On  the  other  hand,  those  which  have  a  whitish, 
soft,  moist,  and  semi-transparent  appearance,  are  less  unfavorable,  and 
when  the  aphthae,  or  eruption,  are  repeated,  it  portends  a  longer  con- 
tinuance of  the  malady.  The  pustules  or  aphthre  are  mentioned  as 
being  frequent  accompaniments  to  the  following  diseases,  namely, 
gastritis,  catarrhs,  enteritis,  metritis,  dysentery,  cholera  infontum, 
peritonitis,  intermittent  and  typhus  fevers,  pleuritis,  pneumonia,  and 
the  third  stage  of  pulmonary  consumption.  Their  prognosis  is  said  to 
be  favorable  when  "they  appear  with  critical  discharges  after  the 
seventh  day,"  and  unfavorable  when  they  occur  as  a  consequence  of  a 
general  sinking  of  the  physical  powers  of  the  body. 

But  it  is  unnecessary  to  enumerate  all  of  the  pathognomonic  indi- 
cations of  the  various  morbid  phenomena  described  by  semeiologists ; 


THE    DENTAL    PULP.  213 

we  have  noticed  more  of  them  than  was  our  intention  to  have  done. 
AVe  shall,  therefore,  conclude  the  present  inquiry,  by  simply  observing 
that  the  indications  furnished  by  the  physical  characteristics,  not  only 
of  the  tongue,  but  by  those  also  of  the  teeth,  the  gums,  salivary  cal- 
culus, the  lips,  and  fluids  of  the  mouth,  are,  as  we  have  endeavored  to 
show,  essential  to  the  successful  exercise  of  the  duties  both  of  the 
dental  and  medical  practitioner. 


CHAPTER  IX. 

THE    DENTAL   PULP. 


THE  pulp  of  a  tooth,  from  the  high  degree  of  vitality  with  which. 
it  is  endowed,  is  one  of  the  most  sensitive  structures  of  the  body, 
and,  like  other  parts,  is  liable  to  become  the  seat  of  various  morbid 
phenomena.  Its  susceptibility  to  morbid  impressions  is  influenced  by 
a  variety  of  circumstances,  such  as  temperament,  habit  of  body,  the 
state  of  the  constitutional  health,  the  condition  of  the  hard  structures 
of  the  tooth,  etc.  A  cause,  which  under  some  circumstances  would 
not  be  productive  of  the  slightest  disturbance,  might,  under  others, 
give  rise  to  active  inflammation,  with  all  its  painful  and  disagreeable 
concomitants.  Increased  irritability  (hypersesthesia)  may  exist  inde- 
pendently of  any  organic  change,  either  in  the  pulp,  dentine,  or 
enamel.  Examples  are  often  met  with  in  females  during  gestation ; 
but  it  arises  more  frequently  as  a  consequence  of  caries  than  from  any 
other  cause  connected  with  the  teeth.  Even  before  the  disease  has 
penetrated  to  the  central  chamber  of  the  organ,  the  pulp  often  assumes 
a  most  wonderful  and  marked  increase  of  irritability,  either  from 
functional  disturbance  arising  from  decomposition  of  the  dentine,  im- 
paired relationship  between  the  two,  or  from  being  more  exposed  to 
the  action  of  external  deleterious  agents.  Impaired  digestion,  as  well 
as  a  disordered  state  of  other  functions  of  the  body,  frequently  pro- 
duces the  same  effect. 

The  susceptibility  of  the  pulp  to  impressions  of  heat  and  cold,  and 
of  acids,  is  always  increased  by  heightened  irritability.  When  this 
exists  to  any  considerable  degree,  the  mere  contact  of  these  agents 
with  the  tooth  is  often  productive  of  severe  pain,  which,  on  their  re- 
moval, usually  very  soon  subsides.  The  pulp,  however,  may  remain 
in  this  condition  for  months,  and  even  years,  without  becoming  the 
seat  of  inflammatory  action. 


214  THE    DENTAL    PULP. 

Preternatural  sensibility  of  tlie  dentine,  whether  in  a  pound  or  par- 
tially decomposed  state,  augments  very  appreciably  the  irritability 
of  the  pulp.  The  sensibility  of  dentine  is  sometimes  so  much  increased 
that  the  mere  contact  of  any  hard  substance  with  a  part  which  has 
become  exposed  by  the  destruction  of  a  portion  of  the  enamel,  is  often 
productive  of  severe  pain.  Impressions  of  heat  and  cold  conveyed 
through  the  conducting  medium  of  a  metallic  filling,  or  through  a  thin 
covering  of  dentine,  as  sometimes  happens  when  a  considerable  portion 
of  the  tooth  has  been  worn  away,  is  a  very  frequent  cause  of  heiglit- 
ened  irritability  of  the  pulp.  With  its  susceptibility  thus  increased, 
the  impressions  produced  by  these  agents  are  often  a  source  of  irrita- 
tion, and  even  of  inflammation  and  suppuration,  causing  the  death  of 
the  entire  crown  and  inner  walls  of  the  root  of  the  tooth.  At  other 
times,  the  irritation  is  only  foilow^ed  by  slight  increase  of  vascular 
action  and  an  effusion  of  plastic  lymph  over  the  affected  part  of  the 
pulp,  which  is  gradually  converted  into  osteo-dentine ;  and  thus  a 
barrier  is  interposed  between  it  and  the  irritating  agents. 

IRRITATION. 

The  pulp  of  a  tooth  may  become  the  seat  of  severe  pain  even  when 
there  is  no  inflammation.  The  slightest  increase  of  vascular  action, 
when  this  organ  is  in  a  preternaturall}^  irritable  condition,  is  pro- 
ductive of  more  or  less  irritation.  The  pressure  of  the  slightly  dis- 
tended vessels  upon  the  nervous  filaments  distributed  upon  it,  at  such 
times,  is  sufficient  to  cause  great  pain. 

Impressions  of  heat  and  cold  are  conveyed  more  readily  to  the  pulp 
when  the  dentine  is  in  a  morbidly  sensitive  condition,  and  when  this 
is  the  case,  they  produce  a  more  powerful  effect. 

The  remedial  indications  of  pain  in  a  tooth  arising  simply  from 
irritation  of  the  pulp,  consist  in  the  removal  of  the  primary  and  ex- 
citing causes.  When  produced  by  impressions  of  heat  and  cold  con- 
veyed to  it  through  the  conducting  medium  of  a  metallic  filling  and 
intervening  super-sensitive  dentine,  if  the  severity  and  continuance  of 
pain  is  such  as  to  warrant  the  belief  that  it  will  give  rise  to  inflamma- 
tion, the  filling  should  be  removed  and  some  non-conducting  substance 
placed  in  the  bottom  of  the  cavity  before  replacing  it.  If  this  is  done 
before  inflammation  actually  takes  place,  it  will  prevent  subsequent 
irritation  from  these  causes.  It  is  worthy  of  remark,  however,  that 
the  pain  thus  produced  is  in  propoi'tion  to  the  sensibility  of  the  sub- 
jacent dentine.  If  this  is  destroyed  previously  to  filling  the  tooth, 
'their  action  upon  the  pulp  will  be  as  effectually  prevented  as  by  the 
interposition  of  a  non-conducting  substance.  But  in  the  application 
of  agents  for  this  purpose,  there  is  danger  of  destroying  the  vitality 


THE    DEIIfTAL    PULP.  215 

of  the  pulp.  The  employment  of  them,  however,  is  resorted  to  more 
frequently  to  prevent  pain  during  the  removal  of  caries  than  to  relieve 
any  subsequent  irritation  from  impressions  of  heat  and  cold. 

Arsenious  acid,  cobalt,  chloride  of  zinc,  chloroform,  and  the  actual 
cautery,  have  all  been  employed  in  the  treatment  of  sensitive  dentiue. 

The  use  of  arsenious  acid  in  dental  jDractice  has  hitherto  been  chiefly 
confined  to  the  destruction  of  the  vitality  of  the  pulps  of  teeth,  but  it 
will  also  destroy  the  sensibility  of  the  dentine,  and  thus  enable  the 
operator  to  remove,  without  pain,  the  semi-decomposed  parts  of  a  sensi- 
tive carious  tooth,  preparatory  to  filling.  In  employing  itfor  this  pur- 
pose, however,  great  care  is  necessary  to  prevent  the  destruction  of  the 
vitality  of  the  pulp,  and  the  injection  of  the  tubuli  of  the  dentine.  This 
is  very  liable  to  happen  when  applied  to  a  tooth  of  a  very  soft  texture, 
especially  if  in  the  mouth  of  a  young  person,  and  when  the  caries  ex- 
tends nearly  to  the  pulp-cavity.  The  action  of  arsenic,  through  the 
intervening  hard  structures,  on  the  pulp,  would  seem,  in  the  first 
instance,  to  cause,  in  some  way,  the  decomposition  of  the  red  globules 
of  the  blood;  whereby  a  pinkish-purple  tinge  is  imparted  to  the  serous 
portion  of  this  fluid,  which  is  conveyed  to  every  part  of  the  dentine. 
Ar.senic  is  absorbed  more  rapidly  when  in  solution  than  in  a  solid 
form;  and  in  teeth  of  a  low  degree  of  density,  or  where  the  dentine  is 
very  vascular,  as  in  the  case  of  young  patients,  its  efiects  may  extend 
through  a  wall  of  this  tissue  of  considerable  thickness,  and  result  in 
the  destruction  of  the  pulp.  When  applied  to  teeth  which  are  highly 
organized,  its  action  may  extend  beyond  the  pulp,  and  being  taken  up 
by  the  circulation  produce  its  peculiar  effect  on  the  constitution. 

But  the  application  of  arsenic  to  a  tooth  is  not  necessarily  followed 
by  this  effect.  It  is  only  in  young  persons,  and  in  teeth  of  very  soft 
texture,  that  this  is  liable  to  occur,  unless  permitted  to  remain  in  the 
tooth  for  a  long  time.  When  it  is  used  merely  for  the  purpose  of  de- 
stroying the  vitality  of  the  surface  of  the  dentine  at  the  bottom  of  the 
cavity,  preparatory  to  the  introduction  of  a  filling,  and  to  prevent  irri- 
tation of  the  pulp  from  impressions  of  heat  and  cold,  it  should  never 
be  permitted  to  remain  more  than  two  hours.  At  the  expiration  of 
this  time  it  should  be  removed,  and  after  thoroughly  washing  and  dry- 
ing the  cavity,  the  filling  may  be  introduced,  without  danger  of  subse- 
quent irritation  of  the  pulp  or  discoloration  of  the  tooth.  The  thirti- 
eth, fortieth,  or  even  fiftieth  part  of  a  grain,  with  an  equal  quantity  of 
'sulphate  of  morphia,  is  sufficient  to  apply  to  a  tooth.  It  should  be  put 
on  a  dossil  of  raw  cotton  or  lint  moistened  with  creosote,  and  placed 
directly  upon  the  bottom  of  the  cavity.  After  the  arsenic  has  been 
applied,  the  cavity  should  be  carefully  filled  with  wax,  cotton  saturated 
with  a  solution  of  gum  sandarach  and  alcohol,  or  HiU's  stopping,  to 


216  THE    DENTAL    PULP. 

prevent  the  }iossibility  of  its  escaping  into  the  mouth,  and  to  exclude 
the  buccal  fluids.  When  the  cavity  is  on  the  approxiinal  surface  of 
the  tooth,  additional  security  may  be  obtained  by  passing  a  ligature  of 
floss  silk  three  or  four  times  around  it  and  tying.  A  small  ring,  cut 
from  tlie  end  of  a  tube  of  caoutchouc,  placed  on  the  tooth  is  even  bet- 
ter than  a  ligature  of  silk. 

Dr.  Arthur  recommends  the  use  of  cobalt  for  destroying  morbid 
sensibility  of  dentine.  He  has  used  it  for  several  years,  and  believes 
it  to  be  as  certain  in  its  effects  as  arsenious  acid,  and  less  liable  to  injure 
the  pulp  of  the  tooth.  It  is  the  arsenic,  however,  with  which  the  cobalt 
is  combined  that  produces  the  effect ;  but  he  thinks  that  its  union  with 
the  cobalt  renders  it  less  liable  to  be  taken  into  the  dentine  by  absorp- 
tion, and,  as  a  consequence,  less  liable  to  produce  a  deleterious  action 
upon  the  pulp.  It  is  used  in  the  form  of  a  brownish-black  oxide,  re- 
duced to  a  fine  powder,  and  applied  to  the  tooth  in  the  same  manner  as 
arsenious  acid. 

For  the  destruction  merely  of  morbid  sensibility  in  the  solid  struc- 
tures of  a  tooth,  chloride  of  zinc,  according  to  the  author's  experience, 
although  somewhat  less  certain  in  its  effects,  is  superior  to  any  prepa- 
ration dependent  for  its  active  properties  upon  the  presence  of  arsenic. 
With  this  agent  it  rarely  happens  that  more  than  five  minutes  are 
required  to  obtain  the  desired  effect.  Although  a  powerful  escharotic, 
it  does  not,  as  all  arsenical  preparations  are  liable  to  do,  produce  any 
deleterious  effect  on  the  pulp  of  the  tooth.  It  is  thought,  however,  in 
some  cases  to  modify  the  texture  of  the  dentine  ;  and,  in  the  opinion  of 
some  practitioners,  so  much  so  as  to  render  it  more  easily  acted  upon 
by  decaying  agencies.  When  first  applied,  it  excites  a  sensation  of 
heat,  followed  by  burning  pain ;  but  these  soon  subside,  and  on  removing 
it  from  the  tooth,  the  parts  of  the  cavity  with  which  it  was  in  contact, 
will,  in  a  large  majority  of  the  cases,  be  found  totally  insensible  to  the 
touch  of  an  instrument.  Dr.  F.  N.  Seabury  relates  a  case  in  which  he 
applied  it  directly  to  the  exposed  pulp  of  an  aching  tooth.  The  pain, 
which  at  first  was  increased,  soon  subsided,  and  after  removing  the 
chloride,  the  tooth  was  filled  in  the  usual  way,  without  inconvenience 
to  the  patient. 

The  chloride  may  be  applied  directly  to  the  cavity  of  a  sensitive 
tooth,  without  being  combined  with  any  other  substance,  on  a  little  raw 
cotton  or  lint ;  or  it  may  be  made  into  a  paste  by  mixing  it  with  an 
equal  quantity  of  flour,  the  moisture  which  it  absorbs  from  the  atmo- ' 
sphere  being  sufficient  for  the  formation  of  the  paste ;  or  it  may  be 
mixed  with  a  little  pure  anhydrous  sulphate  of  lime,  in  an  impalpable 
powder,  and  then  applied  to  the  tooth.  But  before  this  is  done,  as 
much  of  the  decomposed  dentine  as  possible  should  be  removed,  and 


THE    DENTAL    PULP.  217 

the  application  should  be  held  firmly  in  contact  with  the  part  of  the 
cavity  upon  which  it  is  intended  to  act.  This  may  be  done  by  filling 
the  cavity,  after  it  has  been  put  in,  with  softened  wax  or  raw  cotton. 
The  chloride  may  remain  in  the  tooth  from  two  to  five  minutes,  or  until 
the  burning  sensation  produced  by  it  ceases.  A  single  application  will 
generally  suffice  to  destroy  the  sensibility  of  the  wails  of  the  cavity  to 
a  sufficient  depth  to  enable  the  operator  to  remove  any  remaining  por- 
tions of  decayed  dentine  without  pain,  and  to  obtund  the  vitality  of  the 
floor  of  the  cavity  sufficiently  to  prevent  the  transmission  of  impres- 
sions of  heat  and  cold  to  the  pulp.  A  second,  and  even  a  third  appli- 
cation, however,  will  sometimes  be  required.  We  have  before  referred 
to  the  local  action  of  chloroform.  It  is  brief  in  its  efiects,  and  calls 
for  repeated  application  in  a  long  operation,  but  has  the  advantage  of 
being  totally  free  from  the  possibly  injurious  action  of  arsenic,  cobalt, 
and  chloride  of  zinc. 

The  actual  cautery  was  at  one  time  much  used  and  highly  recom- 
mended by  French  dentists  in  the  treatment  of  sensitive  decayed  teeth, 
but  as  the  application  gave  rise,  very  often,  to  inflammation  of  the 
pulp,  its  use  in  England  and  America  was  long  since  laid  aside. 

Less  potent  agents,  such  as  pulverized  galls,  tannic  acid,  etc.,  have 
been  employed  for  the  purpose  of  destroying  morbid  sensibility  in  teeth 
preparatory  to  filling,  and  sometimes  with  good  results.  For  other 
agents  used  in  obtunding  the  sensibility  of  dentine,  the  reader  is  re- 
ferred to  the  chapter  on  "  Filling  Teeth." 

Having  noticed  the  agents  usually  employed  for  destroying  morbid 
sensibility  in  dentine,  we  will  proceed  to  notice  a  few  of  the  non-con- 
ductors of  caloric  that  have  been  used  for  the  accomplishment  of  the 
same  object.  Among  the  substances  which  have  been  employed  for  this 
purpose,  are,  asbestos,  gutta  percha,  HilVs  stopping,  cork,  oiled  silk,  and 
os-artificiel. 

Asbestos,  as  a  non-conductor  of  caloric,  certainly  possesses  every 
desirable  property,  and  is  as  indestructible  in  a  tooth  as  gold.  When 
used  for  this  purpose,  the  purest  variety  should  be  selected.  A  small 
pellet,  made  from  the  filaments  of  this  mineral,  placed  in  the  bottom 
of  a  cavity  previously  to  filling,  will  eflectually  prevent  irritation  of 
the  pulp  from  impressions  of  heat  and  cold.  The  cavity,  however, 
should  be  first  properly  prepared,  washed  with  tepid  water,  and  made 
perfectly  dry.  The  asbestos  may  occupy  from  one-fourth  to  one-sixth 
of  the  depth  of  the  cavity  after  the  filling  has  been  introduced  and 
consolidated. 

A  thin  layer  of  gutta  percha  placed  in  the  bottom  of  the  cavity,  pre- 
viously to  introducing  the  gold,  is  as  effectual  in  preventing  the  trans- 
mission of  impressions  of  heat  and  cold  as  asbestos,  and  can  be  more 


218  THE    DENTAL    PULP. 

conveniently  applied.     There  is,  however,  a  preparation  of  it,  known 
as  "Hill's  stopping,"  better  than  the  simple  article. 

Cork,  though  an  equally  good  non-conductor  of  caloric,  is  thought 
by  some,  as  it  is  more  destructible  than  asbestos  or  gutta  percha,  to  be 
objectionable ;  but  cut  off,  as  it  necessarily  would  be  in  the  bottom  of 
the  cavity  beneath  the  filling,  its  liability  to  undergo  any  change 
would  seem  to  be  rendered  wholly  impossible.  It  is  objected  to  its  use, 
that  it  is  of  a  more  porous  nature  than  gutta  j^croha,  and  cannot  be 
adapted  as  perfectly  to  the  inequalities  of  the  floor  of  the  cavity.  Also 
that  there  is  danger  in  introducing  the  filling  of  forcing  some  portions 
of  the  gold  through  it,  unless  a  very  thick  piece  be  used.  Oiled  silk 
has  also  been  used  in  some  cases  very  successfully,  but  it  is  not  as  good 
a  non-conductor  as  any  of  the  afore-mentioned  agents. 

One  of  the  best  non-conductors  in  use  is  the  oxychloride  of  zinc  in 
the  form  known  as  os-artificiel.  For  the  method  of  applying  this  agent 
and  also  Hill's  stopping,  the  reader  is  referred  to  the  chapiter  on  "Ma- 
terials Employed  for  Filling  Teeth." 

But  a  metallic  filling  is  not  the  only  medium  through  which  impres- 
sions of  heat  and  cold  are  conveyed  to  the  dental  pulp.  When  the 
dentine  on  the  coronal  extremity  or  side  of  a  tooth  becomes  very  thin 
from  loss  of  substance,  occasioned  by  mechanical  or  chemical  abra- 
sion, by  the  use  of  the  file,  erosion,  or  other  cause,  the  pulp  sometimes 
becomes  painfully  susceptible  to  the  action  of  these  agents.  Loss  of 
substance  from  any  of  these  causes  is  also  often  attended  by  exalted 
sensibility  of  the  exposed  dentine ;  and  when  this  is  the  case,  the  con- 
tact of  acids  with  it  is  productive  of  more  or  less  pain.  Nature,  how- 
ever, usually  prevents  the  painful  consequences  that  would  naturally 
arise  from  continued  abrasion  of  the  coronal  ends  of  the  teeth,  and  the 
consequent  exposure  of  their  nervous  pulp,  by  the  gradual  ossification 
of  this  organ ;  so  that  by  the  time  it  Avould  become  exposed,  it  is  con- 
verted into  osteo-dentine.  But  this  does  not  always  take  place  in  time 
to  prevent  irritation  and  pain. 

When  irritation  of  the  pulp  occurs  in  a  tooth  tliat  has  been  filed  on 
one  or  both  sides,  so  much  so  as  to  leave  only  a  thin  covering  of  den- 
tine, the  best  known  means  of  preventing  morbid  sensibility  is  to  keep 
the  filed  surfiice  constantly  clean  by  frequent  friction  with  a  brush  and 
waxed  floss  silk,  or  with  some  other  suitable  substance.  This  opera- 
tion should  be  repeated  after  each  meal,  and  in  the  morning  immedi- 
ately after  rising,  and  at  night  before  going  to  bed.  The  application 
of  nitrate  of  silver,  for  sensitiveness  arising  from  loss  of  substance  or 
from  exalted  sensibility  of  exposed  dentine,  has  proved  successful. 
The  nitrate  in  the  solid  form  is  the  most  convenient.  Enveloping  a 
portion  of  the  stick  with  wax  will  enable  the  operator  to  handle  it  with 


THE    DENTAL,    PULP.  219 

impunity.  Some  are  iu  the  habit  of  applying  salt,  as  soon  as  the  sen- 
sitive  surface  has  been  touched  with  the  nitrate,  to  neutralize  its  effects. 
To  prevent  contact  with  the  gum,  when  it  is  necessary  to  apply  the 
nitrate  to  the  necks  of  the  teeth,  a  coating  of  collodion  may  be  painted 
on  them  with  a  camel's-hair  brush.  Chromic  acid  has  also  been  used 
in  these  cases  with  success. 

"When  caries  has  extended  to  the  central  cavity,  irritation  is  often 
produced  by  contact  of  partially  decomposed  j)ortions  of  dentine  or 
other  foreign  matter  with  the  pulp.  The  proper  remedial  indication 
in  such  cases,  it  is  scarcely  necessary  to  say,  consists  in  the  removal 
of  all  matter  from  the  teeth  that  can  act  either  as  a  mechanical  or 
chemical  irritant.  This  done,  the  cavity  in  the  tooth,  supposing  the 
pulp  to  be  in  a  healthy  condition,  should  be  properly  filled. 

But  when  the  irritation  arises  as  a  consequence  of  exalted  irrita- 
bility and  increased  vascular  action  of  the  pulp,  dependent  upon  dis- 
ease or  altered  function  of  some  other  part  or  parts  of  the  body,  the 
remedial  indications  are  different.  The  treatment  then  should  be  ad- 
dressed to  the  primary  affection.  Examples  of  this  sort  are  of  fre- 
quent occurrence.  They  are  met  with  almost  daily,  particularly  in 
females  during  gestation,  in  dyspeptic  individuals,  and  in  persons 
affected  with  gout  and  chronic  rheumatism.  They  are  also  sometimes 
met  with  in  individuals  who  have  been  exposed  to  miasmatic  emana- 
tions of  marshy  districts,  when  the  irritation  assumes  an  intermittent 
form,  occurring  at  stated  intervals  of  twenty-four,  forty-eight,  or 
seventy-two  hours,  and  continuing  from  one  to  three  hours.  Some  of 
the  worst  forms  of  toothache  are  produced  by  one  or  other  of  these 
causes. 

The  local  disturbance,  when  it  occurs  in  females  during  pregnancy, 
may  generally  be  removed  by  mild  aperients,  warm  foot-bath,  and  ano- 
dynes at  night  on  going  to  bed.  When  it  depends  upon  other  kinds 
of  derangement  of  the  uterine  organs,  treatment  suited  to  the  peculiar 
indications  of  the  case  should  be  instituted.  When  it  occurs  in  a 
person  affected  with  dyspepsia,  rheumatism,  or  gout,  the  constitutional 
treatment  required  by  the  particular  disease  constitutes  the  proper 
remedy.  "When  the  irritation  assumes  an  intermittent  form,  an  emetic 
or  cathartic,  followed  by  quinine,  will  generally  put  a  stop  to  the  local 
disturbance,  provided  it  has  no  connection  with  caries  of  the  crown  of 
the  tooth. 

INFLAMMATION. 

The  pulp  of  a  tooth,  when  healthy,  has  a  grayish-white  appearance, 
and  its  capillaries  are  invisible  to  the  naked  eye,  but  when  it  becomes 
the  seat  of  acute  or  active  inflammation,  they  may  be  distinctly  seen ; 
the  organ  then  assumes  a  bright  red  color.     Inflammation  having  estab- 


220  THE    DENTAL    PULP. 

lishcd  itself  soon  extends  to  every  part  of  the  pulp,  and  even  to  the 
alveolo-deutal  periosteum.  When  permitted  to  run  its  course  un- 
interruptedly, it  usually  terminates  in  suppuration  in  from  three  to 
eight  or  ten  days. 

The  unyielding  nature  of  the  walls  of  the  cavity,  in  which  it  is  on 
all  sides  inclosed,  renders  expansion  of  the  pulp  impossible,  and  as  its 
capillaries  become  distended  with  blood,  they  press  on  the  nervous 
filaments  which  are  everywhere  distributed  upon  it,  causing  at  first 
constant  gnawing  pain ;  which  afterward,  as  the  distension  of  the 
vessels  increases,  becomes  severe,  deep-seated,  throbbing,  and  sometimes 
almost  insupportable. 

Inflammation  may  attack  the  pulps  of  sound  teeth  as  well  as  those 
aflTeeted  with  caries  ;  but  it  occurs  more  frequently  in  the  latter  than 
in  the  former,  and  it  is  oftener  met  with  before  than  after  the  pulp  has 
become  actually  exposed.  The  severity  of  the  pain,  however,  is  de- 
termined by  the  condition  of  the  tooth,  the  state  of  the  general  health, 
and  the  causes  concerned  in  its  production.  The  pulp,  when  in  an 
irritable  condition,  is  more  liable  to  become  the  seat  of  acute  inflam- 
mation than  when  in  a  perfectly  healthy  state,  and  the  occurrence  of 
suppuration  is  soon  followed  by  alveolar  abscess,  unless  an  opening  is 
made  immediately  through  the  crown,  neck,  or  root  of  the  tooth,  for 
the  escape  of  the  matter. 

The  effiision  of  lymph,  which  takes  place  during  the  inflammatory 
stage,  and  which,  under  other  circumstances,  and  when  the  inflamma- 
tion is  less  severe,  is  made  to  play  an  important  part  in  the  reparation 
of  the  injury,  compresses  the  pulp  into  still  narrower  limits  as  it 
accumulates  in  quantity,  and  thus  becomes  an  additional  source  of 
irritation,  adding  fuel  to  the  flame  already  lighted  up. 

Inflammation  of  the  pulp  may  be  caused  by  a  blow  on  the  tooth  ;  by 
impressions  of  heat  and  cold  conveyed  to  it  through  the  enamel  and 
dentine,  or  through  a  metallic  filling  ;  or  by  the  pressure  of  a  filling, 
or  the  direct  contact  of  external  irritating  agents,  such  as  disorganized 
portions  of  the  tooth,  particles  of  alimentary  substances,  acrid  humors, 
etc.  But,  as  we  have  stated  in  another  place,  inflammation  of  the 
dental  pulp  is  not  always  a  necessary  consequence  of  impressions  of 
heat  and  cold ;  pain  may  be  produced  by  them  when  it  does  not  exist ; 
but  in  this  case  it  usually  subsides  soon  after  the  removal  of  the  irri- 
tant. The  pulp  of  a  tooth  may  be  exposed  for  months,  and  subjected 
several  times  a  day  to  the  actual  contact  of  foreign  bodies,  without 
becoming  the  seat  of  acute  inflammation.  The  irritation  and  increased 
vascular  action  thys  occasioned  are,  no  doubt,  removed  by  the  eflrision 
of  lymph,  to  which  they  give  rise,  and  the  pulp,  after  it  has  become 
exposed,  having  room  to  expand  as  its  vessels  become  distended,  does 


THE    DENTAL    PULP.  221 

not  suffer  irritation  from  the  pressure  to  "wliicli  it  would  otherwise  be 
subjected. 

When  suppuration  takes  place,  the  pain  very  nearly  ceases,  but  the 
tooth  for  a  time  remains  sore  to  the  touch,  and  its  appearance  is 
changed.  It  has  no  longer  the  peculiar  animated  translucency  of  a 
living  tooth,  but  has  assumed  an  opaque,  muddy,  or  brownish  aspect. 
With  the  disorganization  of  the  pulp,  the  entire  crown  and  inner 
walls  of  the  root  lose  their  vitality ;  still,  if  the  alveolo-dental  peri- 
osteum has  not  become  seriously  involved  in  disease,  the  vascular  and 
nervous  supply  furnished  to  the  cementum  is  often  sufficient  to  pre- 
vent the  tooth  from  exerting  any  injurious  influence  upon  the  sur- 
rounding and  more  highly  vitalized  parts.  The  cementum,  being 
more  analogous  in  structure  to  true  osseous  tissue  than  dentine,  now 
plays  an  important  part  in  the  animal  economy.  It  being  more 
liberally  supplied  with  vitality  and  with  nutritive  juices,  and  not 
being  sensibly  affected  by  the  death  of  the  other  parts  of  the  organ,  it 
keeps  up  the  living  relationship  of  the  tooth  with  the  alveolo-dental 
periosteum,  at  least  sufficiently  to  prevent  it  from  acting  perceptibly 
as  a  morbid  irritant. 

Inflammation  of  the  pulp  of  a  tooth,  besides  the  local  pain  with 
which  it  is  attended,  often  gives  rise  to  -a  train  of  constitutional  morbid 
phenomena,  usually  of  a  mild,  but  sometimes  of  an  aggravated  and 
even  threatening  character.  Among  these  are  headache,  constipation 
of  .the  bowels,  furred  tongue,  dryness  of  the  skin,  quick,  full,  and  hard 
pulse,  earache,  ophthalmia,  disease  of  the  maxillary  sinus,  etc. 

The  amount  of  constitutional  disturbance  arising  from  inflamma- 
tion of  the  pulp  of  a  tooth,  depends  on  the  state  of  the  general  health, 
and  the  nervous  irritability  of  the  system  at  the  time.  In  the  ma- 
jority of  cases  it  occasions  but  little  inconvenience,  and  disappears  as 
soon  as  the  inflammation  ceases,  but  sometimes  it  assumes  a  very 
alarming  character.  A  fatal  case  of  tetanus,  produced  by  inflamma- 
tion of  the  pulp  of  a  lower  molar,  occurred  a  few  years  ago  in  Balti- 
more. The  subject  was  a  young  lady  about  eighteen  years  of  age. 
The  system  at  the  time,  from  great  bodily  fatigue  and  mental  excite- 
ment, was  in  an  exceedingly  irritable  condition,  but  in  other  respects, 
though  constitutionally  rather  delicate,  she  was  in  the  enjoyment  of 
good  health. 

There  is  not  an  organ  or  tissue  of  the  body  in  which  acute  inflam- 
mation is  more  intractable  in  its  nature,  and  rapid  in  its  progress, 
than  in  the  pulp  of  a  tooth  ;  and,  when  we  take  into  consideration  its 
situation,  and  its  physical  and  vital  peculiarities,  it  is  not  to  be  won- 
dered that  it  should,  in  so  large  a  majority  of  the  cases,  terminate  in 
the  disorganization  of  the  part.     Still,  it  may  sometimes  be  arrested, 


222  THE    DENTAL    PULP. 

and  the  remedial  indications  here,  though  they  cannot  be  as  readily 
and  fully  carried  out,  are  the  same  as  for  inflammation  in  any  other 
part  of  the  body.  The  first  and  most  important  one  consists  in  the 
removal  of  all  local  and  exciting  causes.  If  it  be  the  result  of  irri- 
tation produced  by  the  pressure  of  a  filling,  the  plug  should  be  im- 
mediately removed,  leeches  applied  to  the  gum  of  the  affected  tooth, 
and,  if  the  patient  be  of  a  full  habit,  blood  may  be  taken  from  the 
arm,  and  a  brisk  saline  purgative  prescribed.  The  removal  of  the 
filling,  however,  when  the  inflammation  has  previously  made  much 
progress,  Avill  not  prevent  suppuration,  but  it  may  keep  it  from  ex- 
tending to  every  part  of  the  pulp.  When  an  external  opening  is 
made  for  the  escape  of  the  matter,  the  moment  suppuration  takes  place, 
the  remaining  portion  of  the  pulp  will  be  relieved  from  the  pressure 
which  caused  the  irritation,  and  then  the  inflammatory  action  may 
cease.  But  if  the  matter  remains  in  the  central  cavity  of  the  tooth, 
the  part  of  the  pulp  which  has  not  suppurated  will  still  be  subjected 
to  pressure,  and  the  inflammation  and  suppuration  will  go  on  until  the 
entire  organ  perishes.  Nor  will  the  disorganizing  process  stop  here. 
The  alveolo-deutal  membrane,  at  the  extremity  of  the  root,  will  soon 
become  implicated,  and  in  a  short  time  alveolar  abscess  will  form, 
thus  terminating  the  acute  stage  of  the  disease. 

There  may  be  no  indications  of  irritation  or  inflammation  for 
several  weeks,  or  even  months,  after  a  tooth  has  been  filled ;  but  at 
the  expiration  of  this  time,  the  pulp,  from  increased  irritability, 
caused  perhaps  by  some  change  in  the  state  of  the  patient's  general 
health,  may  be  attacked  by  inflammation.  Although  this  very  seldom 
happens,  it  does,  nevertheless,  sometimes  occur.  When  there  is  reason 
to  apprehend  that  it  is  about  to  take  place  —  and  it  may  be  suspected 
if  pain  is  felt  in  the  tooth  when  anything  hot  or  cold  is  taken  into  the 
mouth,  or  if  it  becomes  the  seat  of  gnawing  or  gradually  increasing 
pain  —  the  filling  should  be  removed.  If  the  pain  now  ceases,  a  thick 
layer  of  gutta  percha  dissolved  in  chloroform,  or  Hill's  stopping,  or 
os-artificiel,  may  be  placed  in  the  bottom  of  the  cavity,  and  the  filling 
replaced  ;  using  the  precaution,  as  before  directed,  to  introduce  the 
gold  in  such  a  way  as  to  prevent  the  liability  of  depressing  the  floor 
of  the  cavity.  But  if  the  pain  and  inflammation  continue  unabated, 
and  the  application  of  such  escharotics  as  chloride  of  zinc,  nitrate  of 
silver,  and  chromic  acid,  fails  to  reduce  the  congestion  and  hypertro- 
phy, it  may  be  necessary  to  extract  the  tooth,  or  expose  the  pulp,  and 
destroy  its  vitality  by  applying  to  it  some  powerful  escharotic,  as 
arsenious  acid,  which,  acting  more  promptly,  and  with  more  certainty 
than  any  other,  seems  best  adapted  to  the  purpose.  When  this  is 
done,  it  is  usually  with  the  view  of  securing  the  retention  and  preser- 


THE    DENTAL    PULP.  223 

vation  of  the  tooth  by  filling  the  pulp-cavity  and  root,  an  operation, 
now  very  frequently  performed  by  dentists. 

The  abstraction  of  blood  directly  from  the  pulp,  one  might  suppose, 
would  often  be  successful  in  arresting  the  inflammation  ;  but  we  do 
not  think  this  has  been  resorted  to  for  this  purpose  suflieiently  often  to 
determine  its  therapeutic  value.  At  iftiy  rate,  it  seems  reasonable  to 
suppose  that  if,  by  this  means,  the  congestion  of  the  capillaries  could 
be  removed,  the  tumefied  pulp  would  be  reduced  to  its  natural  size, 
and  be  relieved  from  the  pressure  to  which,  as  a  consequence  of  its 
distended  condition,  it  is  subjected.  To  obtain  the  largest  amount  of 
benefit  capable  of  being  derived  from  the  operation,  the  opening  should 
be  made  in  that  portion  where  one  of  the  principal  arteries  would  be 
most  likely  to  be  punctured ;  and  this,  it  seems  to  us,  would  be  just 
where  the  canal  of  the  root  enters  the  chamber  of  the  crown  of  the 
tooth.  But  in  making  the  puncture  here,  the  pulp  being  very  small 
at  this  point,  there  is  danger  of  cutting  it  off;  and  as  reunion  might 
not  take  place,  the  portion  in  the  central  cavity  would  necessarily 
perish. 

If  the  pulp  were  exposed,  there  would  be  a  better  opportunity  of 
relieving  the  congested  condition  of  its  capillaries  by  the  abstraction 
of  blood ;  but  the  diflSculty  of  obtaining  free  access  to  the  organ  by 
drilling  a  hole  through  the  intervening  dentine  is  very  great ;  the 
tooth,  when  suffering  from  inflammation,  being  usually  so  sore  to  the 
touch  that  the  slightest  pressure  is  productive  of  great  pain.  Deple- 
tion of  the  pulp  may  be  accomplished  by  means  of  a  fine,  sharp- 
pointed  instrument;  or  Dr.  Allport's  method  of  treating  exposed 
pulps  may  be  resorted  to,  namely,  that  of  excising  a  portion  of  the 
pulp  at  the  orifice  of  exposure,  and  then  drawing  the  edges  together 
so  as  to  induce  union  by  first  intention.  If  the  tooth  is  an  incisor  or 
cuspid,  and  the  pulp  cannot  be  restored  to  health,  its  vitality  should 
be  destroyed  ;  or,  if  suppuration  has  previously  taken  place,  an  open- 
ing should  be  made  into  the  chamber  of  the  tooth  as  before  directed, 
for  the  escape  of  the  matter.  Should  it  be  found,  after  this  has 
escaped,  that  disorganization  has  not  extended  to  every  part  of  the 
pulp,  the  remaining  portion  may  be  destroyed  in  the  manner  hereafter 
to  be  described.  This  done,  the  pulp-cavity  and  root,  as  soon  as  the 
inflammation  of  the  socket  has  completely  subsided,  may  be  filled. 

Inflammation  of  the  dental  pulp  is  not  always  acute ;  it  sometimes 
assumes  a  chronic  and  local  form.  This  often  occurs  where  the 
chamber  of  a  tooth  has  become  gradually  exposed  by  caries  of  the 
dentine ;  and  when  this  happens,  the  action  of  the  fluids  of  the  mouth, 
and  of  other  foreign  substances  which  obtain  access  to  the  cavity,  as 
well  as  of  the  decomposed  portions  of  the  tooth  substance,  causes  an 


224  THE    DENTAL    PULP. 

increase  of  vascular  action  in  the  exposed  part,  followed  very  often 
by  a  slight  discharge  ;  but  the  morbid  action  thus  induced  is  compara- 
tively seldom  accompanied  by  pain.  The  pulp  may  remain  thus 
partially  exposed  for  months,  and  even  years,  without  causing  any 
other  inconvenience  than  a  momentary  twinge  of  pain  Avhen  some 
hard  substance  is  accidentally  introduced  into  the  cavity  of  the  tooth, 
which  subsides  immediately  after  its  removal.  Sooner  or  later,  how- 
ever, the  pain  thus  excited  will  become  more  permanent,  continuing 
each  time  it  occurs  from  five  or  ten  minutes  to  one  or  more  hours  after 
the  cause  of  the  irritation  has  been  removed.  If  a  tooth  be  filled 
under  such  circumstances,  the  pressure  of  the  fluid  upon  the  pulp, 
which  is  poured  out  from  its  exposed  surface  beneath  the  filling,  will 
give  rise  to  a  more  general  and  active  form  of  inflammatory  action. 

The  liability  of  the  tooth  to  ache  increases  as  the  pulp  becomes 
more  and  more  exposed  by  the  gradual  decomposition  of  the  dentine; 
and  the  inflammation  may  ultimately  assume  a  more  active  form,  or 
the  pulp  may  become  the  seat  of  fungous  growth,  or  it  may  be  ab- 
sorbed or  destroyed  by  ulceration,  or  by  gangrene  and  mortification. 
Cases  sometimes  occur  in  which  the  disease  is  attended  with  severe 
darting  pains,  often  occurring  several  times  in  the  space  of  two  or 
three  minutes,  succeeded  by  intervals  of  perfect  ease  for  many  hours. 
At  other  times  it  is  attended  by  dull,  aching  jiain,  aggravated  by 
taking  sweet  or  acid  substances  into  the  mouth.  In  cases  of  this  sort, 
the  application  of  heating  or  stimulating  substances  to  the  exposed 
surface  of  the  pulp  will  usually  procure  relief.  Permanent  exemp- 
tion from  pain,  however,  is  not  always  obtained,  and,  sooner  or  later,  it 
may  become  necessary  either  to  destroy  the  pulp  or  to  extract  the 
tooth. 

The  body  of  the  pulp,  when  the  organ  becomes  exposed  from  a 
decayed  opening  in  the  grinding  surface  of  a  molar,  is  sometimes 
absorbed,  while  its  prolongations  in  the  roots  often  remain  unchanged 
for  two  or  more  years. 

Chronic  inflammation  of  an  exposed  surface  of  the  jiulp,  when  long 
continued,  sometimes  gives  rise  to  ulceration, —  a  disoi'ganizing  process, 
which  often  causes  the  destruction  of  a  large  portion  of  the  part  occu- 
pying the  central  chamber  of  the  crown  of  the  tooth,  making  in  it 
numerous  little  excavations.  The  ulcerated  surface  usually  presents  a 
yellowish  appearance ;  when  the  disorganizing  process  is  arrested 
before  it  has  eflfected  the  destruction  of  any  very  large  portion  of  the 
pulp,  it  usually  becomes  covered  with  healthy  granulations. 

When  the  inflammation  occurs  in  cachectic  individuals  it  often  as- 
sumes an  acute  form,  and  sometimes  terminates  in  gangrene  and  mor- 
tification.    The  loss  of  vitality  may  be  confined  to  the  body  of  the 


THE    DEXTAL    PULP.  225 

pulp,  or  it  may  extend  to  every  part  of  the  organ.  In  the  former 
case  the  pain  continues,  but  in  the  latter  it  ceases  as  soon  as  mortifica- 
tion takes  place.  When  this  happens,  the  entire  pulp,  which  has  now 
a  dark-brown  or  black  color,  may  be  removed.  But  this  is  not  a  very 
common  termination. 

The  symptoms  of  chronic  as  well  as  acute  inflammation  are  always 
modified  by  the  state  of  the  general  health,  habit  of  body,  and  the 
temperament  of  the  individual.  The  pain  attending  the  former,  how- 
ever, is  periodical,  occurring  at  irregular  and  uncertain  intervals,  and 
constitutes  that  variety  of  toothache  so  often  relieved  by  local  applica- 
tions ;  whereas,  in  the  latter,  it  is  constant. 

In  chronic  inflammation,  the  pulp  is  either  actually  exposed  or  onlj 
covered  by  decomposed  or  j)artially  decomposed  dentine,  and  the  dis 
eased  surface  rarely  embraces  a  larger  circumference  than  that  described 
by  the  bottom  of  the  decayed  cavity.  The  inflammation,  therefore,  is 
local  as  well  as  chronic,  but  nevertheless,  it  is  often  of  so  persistent  a 
character,  as  to  render  its  removal  exceedingly  difficult.  The  dentist, 
however,  is  not  so  much  restricted  in  the  application  of  remedies  as  in 
the  treatment  of  acute  inflammation,  and  to  the  action  of  which  it 
yields  more  readily.  But  notwithstanding  all  this,  he  will  necessarily 
encounter  difficulties  in  his  efforts  to  subdue  it.  A  greater  length  of 
time  is  sometimes  required  than  the  patient  is  willing  to  give  ;  and  the 
opening  through  the  crown  to  the  central  cavity  is  frequently  too  small, 
previously  to  the  removal  of  the  partially  decomposed  dentine,  to  admit 
of  the  direct  application  of  the  necessary  remedial  agent  to  the  inflamed 
surface  of  the  pulp.  Again,  it  often  happens,  that  the  situation  of  the 
tooth  and  cavity  are  such  as  to  prevent  a  complete  view  of  the  diseased 
part.  It  is  important  that  the  operator  should  get  such  a  view  to 
enable  him  to  determine  whether  the  inflamed  surface  is  ulcerated,  or 
pours  out  a  serous  fluid;  or  whether  the  morbid  condition  is  simply  one 
of  irritation,  produced  by  the  presence  of  acrid  matter,  or  of  partially 
or  wholly  decomposed  dentine.  Unless  his  diagnosis  is  correct,  his  pre- 
scription will  be  as  likely  to  do  harm  as  good  ;  but,  having  ascertained 
the  exact  character  of  the  disease,  he  may  often  be  able  to  institute 
treatment  that  will  result  in  the  restoration  of  the  pulp  and  the  pre- 
servation of  the  tooth. 

It  is  important,  too,  to  understand  the  part  which  nature  plays  in 
the  curative  process ;  for  cure  here,  as  in  other  parts  of  the  body,  is 
effected  by  that  internal  force,  which,  as  Chomel  says,  "presides  over 
all  the  phenomena  of  life,  contends  unremittingly  with  physical  and 
chemical  laws,  receives  the  impressions  of  deleterious  agents,  reacts 
against  them,  and  eflfects  the  resolution  of  disease."  This  vital  force  is 
sometimes  exercised  in  the  cure  of  disease  in  the  pulp  of  a  tooth,  but 
15 


226  THE    DENTAL    PULP. 

more  frequently  in  its  prevention  ;  as  is  shown  by  the  gradual  ossiSoa- 
tion  of  the  organ  in  those  cases  where  it  wouhl  otherwise  become  ex- 
posed by  mechanical  or  spontaneous  abrasion  of  the  solid  structures 
which  inclose  it ;  and  occasionally  by  the  formation  of  secondary  den- 
tine upon  the  surface  of  the  original  or  primary  dentine  at  a  point 
toward  which  the  caries  is  advancing.  Nature,  no  doubt,  would  always 
provide  in  this  way  against  the  exposure  of  the  pulp,  ir  the  occurrence 
were  always  long  enough  preceded  by  sufficient  irritation  or  increase 
of  vascular  action  in  it  to  call  her  energies  into  operation.  But  the 
formation  of  osteo-dentine,  which  constitutes  the  protective  wall  of  de- 
fence, is  a  tardy  process,  and,  as  a  general  rule,  proceeds  more  slowly 
than  the  caries  in  the  tooth,  which  causes  the  exposure  of  the  pulp. 
Besides,  it  often  happens  that  its  approach  is  not  announced  by  the 
slightest  irritation,  a  condition  necessary  to  the  new  formation,  until  it 
reaches  the  central  cavity.  At  other  times,  the  approach  of  the  disease 
gives  rise  to  too  much  irritation,  a  condition  equally  unfavorable  to  the 
dentin ification  of  the  pulp.  Thus,  no  protective  covering  being  formed, 
it  soon  becomes  exposed,  when  it  is  subjected  to  the  action  of  such 
irritating  agents  as  may  chance  to  be  bi-ought  into  contact  with  it. 
Hence,  its  liability  to  become  the  seat  of  chronic  inflammation  as  well 
as  other  forms  of  diseased  action. 

If  the  disease  is  attended  with  pain,  the  removal  of  this  must  first 
claim  attention,  and  should  be  effected  with  as  little  delay  as  possible; 
otherwise  the  morbid  action  may  extend  to  every  part  of  the  pulp  and 
peridental  membrane,  and  assume  a  more  active  and  unmanageable 
form.  If  the  pain  is  the  result  of  irritation  produced  by  the  direct 
action  of  mechanical  or  chemical  agents,  the  cavity  in  the  tooth  should 
at  once  be  carefully  freed  from  all  extraneous  substances  and  decom- 
posed portions  of  dentine.  This  done,  a  dossil  of  raw  cotton  or  lint  — 
saturated  with  spirits  of  camphor,  laudanum,  sulphuric  ether,  chloro- 
form, creosote,  or  some  one  of  the  essential  oils  —  may  be  applied. 
Immediate  relief  is  sometimes  obtained  by  an  application  of  this  sort. 
Counter-irritants  have  sometimes  been  used  with  advantage.  The  pain 
has  often  been  removed  by  exciting  increased  secretion  of  saliva,  but 
when  a  sialagogue  is  used,  the  cavity  in  the  tooth  should  be  filled  with 
raw  cotton  or  lint  to  prevent  the  agent  from  being  brought  in  contact 
with  the  exposed  surface  of  the  pulp.  But  a  remedy  which  will  relieve 
the  pain  in  one  ease  often  aggravates  it  in  another. 

When  the  irritation  is  produced  by  acidulated  buccal  fluids,  the 
application  of  carbonate  of  soda,  or  some  other  alkali,  will  often  give 
immediate  temporary  relief;  but  as  the  condition  of  the  secretions  of  the 
mouth,  especially  the  salivary,  is  usually  owing  to  gastric  derangement, 
the  correction  of  this  constitutes  the  first  and  most  important  remedial 


THE    DENTAL    PULP.  227 

indication.  When  any  application  is  made  to  the  pulp  for  the  purpose 
of  removing  irritation  and  pain,  its  full  effect  will  not  be  obtained  un- 
less the  fluids  of  the  mouth  are  excluded  from  the  cavity  of  the  tooth ; 
this  may  be  done  by  closing  the  orifice  with  softened  wax,  or  cotton 
saturated  with  the  sandarach  solution,  using  the  precaution  not  to 
force  it  in  so  far  as  to  press  the  application  previously  made  upon  the 
exposed  pulp. 

SPONTANEOUS    DISORGANIZATION. 

The  spontaneous  destruction  of  thepulp  of  a  tooth  is  an  affection  which 
seems  to  have  been  entirely  overlooked  by  writers  on  dental  pathology; 
and,  although  it  is  one  which  rarely  occurs,  examples  of  it  are  met  with 
sufficiently  often  to  entitle  it  to  a  place  among  the  diseases  of  the  teeth. 
The  first  case  which  attracted  the  attention  of  the  author  occurred  in 
1836,  and  he  has  subsequently  met  with  six  or  seven  others.  In  each 
of  them  the  disorganization  had  been  carried  on  so  insidiously,  that 
neither  the  presence  of  disease  nor  structural  alteration  was  suspected, 
until  the  teeth  had  assumed  a  dull  brownish  or  bluish-brown  appear- 
ance. The  death  of  the  pulp  had  not  been  preceded  in  any  of  these 
cases  by  the  slightest  indication  of  inflammatory  action.  It  had  appa- 
rently resulted  from  want  of  sufficient  vital  energy  to  sustain  the 
nutritive  function. 

The  sockets  of  the  affected  teeth  in  these  cases  were,  seemingly,  in 
a  healthy  condition,  —  a  circumstance  which,  when  \ye  take  into  con- 
sideration that  the  parts  of  the  extremity  of  the  roots  were  exposed  to 
the  action  of  the  disorganized  remains  of  the  dental  pulps,  may  appear 
somewhat  strange.  But  this  may  have  been  owing,  partly,  to  dimin- 
ished excitability  in  the  alveolo-dental  periosteum,  and  partly  to  the 
smallness  of  the  quantity,  and  the  inocuous  character  of  the  matter 
contained  in  the  central  cavities  of  the  teeth.  The  gums  of  that  portion 
of  the  alveolar  border  occupied  by  the  affected  teeth  had  a  pale,  gray- 
ish-purple appearance,  but  exhibited  no  indications  of  actual  disease. 
They  were  as  thin  and  their  margins  as  distinctly  festooned  here  as  in 
any  other  part  of  the  mouth.  In  some  instances,  the  teeth  had  been 
in  this  condition  for  seven  or  eight  years,  On  perforating  the  crowns, 
only  a  drop  of  dark-brown  matter,  about  the  consistence  of  thin  cream, 
and  having  but  little  odor,  escaped  from  the  pulp-cavity  of  each. 

In  all  the  cases  which  the  author  has  seen  of  this  remarkable  affec- 
tion, the  loss  of  vitality  had  taken  place  previously  to  the  twentieth 
year  of  age,  and,  according  to  his  observations  upon  the  subject,  it 
seldom  confines  itself  to  a  single  tooth,  but  occurs  simultaneously  in 
corresponding  teeth.  The  pulps  of  several  usually  perish  at  about  the 
same  time.    In  the  first  case  to  which  his  attention  was  called,  six  had 


228  THE    DENTAL    PULP. 

lost  their  vitality.  The  affection,  too,  seems  to  ])e  principally  confined 
to  the  incisoi-s  and  cuspids,  and  sound  teeth  appear  to  be  as  subject  to 
it  as  those  which  are  carious. 

Now,  as  the  disorganization  of  the  pulp,  in  cases  of  this  sort,  is  not 
the  result  of  inflammatory  action,  it  must  be  dependent  upon  con- 
stitutional rather  than  local  causes  —  upon  some  peculiar  cachexia, 
which  causes  the  function  of  sanguinification  to  be  imperfectly  per- 
formed. This  inference,  too,  seems  to  be  fully  warranted  bv  the  ap- 
pearance of  the  subjects  in  all  the  cases  which  the  author  has  had  an 
opportunity  of  examining  —  characterized  by  an  extremely  pale  and 
slightly  bloated  aspect  of  countenance,  indicating  a  serous  condition 
of  blood. 

The  remedial  indications  in  cases  of  this  sort  are  the  same  as  in 
necrosis  produced  by  inflammation  and  suppuration  of  the  lining  mem- 
brane and  pulp. 

FUNGOUS   GROWTH. 

The  pulp  of  a  tooth,  when  exposed  by  decay  of  the  crown,  some- 
times becomes  the  seat  of  a  fungous  gi'owth,  in  the  form  of  a  small 
vascular  tumor.  These  morbid  growths  sometimes  attain  the  size  of  a 
large  pea,  completely  filling  the  cavity  made  in  the  crown  of  the  tooth 
by  decay  ;  at  other  times  they  do  not  exceed  that  of  a  small  elderberry. 
The  former  have  little  sensibility,  and  bleed  freely  from  the  slightest 
injury ;  the  latter  are  less  vascular,  but  are  nearly  as  sensitive  as  the 
pulp  in  a  healthy  state. 

It  often  happens  that  a  fungous  growth  of  the  gum  or  dental  peri- 
osteum, finding  its  way  through  an  opening  in  the  side  of  the  neck  or 
root  of  a  decayed  tooth,  appears  in  the  central  cavity,  and  is  sometimes 
mistaken  for  a  morbid  growth  of  the  pulp.  Such  tumors  usually  grow 
very  fast,  and  sometimes  attain  the  size  of  a  hickory  nut.  They  are 
exceedingly  vascular,  bleeding  profusely  when  wounded,  and  are  soon 
reproduced  after  removal.  The  author  has  met  with  tumors  of  this 
kind  which  had  originated  in  the  alveolo-dental  periosteum  of  the  ex- 
tremity of  the  root. 

The  only  remedy  in  such  cases  is  the  removal  of  the  tooth.  A  cure 
cannot  be  effected  by  extirpating  the  morbid  growth.  The  author  has 
frequently  removed  them  nearly  to  the  extremity  of  the  root,  but  they 
have  always  reappeared  in  a  few  days  or  weeks  after  the  operation. 
Even  if  a  return  of  the  disease  could  be  prevented,  the  extraction  of 
the  tooth  should  be  insisted  on,  as  all  teeth  in  which  tumors  of  this 
sort  are  situated  are  morbid  irritants,  and  cannot  remain  without 
detriment  to  the  health  of  the  parts  with  which  they  are  in  immediate 
connection. 


THE    DENTAL    PULP.  229 

When  there  is  a  tendency  to  fungous  growth  of  the  pulp,  the  appli- 
cation of  an  escharotic  has  proved  serviceable.  Of  these  agents,  chromic 
acid  appears  to  be  the  most  effective. 

OSSIFICATION. 

Allusion  has  been  made  several  times,  in  the  course  of  this  work,  to 
the  ossification  of  the  dental  pulp,  as  a  means  employed  by  nature  to 
prevent  the  exposure  of  this  most  delicate  and  exquisitely  sensitive 
structure.  But  examples  of  it  are  occasionally  met  with  in  teeth 
which  have  suffered  no  loss  of  substance,  either  from  mechanical  or 
spontaneous  abrasion,  or  from  the  decay  of  the  dentine.  The  occur- 
rence, whatever  may  be  the  circumstances  under  which  it  takes  place, 
is  evidently  the  result  of  the  operation  of  an  established  law  of  the 
economy,  dependent  upon  moderate  irritation  and  a  slight  increase  of 
vascular  action ;  ossification  having  commenced,  it  usually  goes  on 
until  every  part  of  the  pulp  is  converted  into  a  substance  analogous  to 
cementum.  We  infer,  then,  that  when  the  puljD  of  a  tooth  becomes  the 
seat  of  a  sufl[icient  amount  of  irritation,  ossification  must  follow  as  a 
necessary  consequence ;  but  if  the  irritation  be  succeeded  by  active 
inflammation,  a  different  result  may  be  expected. 

The  irritation  necessary  for  the  ossification  of  the  pulp  of  a  tooth 
sometimes  arises  from  constitutional  causes;  but  in  the  majority  of 
cases,  it  results  from  the  action  of  local  irritants,  and  most  frequently 
from  impressions  of  heat  and  cold,  communicated  through  the  medium 
of  a  metallic  filling  or  a  thin  layer  of  dentine. 

During  the  ossification,  a  sensation  is  occasionally  experienced  in 
the  tooth  somewhat  similar,  though  altogether  less  in  degree,  to  that 
which  attends  the  knitting  of  the  fractured  extremities  of  a  broken 
hone.  A  numb,  vibratory  pain,  barely  perceptible,  is  felt  passing 
through  the  tooth  several  times  a  day,  but  only  lasting  a  second  or  two 
at  a  time.  It  is  scarcely  sufiicient  to  occasion  any  annoyance,  or  to 
attract  anything  more  than  momentary  attention. 

With  the  ossification  of  the  pulp,  the  crown  and  inner  walls  of  the 
root  lose  their  vitality,  but  the  appearance  of  the  tooth  is  not,  as  in  the 
case  of  necrosis  arising  from  the  disorganization  of  the  pulp,  materially 
affected.  The  central  cavity  being  filled  with  semi-translucent  osteo- 
dentine,  the  crown  retains  its  natural  color.  The  discoloration  and 
opacity  attending  necrosis,  produced  by  other  causes,  result  partly 
from  the  presence  of  putrid  matter  in  the  pulp-cavity,  and  partly 
from  its  absorption  by  the  surrounding  dentinal  walls. 


230  ALVEOLAR    PERIOSTITIS. 


CHAPTER  X. 

ALVEOLAR   PERIOSTITIS. 

ALVEOLAR  periostitis,  or  periodontitis  —  inflammation  of  the 
investing  membrane  of  the  roots  of  the  teeth,  a  tissue  liighly 
vascular  and  very  susceptible  to  inflammatory  conditions  —  may,  in  a 
great  majority  of  cases,  be  regarded  as  a  premonitory  stage  of  alveolar 
abscess,  as  it  rarely  occurs  before  the  pulp  has  been  deprived  of  its 
vitality. 

Inflammation  of  the  periosteum  of  a  tooth  may  be  acute  or  chronic, 
each  variety  being  modified  in  its  character  by  the  state  of  the  con- 
stitutional health,  and  by  the  causes  concerned  in  its  production.  The 
premonitory  symptoms  of  the  acute  variety  are  a  slight  sensation  of 
uneasiness  and  tension,  a  feeling  of  fulness  about  the  affected  part, 
and  a  desire  to  press  the  teeth  together.  Pressure  appears  to  afford 
temporary  relief,  but  the  uneasy  feeling  returns  on  the  jDressure  being 
withdrawn. 

These  symptoms  are  soon  followed  by  a  dull,  heavy,  and  continuous 
pain,  and  the  affected  tooth  apj^ears  to  be  longer  than  the  adjoining 
ones.  The  appearance  of  the  gums  at  this  stage  of  the  affection  also 
indicates  the  existence  of  disease  in  the  investing  membrane  ;  they  be- 
come very  tender  and  swollen,  and  change  from  a  pale  rose  color  to  a 
deep  red  or  purple  opposite  the  root  of  the  affected  tooth. 

At  first  the  inflammation  is  confined  to  the  free  margins,  but  soon  it 
becomes  more  general,  until  the  whole  of  the  gum  about  the  root  of 
the  tooth  is  involved.  Although  the  pain  increases  in  severity,  it  yet 
preserves  the  same  character,  and  even  when  not  continuous,  it  seldom 
ceases  for  any  great  length  of  time.  At  length  suppuration  occurs, 
and  we  have  the  condition  known  as  alveolar  abscess ;  this  process 
sometimes  extending  to  nearly  every  part  of  the  periosteum,  causing 
the  entire  death  of  the  tooth,  and  often  followed  by  erosion  of  the 
root  and  necrosis  of  the  alveolus.  When  favored  by  a  cachectic 
habit  of  body,  it  often  extends  to  the  periosteum  of  the  jaM%  followed 
by  suppuration  and  necrosis.  The  following  case  will  give  some  idea 
of  the  severity  it  occasionally  assumes : 

In  1840,  a  poor  girl,  aged  fourteen,  was  .  brought  to  the  author. 
About  three  months  before  she  had  been  taken  to  a  barber  tooth- 
drawer  for  the  purpose  of  having  the  first  left  inferior  molar  extracted. 
The  crown  was  broken  off",  the  roots  left  in  the  socket.     Inflammation 


ALVEOLAR    PERIOSTITIS.  231 

supervened.     This  soon  extended  to  the  periosteum  of  the  entire  bone 
from  the  second  bicuspid  to  the  coronoid  process  ;  as  it  was  permitted 

to  run  its  course  uninterruptedly, 

•     ^   1  •  -1  fiG.  47. 

it  terminated  m  necrosis  and  ex- 
foliation of  all  this  portion  of  the 
bone  (Fig.  47),  the  anterior  ex- 
tremity of  which,  when  first  seen 
by  the  author,  had  passed  through 
the  integuments  of  the  lower  part 
of  the  face,  and  protruded  ex- 
ternally. A  few  days  after  it  was 
removed  without  difficulty. 

Acute  inflammation  of  the  peri- 
osteum having  terminated  in  suppuration,  sometimes,  instead  of  sub- 
siding altogether,  degenerates  into  a  chronic  form,  and  when  favored 
by  some  constitutional  vice,  as  the  scorbutic,  venereal,  or  scrofulous, 
it  often  gives  rise  to  the  destruction  of  the  socket  and  loss  of  the 
tooth. 

Chronic  inflammation  of  the  dental  periosteum  is  not  always  pre- 
ceded by  the  active  form  of  the  disease,  but  may  assume  this  form  at 
the  commencement.  In  this  case  it  is  complicated  with  tumefaction 
of  the  gums,  and  discharge  of  puriform  matter  from  between  their 
edges  and  the  necks  of  the  teeth. 

CAUSES. 

Alveolar  periostitis,  in  most  instances,  is  the  result  of  inflammation 
of  the  pulp  of  a  tooth,  either  from  direct  exposure  or  the  presence  of 
an  irritating  substance,  such  as  the  remains  of  a  dead  or  decomposing 
pulp,  salivary  calculus,  the  free  use  of  arsenious  acid,  the  injudicious 
use  of  agents  employed  for  obtunding  the  sensitiveness  of  dentine,  the 
action  of  mercurial  remedies,  etc.  It  may  also  result  from  the  loss  of 
an  antagonizing  tooth,  violence,  proximity  of  a  metallic  filling  to  the 
pulp,  overhanging  portions  of  a  filling,  and  the  presence  of  caries 
beyond  the  margin  of  the  gum.  Besides  the  local  causes  enumerated, 
there  are  also  constitutional  causes,  such  as  a  syphilitic  taint  through 
an  infiltration  of  lymph  and  serum  into  the  periosteum,  or  between  it 
and  the  root  of  the  tooth  or  alveolar  walls  of  the  socket;  also  rheu- 
matism, especially  in  those  who  have  been  subjected  to  an  excess  of 
mercury,  and  scrofula,  which  produces  a  form  of  periostitis  common  to 
children. 

TREATMENT. 

The  treatment  of  alveolar  periostitis  will  depend  upon  the  causes 
producing  and  influencing  the  disease,  and  the  condition  of  the  gen- 


232  ALVEOLAR    PERIOSTITIS. 

eral  system.  The  first  thing  to  be  attended  to  is  the  removal  of  all 
irritants,  after  which  the  congestion  of  the  affected  i)art  may  be  re- 
lieved by  the  use  of  such  irritating  agents  as  produce  counter-irritation, 
or  by  depletion. 

When  the  pulp  of  the  tooth  is  inflamed  it  should  receive  immediate 
attention,  and  if  the  pulp  is  dead,  all  the  debris  should  be  removed 
from  its  canal  by  means  of  nerve  instruments,  and  syringing  with 
tepid  water.  To  produce  counter-irritation,  such  irritating  agents  as 
iodine  and  creosote,  tincture  of  capsicum,  tincture  of  iodine,  often 
prove  serviceable.  An  excellent  application  is  composed  of  equal 
parts  of  the  officinal  tincture  of  iodine  and  tincture  of  aconite  root 
applied  to  the  gum  two  or  three  times  daily  in- the  acute  form  of  the 
affection.  Cautharidal  collodion  is  also  an  excellent  counter-irritant, 
and  is  applied  to  the  gum,  after  the  surface  is  dried  with  a  napkin,  by 
means  of  a  camel's-hair  brush,  taking  care  to  protect  the  lip,  and  to 
prevent  moisture  from  interfering  before  the  ether  in  the  jireparation 
evaporates  and  an  artificial  cuticle  is  formed.  Within  a  few  hours 
blistering  results,  and  the  periostitis  is  effectually  relieved.  Lead- 
water,  in  the  proportion  of  a  fluidounce  to  two  fluiddrachms  of 
laudanum  applied  in  the  same  manner  as  the  agent  before  named,  has 
also  been  successfully  used.  Depletion  may  be  accomplished  by  means 
of  the  gum  lancet,  or  by  the  use  of  leeches. 

Hypodermic  injections  of  morphia  have  also  been  resorted  to  for 
the  relief  of  the  intense  pain  of  this  affection  ;  also,  with  good  effect, 
the  application  of  rhigoleue  or  ether  spray  until  the  gum  about  the 
affected  tooth  is  blanched.  As  a  topical  application,  rhigolene  has 
been  recommended,  applied  to  the  gum  on  a  pellet  of  cotton  after  free 
scarification. 

Constitutional  treatment  is  also  serviceable,  such  as  the  administra- 
tion of  saline  cathartics.  A  ^preparation  known  as  mercurius  vivus, 
the  third  decimal  trituration,  given  in  small  doses  two  or  three  times 
a  day,  has  been  recommended  by  Prof.  Chase,  and  used  successfully  by 
others  in  relieving  acute  periostitis.  During  the  treatment,  a  cap  of 
gutta-percha  moulded  to  the  crowns  of  one  or  two  teeth  on  the  opposite- 
side  of  the  jaw,  will  protect  the  affected  tooth  from  any  irritation 
which  may  be  caused  by  the  occlusion  of  the  opposing  ones,  and  thus 
facilitate  the  restoration.  For  the  treatment  of  the  chronic  variety 
of  alveolar  periostitis,  the  reader  is  referred  to  chronic  inflammation 
and  tumefaction  o\  i'he  2:uin3 


ALVEOLAE    ABSCESS.  233 


CHAPTER  XI. 

ALVEOLAR    ABSCESS. 

S  most  of  the  phenomena  attending  the  formation  of  alveolar 
abscess  are  noticed  in  the  chapter  on  toothache,  it  will  not  be 
necessary,  in  this  place,  to  dwell  upon  them  at  much  length.  The  peri- 
osteum of  a  tooth  having  become  the  seat  of  acute  inflammation,  plastic 
lymph  is  effused  at  the  extremity  of  the  root.  This  is  condensed  into 
a  sac  or  cyst,  which  closely  embraces  the  root  near  its  apex,  the  walls 
of  lymph  become  vascular,  and  perform  the  functions  of  secretion  and 
absorption,  and  as  suppuration  takes  place,  pus  is  formed  in  the  centre 
of  the  sac.  The  inflammation,  in  the  mean  time,  having  extended  to 
the  gums  and  neighboring  parts,  they  swell  and  become  painful,  and 
as  the  pus  accumulates  in  the  sac,  it  distends  and  presses  upon  the 
surrounding  walls  of  the  alveolus,  which,  by  a  sort  of  cliemico-vital 
process,  are  gradually  broken  down.  By  this  means  an  opening  is 
ultimately  made  through  one  side  of  the  socket,  when  the  pus,  coming 
in  contact  with  the  investing  soft  structures,  presses  upon  them  and 
causes  their  absorption.  Thus  an  outlet  is  effected  for  the  escape  of  the 
accumulated  matter. 

The  opening  which  gives  egress  to  the  pus,  is  usually  in  the  gum 
opposite  the  extremity  of  the  root,  but  the  matter  may  escape  from 
some  other  and  more  remote  point.  It  may  make  for  itself  an  opening 
through  the  cheek  or  through  the  base  of  the  lower  jaw,  and  be  discharged 
externally ;  or  it  may  pass  up  into  the  maxillary  sinus,  or  through  the 
nasal  plates  of  the  superior  maxilla,  or  form  a  passage  between  the  two 
plates  of  the  bone,  and  escape  from  the  centre  of  the  roof  of  the  mouth. 

The  formation  of  abscess  in  the  alveolus  of  an  inferior  dens  sapienti^e, 
is  sometimes  attended  with  inflammation  and  swelling  of  the  tonsils  and 
of  the  muscles  of  the  cheek  and  neck.  The  author  has  known  trismus 
to  result  from  this  cause. 

The  pain  attending  the  formation  of  alveolar  abscess,  is  deep-seated, 
throbbing,  and  often  so  excruciating  as  to  be  almost  insupportable. 
But  as  soon  as  suppuration  takes  place,  it  loses  its  severity,  and  with 
the  escape  of  the  pus  nearly  or  altogether  ceases ;  but  the  tooth,  from 
the  thickened  condition  of  the  alveolo-dental  periosteum,  particularly 
at  the  apex  of  the  root,  often  remains  sore  and  sensitive  to  the  touch 
for  several  days.  The  energies  of  the  disease,  however,  having  been 
expended,  the  secretion  of  the  pus,  in  the  majority  of  cases,  wholly 


234  ALVEOLAR    ABSCESS. 

ceases,  and  the  opening  in  the  gums  closes.  From  the  increased  sus- 
ceptibility in  the  alveolo-dental  periosteum  to  morbid  impressions,  occa- 
sioned by  the  presence  of  a  tooth  deprived  of  a  large  portion  of  its 
vitality,  a  recurrence  of  the  inflammation  is  liable  to  take  place,  -when 
pus  will  be  again  formed  and  the  passage  for  its  escape  re-established. 
But  the  pain  attending  any  subsequent  attack  is  seldom  so  severe  as 
in  the  first  instance. 

There  are  some  cases,  however,  in  which  the  inflammation,  instead 
of  subsiding  altogether,  degenerates  into  a  chronic  form.  In  this  case, 
the  sac  at  the  extremity  of  the  root  continues  to  secrete  pus,  though  the 
quantity  is  usually  small,  and  the  opening  in  the  gums  remains  unclosed. 

Persons  of  a  scrofulous  diathesis  are  very  liable  to  this  afiection, 
which,  in  these  cases,  very  soon  assumes  a  chronic  form. 

In  the  extraction  of  a  tooth  wdiich  has  given  rise  to  the  formation 
of  abscess,  the  sac  is  often  brought  away  with 

Fro.  48.         Fig.  49.       ^^^     rp^^.^  ^g^^j^   j^^  ^^.j^j^l^    ^j^-^  ^^^^  happened, 

taken  from  the  upper  jaw  —  one  a  cuspid,  and 
the  other  a  first  molar  —  are  represented  in  the 
accompanying  cuts,  Figs.  48  and  49.  In  the 
case  of  the  molar,  the  sac  is  attached  to  the 
palatine  root.  Both  of  these  teeth  were  ex- 
tracted ptreviously  to  the  formation  of  an  ex- 
ternal opening  for  the  escape  of  the  matter. 

Although  in  the  majority  of  cases  the  sac  is 
attached  to  the  apex  of  the  root,  yet  it  is  not 
unusual  for  the  point  of  attachment  to  be  on  the  side  of  the  root,  as  in 
the  case  of  the  superior  front  teeth,  and  bicuspids,  or  in  the  bifurcation 
of  the  roots,  in  the  case  of  the  molars,  for  example.  "When  the  sac 
is  situated  upon  the  side  of  the  root  of  a  superior  front  tooth,  it  is 
generally  upon  the  labial  surface,  and  when  it  is  situated  at  the  apex 
of  the  root  of  a  molar  tooth,  the  palatine  root  is  the  one  generally 
affected.  The  temporary  teeth  are  much  more  liable  to  this  disease 
than  the  permanent  teeth,  and  the  superior  incisors  more  susceptible 
than  the  inferior  teeth  of  the  same  class. 

But  the  treatment  of  inferior  teeth  affected  with  abscess,  especially  the 
bicuspids  and  molars,  is  often  more  difficult  than  that  of  the  superior, 
on  account  of  the  gravitation  of  the  pus,  and  the  impossibility  in  many 
cases  of  making  an  opening  through  the  alveolar  process  so  low  as  the 
extremity  of  the  root,  owing  to  the  muscular  attachment  being  so  high 
on  the  ridge. 

The  time  required  for  the  formation  of  alveolar  abscess  varies  from 
three  to  ten  or  fifteen  days,  according  to  the  violence  of  the  inflamma- 
tion.   But  a  collection  of  pus  may  be  detected  by  fluctuation  under  the 


ALVEOLAR    ABSCESS.  235 

finger,  if  applied  to  the  tumefied  gum  one  or  two  days  before  an  exter- 
nal opening  is  spontaneously  formed  for  its  escape. 

The  inflammation  and  pain  attending  the  formation  of  abscess  in  the 
socket  of  a  tooth  often  give  rise  to  general  febrile  symptoms,  headache, 
and  constipation  pf  the  bowels.  In  the  acute  form  of  this  disease,  the 
pain  is  intense,  while  in  the  chronic  form,  where  the  pus  is  constantly 
secreting  and  discharging,  the  sensation  experienced  is  soreness  and  an 
uneasy  feeling,  with  slight  pain  upon  a  change  of  temperature. 

CAUSES. 

The  immediate  cause  of  alveolar  abscess  is  inflammation  of  the 
alveolo-dental  periosteum,  and  this  may  arise  from  inflammation  and 
suppuration  of  the  lining  membrane  and  pulp ;  or  from  an  accumula- 
tion of  purulent  matter  at  the  extremity  of  the  root,  the  egress  of  which, 
through  the  natural  opening,  has  been  prevented  ;  for  example,  where 
the  cavity  in  the  crown  of  a  tooth  has  been  filled  and  the  decomposed 
pulp  allowed  to  remain  in  the  root  canal.  It  may  also  be  produced 
by  mechanical  violence,  the  irritation  of  a  dead  tooth,  or  by  the  pres- 
ence of  a  portion  of  a  gold  filling  forced  through  the  root  of  a  tooth; 
as  in  the  following  case,  related  to  the  author  by  his  friend  Prof.  C. 
Johnston,  of  Baltimore.  A  medical  gentleman  called  upon  a  dentist 
of  this  city  to  treat  a  left  first  upper  molar  affected  Avith  caries.  It 
was  decided  to  remove  the  diseased  pulp  and  introduce  a  root  filling, 
and  accordingly  the  operation  was  undertaken ;  but  in  packing  the 
first  pellet  in  an  external  root,  the  instrument  suddenly  slipped  forward, 
and  from  this  circumstance,  as  well  as  from  the  pain,  it  became  evident 
that  the  gold  had  passed  out  of  the  tooth.  For  nine  months  afterwards 
no  inconvenience  followed  the  operation,  which  was  otherwise  satisfac- 
torily completed  ;  when  suddenly  there  appeared  a  soreness  of  the  gum 
of  the  same  tooth.  Soon  after  a  small  tumor  arose  upon  the  face,  half 
an  inch  above  the  left  angle  of  the  mouth,  maturated,  and  burst  spon- 
taneously, discharging  the  erring  pellet  of  gold.  In  a  few  days  the 
opening  closed,  and  a  perfect  cure  resulted. 

TREATMENT. 

The  treatment  of  alveolar  abscess  should  be  preventive  rather  than 
curative,  for  it  rarely  happens,  after  it  has  occurred,  that  the  integrity 
of  the  parts  is  so  perfectly  restored  as  to  prevent  a  recurrence  of  the 
affection.  Although  the  secretion  of  pus  may  cease  for  a  time,  and 
the  opening  in  the  gums  become  obliterated,  the  tooth,  being  deprived 
of  a  large  portion  of  its  vitality,  is  liable,  whenever  the  excitability  of 
the  alveolo-dental  periosteum  is  increased  by  any  derangement  of  the 
general  system,  to  give  rise  to  a  recurrence  of  the  disease.     Especially 


236  ALVEOLAR    ABSCESS. 

is  this  tlie  case  when  the  disease  has  assumed  the  chronic  form.  The 
formation  of  an  abscess,  therefore,  should,  if  possible,  be  i)revented  by 
the  use  of  such  means  as  are  referred  to  in  the  treatment  of  "  Alveolar 
Periostitis,"  the  termination  of  this  disease  being  alveolar  abscess.  But 
should  these  means  fail  to  prevent  the  formation  of  pus,  we  then  have  to 
resort  to  either  therapeutic  or  surgical  treatment. 

The  therapeutic  treatment  consists  in  the  application  of  such  remedial 
agents  as  will  cause  the  absorption  or  destruction  of  the  sac  contain- 
ing the  pus,  such  as  creosote,  carbolic  acid,  nitrate  of  silver,  iodine, 
etc.  The  contents  of  the  abscess,  however,  should  first  be  discharged  by- 
making  an  opening  in  the  tumefied  gum  with  a  sharp  lancet,  provided 
the  disease  has  been  allowed  to  progress  to  such  a  degree  as  to  render 
this  operation  necessary.  If  no  opening  has  been  formed  through  the 
alveolar  process,  the  decay  in  the  crown  cavity  should  be  removed,  and 
the  orifice  of  the  pulp  canal  be  so  enlarged  as  to  admit  a  nerve  instru- 
ment or  small  broach,  by  means  of  which  it  can  be  cleaned  out,  and 
thus  allow  the  matter  to  escape  through  the  tooth.  Tepid  water  should 
then  be  injected  into  the  pulp  canal  by  means  of  a  small  syringe  until 
all  decomposed  matter  is  removed,  when  one  of  the  remedial  agents 
mentioned  above  may  be  substituted  for  the  tepid  water,  or  applied  on 
a  strand  of  floss  silk,  which  is  carried  to  the  apex  of  the  root  by  means 
of  a  nerve  instrument  or  broach.  At  the  end  of  twenty-four  or  forty- 
eight  hours,  according  to  the  character  of  the  symptoms,  this  treatment 
is  repeated,  the  crown  cavity  during  the  interval  being  filled  with  cot- 
ton. A  combination  of  several  of  the  remedial  agents  is  serviceable 
in  obstinate  cases,  such  as  creosote  and  tincture  of  iodine,  carbolic  acid, 
and  tincture  of  iodine,  or  creosote  and  tannin  in  alcohol. 

The  following  solution  of  Dr.  Percy  Boulton,  possesses  therapeutic 
virtues  of  superior  efficiency,  especially  after  creosote,  or  carbolic  acid, 
or  nitrate  of  silver  have  been  used  to  stimulate  the  secreting  surfaces 
to  a  healthy  action : 

R.  Tr.  iodine  comp.,  YH-^i'' 

Acid  carbolic  cryst.  (fusa),  TH^j. 

Glycerinse,  J^iij- 

Aq.  distillat.,  3V.  —  M. 

This  solution  possesses  anti-septic  and  stimulant  properties.  Where 
a  fistulous  opening  exists  through  the  wall  of  the  alveolar  cavity  and 
gum,  this  opening  should  be  enlarged,  and  the  remedial  agents,  after 
the  accumulated  pus  has  escaped,  be  thus  applied  directly  to  the  seat 
of  the  disease.  In  the  chronic  form  of  this  disease,  accompanied  with 
a  fistulous  opening  through  the  alveolar  process  and  gum,  some  opera- 
tors are  in  the  habit  of  carefully  cleaning  out,  preparing  and  filling 


ALVEOLAR    ABSCESS.  237 

the  pulp  canal  to  the  extremity  of  the  root,  and  after  this  treating  the 
abscess  through  the  fistulous  opening  (which  is  enlarged  for  the  pur- 
pose) either  by  the  application  of  therapeutic  agents  or  by  what  is 
designated  the  surgical  treatment. 

This  surgical  treatment  consists  in  making  an  opening,  or  enlarging 
the  fistulous  one,  through  the  alveolus  opposite  the  extremity  of  the 
affected  root  by  means  of  a  small  trephine,  drill,  or  chisel,  first  making 
a  vertical  incision  in  the  gum  with  the  lancet,  and  thus  gaining  access 
to  the  seat  of  the  disease.  The  attachment  of  the  sac  to  the  root  is 
then  broken  up  by  means  of  a  delicate  instrument  which  permits  of 
being  passed  about  the  extremity  of  the  root,  and  the  w^ound  in  the 
gum  kept  open  for  a  few  days  by  inserting  a  tent,  in  order  that  the 
remains  of  the  sac  may  escape,  and  such  agents  as  tannin  and  glycerine, 
carbolic  acid  and  glycerine,  etc.,  may  be  applied.  It  rarely  happens 
that  this  surgical  treatment  can  be  made  through  the  pulp  canal  of  the 
root  and  without  an  opening  in  the  alveolar  process.  During  treat- 
ment, to  j)revent  the  occlusion  of  the  teeth,  where  this  may  be  neces- 
sary, a  cap  of  gutta-percha  can  be  moulded  over  the  adjoining  teeth 
by  first  softening  this  material  in  warm  water. 

When  escharotic  agents  are  injected  into  the  pulp-cavity  and  through 
the  fistulous  opening  in  the  process  and  gum,  their  contact  with  the 
mucous  membrane  may  be  prevented  by  the  introduction  of  a  Hill's 
stopping  filling  in  the  crown  cavity,  in  the  centre  of  which  an  opening 
is  made  to  admit  closely  the  point  of  the  syringe,  while  at  the  same 
time  the  parts  about  the  fistulous  opening  are  protected  by  bibulous 
paper,  cotton,  and  napkins.  When  there  is  a  tendency  of  the  accumu- 
lated pus  in  the  sac  of  an  abscess  upon  one  of  the  inferior  teeth  to 
discharge  through  an  external  opening  in  the  cheek,  or  beneath  the 
jaw,  this  result  may  be  prevented  by  a  free  incision  in  the  gum  oppo- 
site the  rootof  the  affected  tooth  ;  should  the  discharge  however,  through 
an  external  opening  be  inevitable,  the  immediate  extraction  of  the 
tooth  is  necessary. 

The  application  of  fomentations  and  emollient  poultices  externally 
are  rarely  productive  of  any  advantage,  and  may  do  harm  by  promot- 
ing the  discharge  of  matter  through  the  cheek  or  lower  part  of  the 
face.  When  this  occurs,  a  depression,  wdth  puckering  of  the  skin,  is 
apt  to  remain  after  the  escape  of  pus  through  the  opening  ceases  and 
the  orifice  has  closed,  causing  disfiguration  of  the  face. 

A  very  singular  case  of  fistulous  opening  through  the  external 
integument  is  mentioned  by  Mr.  Thomas  Bell.  It  had  resulted  from 
an  abscess  in  the  socket  of  the  right  inferior  dens  sapientise,  and  the 
discharge  of  matter  had  been  kept  up  for  two  years  before  he  saw 
the  patient.     "  At  this  time,"  says  Mr.  B.,  "  a  funnel-shaped  depression 


238  ALVEOLAR    ABSCESS. 

existed  in  the  skin,  which  could  be  seen  to  the  depth  of  nearly  three- 
quarters  of  an  inch,  and  a  small  probe  could  be  passed  through  it  into 
the  sac  of  the  abscess,  underneath  the  root  of  the  tooth.  The  abscess 
had  now  remained  open  for  two  years,  during  the  latter  part  of  which 
time  the  parts  had  been  in  the  state  I  have  described.  I  removed  the 
tooth,  and,  as  I  anticipated,  no  further  secretion  of  pus  took  place; 
but  so  perfectly  had  the  communication  been  established,  that  when 
the  gum  healed,  it  left  by  its  contraction  a  fistulous  opening,  through 
which  a  portion  of  any  fluid  received  into  the  mouth  passed  readily  to 
the  outside  of  the  cheek  ;  and  I  could,  by  carefully  introducing  a  fine 
probe,  pass  it  completely  through  the  passage.  So  free,  in  fact,  was 
the  communication,  that  some  of  the  hairs  of  the  whiskers,  with  which 
the  external  portion  of  the  depression  was  filled,  grew  through  the 
internal  opening,  and  appeared  in  the  mouth. 

"  I  passed  through  it  a  very  fine  knife,  resembling  the  couching- 
needle,  and  removed,  as  perfectly  as  possible,  a  circular  portion  of  the 
parietes  of  the  tube  toward  the  gum;  but  failed  in  this,  and  several 
other  attempts,  to  produce  a  union.  It  was,  therefore,  resolved  that 
the  whole  parietes  of  the  depression  should  be  removed,  extending  the 
incision  as  far  internally  as  possible  ;  and  the  integuments  thus  brought 
together  as  a  simple  wound.  In  consequence,  however,  of  the  suppu- 
ration of  a  small  gland  in  the  immediate  neighborhood,  the  operation 
was  deferred  until  that  should  have  been  dispersed ;  it,  therefore, 
remains  at  present  in  the  state  in  which  I  have  described  it." 

It  rarely  happens,  however,  that  anything  more  is  necessary  for  the 
cure  of  the  external  opening  than  the  extraction  of  the  tooth  which 
has  given  rise  to  the  formation  of  the  abscess.  The  author  has  been 
consulted  in  many  cases,  and  has  never  found  it  necessary  to  resort  to 
other  means ;  but  should  the  external  opening  remain,  the  wall  of  the 
tube  and  depression  may  be  removed  in  the  manner  just  described. 

The  formation  of  an  abscess  in  the  alveolus  of  a  lower  wisdom  tooth 
is  sometimes  productive  of  very  serious  and  even  alarming  consequences. 
The  following  is  one  of  several  similar  cases  w^hich  have  fallen  under 
the  observation  of  the  author : 

In  1832,  he  was  sent  for  in  great  haste  to  visit  a  physician  who 
resided  thirty  miles  in  the  country.  He  had  been  attacked  two  weeks 
before  with  severe  pain  in  the  left  dens  sapientire  of  the  lower  jaw. 
At  the  expiration  of  three  or  four  days,  a  physician  was  called  in,  who 
made  several  unsuccessful  attempts  to  extract  the  tooth. 

The  inflammation  now  extended  rapidly  to  the  fauces,  tonsils,  and 
muscles  of  the  jaw  and  face.  Obstructed  deglutition  and  a  constant 
fever  supervened,  upon  which  repeated  blood-lettings,  cathartics,  and 
fomentations  applied  to  the  face  had  little  eflfect.    His  respiration  was 


ALVEOLAE    ABSCESS.  239 

difficult,  and  the  muscles  of  his  jaws  soon  became  so  rigid  and  firmly 
contracted  that  his  mouth  could  not  be  opened. 

This  was  the  condition  of  the  patient  when  the  author  first  saw 
him,  which  was  the  morning  of  the  day  following  the  one  ou  which 
he  was  sent  for.  In  addition  to  the  treatment  which  had  previously 
been  pursued,  an  injection  with  two  grains  of  tartar  emetic  was  admin- 
istered. About  seven  o'clock  in  the  evening,  the  fever  was  succeeded 
by  alternate  paroxysms  of  cold  and  heat.  An  effort  was  now  made 
to  force  open  his  mouth  with  a  wooden  wedge.  This  was  partially 
successful,  but  his  teeth  could  not  be  forced  asunder  sufficiently  to 
admit  of  the  introduction  of  the  smallest  sized  tooth-forceps.  But 
while  his  jaws  were  thus  partially  separated,  he  attempted  to  swallow 
some  w'arm  tea;  in  the  effort  an  abscess  burst  and  discharged  nearly 
a  table-spoonful  of  pus  from  his  mouth,  and  it  was  supposed  that 
double  that  quantity  passed  down  into  his  stomach.  This  gave  imme- 
diate relief,  but  it  was  not  until  about  three  o'clock  in  the  afternoon 
of  the  next  day  that  his  jaws  could  be  forced  apart  sufficiently  to 
permit  the  extraction  of  the  tooth  which  had  caused  the  trouble.  To 
the  roots  of  this,  which  were  united,  there  was  attached  a  sac,  about 
the  size  of  a  large  pea,  filled  with  pus.  The  patient  recovered  ra^jidly, 
and  in  a  few  days  was  quite  well. 

The  following  is  the  most  singular  case  of  alveolar  abscess  which 
has  ever  fallen  under  the  observation  of  the  writer.  The  subject  was 
a  lady  about  thirty  years  of  age.  She  had  been  troubled  with  a 
dripping  of  pus  from  behind  the  curtain  of  th6  palate  for  about 
twelve  months,  and  becoming  somewhat  alarmed  at  its  continuance, 
she  called  the  attention  of  her  family  physician.  Prof.  Bond,  to  it, 
who  carefully  examined  the  case,  and  endeavored  to  ascertain  the 
place  from  whence  the  matter  came.  He  soon  satisfied  himself  that 
it  w^as  from  the  socket  of  a  diseased  tooth.  Upon  passing  his  finger 
around  on  the  gums  covering  the  superior  alveolar  border,  he  dis- 
covered a  protuberance  over  the  root  of  each  upper  central  incisor, 
nearly  as  large  as  a  hazel-nut.  This  tended  to  confirm  the  opinion 
which  he  had  formed  as  to  the  source  from  whence  the  matter  came, 
and  he  requested  us  to  visit  the  lady  with  him,  which  we  did  on  tlie 
following  day.  On  examining  the  case,  we  advised  the  iaimediate  re- 
moval of  the  affected  teeth,  and  the  more  strongly  as  they  were  found 
to  be  in  a  necrosed  condition. 

The  lady  readily  consented  to  the  operation,  which  was  performed 
on  the  following  day.  The  discharge  of  matter  from  behind  the  cur- 
tain of  the  palate  immediately  ceased,  and  the  patient  was  relieved 
from  an  affection  which  had  been  a  source  of  great  annoyance.  The 
pus  from  the  abscess,  in  this  case,  instead  of  passing  out  through  the 


240       NECROSIS    OF    THE    ALVEOLAR    PROCESSES. 

nasal  plates  of  the  superior  maxilla,  passed  back  over  the  roof  of  the 
mouth,  and  escaped  in  the  manner  described. 

The  author  was  lately  C(msulted  in  a  case  of  a  similar  character  to 
the  one  last  noticed.  The  pus  had  found  its  way  from  the  socket  of 
a  first  superior  molar  to  about  the  centre  of  the  palatine  arch,  thence 
passed  up  into  the  i3osterior  nares,  and  was  discharged  from  behind 
the  velum  palati. 

Inflammation  of  the  investing  membrane  of  the  roots  of  an  inferior 
dens  sapientite  may  produce  equally  serious  effects,  without  occasioning 
the  formation  of  an  abscess  in  the  alveolus.  The  eruption  of  these 
teeth  are  sometimes  attended  with  like  consequences.  The  irritation 
has,  in  some  instances,  extended  to  the  lungs,  and  even  been,  in  de- 
cidedly consumptive  persons,  the  exciting  cause  of  consumption. 

The  occurrence  of  alveolar  abscess  in  the  socket  of  a  temporary 
tooth  is  often  followed  by  exfoliation  of  the  sockets  of  several  teeth, 
and  sometimes  of  considerable  portions  of  the  jaw-bone,  seriously  in- 
juring the  rudiments  of  the  permanent  teeth,  and  sometimes  causing 
their  destruction.  The  author  saw  a  case,  a  few  years  since,  in  which 
an  abscess  of  the  alveolus  of  the  first  lower  temporary  molar  had  oc- 
casioned exfoliation  of  the  socket?  of  a  cuspid  and  two  molars. 
About  one-half  of  the  alveolar  cells  of  the  two  bicuspids  and  the 
cuspid  of  the  second  set  were  also  exfoliated,  thus  leaving  their  im- 
perfectly formed  crowns  entirely  exposed. 


CHAPTER  XII. 

NECROSIS    AND    EXFOLIATION    OF   THE    ALVEOLAR    PROCESSES. 

THE  alveolar  processes,  as  well  as  other  osseous  structures,  are 
liable  to  necrosis  or  loss  of  vitality.  "When  their  connection  with 
the  periosteum  —  the  source  from  whence  they  derive  their  nourish- 
ment and  vitality  —  is  destroyed,  death  follows  as  a  necessary  conse- 
quence. The  loss  of  vitality  may  be  confined  to  the  socket  of  a  single 
tooth,  but  more  frequently  it  extends  to  several,  and  sometimes  to  the 
entire  alveolar  border,  occasionally  including  a  part  or  the  whole  of 
the  jaw.  It  may  occur  in  either  jaw,  but  it  is  more  liable  to  take  place 
in  the  lower  than  in  the  upper.  When  confined  to  the  alveoli,  the 
dead  part  is  never  replaced  with  new  bone,  but  examples  are  on 
record  of  the  regeneration  of  a  part,  and  even  the  whole  of  the  lower 
jaw.  It  is,  however,  denied  by  some,  that  the  loss  of  any  portion  of 
this  bone  is  ever  replaced  by  true  osseous  structure. 


NECEOSIS    OF    THE    ALVEOLAE    PEOCESSES.        241 

"When  one  or  more  of  the  sockets  of  the  teeth  lose  their  vitality, 
nature  exerts  all  her  energies  to  separate  the  dead  from  the  living 
bone ;  this  process,  technically  termed  exfoliation,  is  supposed  by  some 
to  consist  in  a  sort  of  suppurative  inflammation,  but  there  is  reason 
to  believe  it  is  effected  by  the  action  of  a  corrosive  fluid  poured  out 
from  the  fungous  granulations  of  the  living  bone  in  immediate  con- 
tact with  the  necrosed  part.  During  the  process  of  exfoliation,  a  thin 
acrid  matter  is  discharged  from  one  or  more  fistulous  openings  through 
the  gums  or  from  between  them  and  the  necks  of  the  teeth ;  the  gums 
having  lost  their  connection  with  the  necrosed  bone,  become  soft  and 
spongy,  and  assume  a  dark  purple  appearance,  are  preternaturally 
sensitive  to  the  touch,  and  bleed  from  the  most  trifling  injury. 

In  the  admirable  work  of  Mr.  Fox,  on  the  Natural  History  and 
Diseases  of  the  Teeth,  there  are  two  engravings  of  exfoliated  alveolar 
processes.  The  first  represents  the  alveoli  of  a  central  and  lateral 
incisor  and  that  of  the  left  cuspid,  with  a  portion  of  the  maxilla,  ex- 
tending about  five-eighths  of  an  inch  above  the  apex  of  the  roots  of 
the  last-mentioned  tooth.  The  subject  in  this  case  was  a  gentleman 
whose  left  lateral  incisor  became  carious;  inflammation  and  pain 
ensued,  together  with  swelling  of  the  gums  and  lip.  Instead  of  con- 
sulting a  physician,  he  applied  poultices  to  his  face,  until  suppuration 
in  the  alveolus  took  place,  causing  the  formation  of  an  external  open- 
ing through  the  gums  for  the  discharge  of  the  matter.  After  his- 
mouth  had  remained  for  some  time  in  this  condition,  he  applied  to  Mr- 
Fox,  who,  upon  examination,  found  that  not  only  had  the  decayed 
tooth  become  loose,  but  also  one  on  each  side  of  it.  The  first  he  ex- 
tracted, and  discovered  that  the  alveolus,  from  the  destruction  of  the 
periosteum,  was  quite  rough.  The  adjoining  teeth,  still  continuing 
loose,  were  in  a  few  weeks  removed,  and  the  slight  force  that  was 
applied  brought  with  them  the  alveolar  processes  of  the  whole  of  the 
three .  teeth,  and  also  a  considerable  portion  of  the  jaw-bone.  The 
other  engraving  represents  an  inferior  molar  and  two  bicuspids,  with 
their  sockets  and  a  very  large  piece  of  jaw-bone.  The  necrosis  and 
exfoliation  in  this  case,  as  in  the  other,  was-  produced  by  alveolar 
abscess. 

The  author  has  met  with  several  very  similar  cases,  though  all  were 
not  produced  by  the  same  cause,  and  he  has  several  specimens  in  his 
possession,  two  of  which  were  presented  to  him  by  his  brother,  the 
late  Dr.  John  Harris. 

He  has   also   met  with  two  cases  of  necrosis   and   exfoliation  of 
the  alveolar  processes,  which  are  worthy  of  special  notice.     The  sub- 
ject of  the  first  case  was  a  gentleman  of  a  strumous  habit,  about  thirty 
years  of  age;  the  necrosis  and  exfoliation  extended  to  the  sockets  o£ 
16 


242       NECROSIS    OF    THE    ALVEOLAR    PROCESSES. 

all  the  teeth  in  the  upper  jaw.  In  May,  1851,  he  had  the  nerve  de- 
stroyed iu  the  second  bicuspid,  on  the  right  side  of  the  superior  maxilla. 
We  believe  it  was  afterward  removed,  and  the  pulp-cavity  and  root 
filled.  About  six  weeks  after,  as  nearly  as  we  could'  ascertain,  the 
socket  of  the  tooth  became  slightly  painful,  but  as  his  suffering  was 
not  constant,  he  supposed  it  would  soon  cease.  The  pain  ultimately, 
however,  began  to  increase,  and  by  the  latter  part  of  the  following 
September  was  so  severe,  and  attended  by  so  much  constitutional  dis- 
turbance, that  he  was  induced  to  consult  a  physician.  After  having 
been  under  medical  treatment  for  about  two  weeks,  the  author  was  re- 
quested by  the  medical  attendant  to  see  him.  The  affected  tooth  was 
found  to  be  loose,  and  its  socket  in  a  necrosed  condition;  inflamma- 
tion had  extended  to  every  part  of  the  alveolar  border ;  the  gums 
were  very  much  swollen,  and  nearly  all  the  teeth  sensitive  to  the 
touch.  As  the  patient  was  laboring  under  considerable  cerebral  de- 
rangement, and  as  no  advantage  could  be  derived  from  the  removal 
of  the  tooth  at  this  time,  it  was  deemed  advisable  to  let  it  remain 
until  exfoliation  of  the  necrosed  socket  should  take  place. 

Without  going  into  a  detailed  description  of  the  local  and  constitu- 
tional treatment  subsequently  pursued,  it  will  be  suflBcient  to  state  that 
necrosis  extended  to  the  sockets  of  all  the  other  teeth,  except  those  of 
the  second  and  third  molars  on  each  side  of  the  mouth.  In  the  course 
of  about  two  months,  twelve  teeth,  together  with  their  exfoliated 
sockets,  and  several  large  pieces  of  the  maxillary  bone  were  removed. 
It  was  hoped  that  the  disease  would  stop  here,  but  in  three  or  four 
weeks  the  four  remaining  molars  became  very  sore  to  the  touch,  and  as 
purulent  matter  began  to  be  discharged  from  their  sockets,  it  became 
necessary  to  remove  them.  Several  small  pieces  of  bone  were  exfoli- 
ated after  the  last  operation,  but  at  the  expiration  of  about  four  months 
from  this  time  his  mouth  was  sufficiently  restored  to  enable  him  to 
wear  a  temporary  set  of  artificial  teeth. 

The  subject  of  the  second  case  was  a  lady  of  a  cachectic  habit,  about 
thirty-five  years  of  age.  The  necrosis  resulted 
from  inflammation  of  the  alveolo-dental  peri- 
osteum, occasioned  by  irritation  produced  by 
the  roots  of  four  incisors,  upon  which  pivot 
teeth  had  been  placed,  which,  however,  had 
been  removed  some  two  or  three  weeks  before 
the  author  saw  the  patient.  At  this  time  nec- 
rosis had  extended  not  only  to  the  sockets  of  these  teeth,  but  also  up  to 
the  nasal  crest  of  the  maxillary  bone,  and  the  process  of  exfoliation 
had  already  proceeded  so  far,  that  he  was  enabled  to  remove  the  entire 
piece,  the  appearance  of  which  is  represented  in  Fig.  50.     In  July, 


NECEOSIS    OF    THE    ALVEOLAE    PEOCESSES.        243 

1852,  a  few  weeks  after  the  removal  of  this  piece,  he  again  saw  the 
patient,  and,  on  examination,  found  a  large  portion  of  the  palatine 
plate  of  the  bone  in  a  necrosed  state  ;  but  the  process  of  separation 
had  not  yet  pi*oceeded  far  enough  to  enable  him  to  remove  it. 

The  accompanying  engraving,  made  from  a  drawing  furnished  the 
author  by  Dr.  Maynard,  repre- 
sents a  case  of  necrosis  and  ex-  ■^^*^'  ■^^• 
foliation  of  a  portion  of  the  outer 
wall  of  the  alveolar  ridge,  and  the 
consequent  protrusion  of  the  roots 
of  the  teeth  on  one  side  of  the 
mouth.  The  only  facts  which 
Dr.  Maynard  had  been  able  to 
procure  in  relation  to  this  case  were  contained  in  the  patient's  state- 
ment:  "That  in  1818  he  took  a  cold,  which  settled  in  his  upper  jaw, 
and  a  large  piece  of  the  jaw-bone  came  away."  The  cast  from  which 
the  drawing  was  made  was  taken  in  1840 ;  at  which  time  the  doctor 
cut  off  the  apices  of  several  roots  which  projected  from  the  gums. 

Phosphor  -  Necrosis. — Necrosis  of  the  bones  of  the  jaws  may  also 
result  from  exposure  to  the  fumes  of  phosphorus,  as  in  the  manu- 
facture of  matches,  for  example. 

The  disease,  when  due  to  such  a  cause,  usually  commences  about 
a  carious  tooth,  or  in  an  alveolar  cavity  opened  by  the  extraction  of  a 
tooth,  and  is  sometimes  complicated  with  affections  of  the  lungs  and 
air  passages. 

In  phosphor-necrosis  there  is  a  peculiar  pasty  appearance  of  the  face, 
puffiness  of  the  cheeks,  and  considerable  pain  and  swelling  in  the 
affected  jaw.  Instead  of  the  separation  of  a  sequestrum,  the  dead  bone 
becomes  incrusted  with  a  pumice-stone  like  material,  which  adheres 
very  firmly  to  it.  Abscesses  form  and  discharge  externally  through 
the  skin  of  the  cheek,  and  leave  fistulous  openings  for  the  escape  of 
the  matter. 

CAUSES. 

The  immediate  cause  of  necrosis  is  the  death  of  the  periosteum,  occa- 
sioned by  inflammation.  The  cause  of  this,  as  has  already  been  shown, 
is,  in  a  large  majority  of  the  cases,  dental  irritation.  Necrosis  of  the 
alveolar  process  occurs  very  frequently  while  the  system  is  under  the 
influence  of  mercurial  medicines,  and  during  bilious  and  inflammatory 
fevers,  and  certain  other  constitutional  diseases,  as  syphilis,  small-pox, 
etc.    It  may  also  result  from  mechanical  injuries. 


244  ABSORPTION    OF    THE    ALVEOLI. 

TREATMENT. 

The  treatment  of  eases  of  this  kind  consists  in  the  removal  of  the 
sequestra,  strict  attention  to  cleanliness,  and  the  free  use  of  chlorinated 
washes.  As  soon  as  the  dead  portions  of  bone  become  separated  from 
the  living,  and  can  be  easily  removed,  they  should  be  taken  a^vay  with 
a  pair  of  forceps.  Should  the  removal  of  a  considerable  portion  of 
the  bone  of  the  jaw  be  requisite,  it  is  seldom  necessary  to  interfere 
with  the  skin,  or  make  an  external  incision.  The  whole  of  the  lower 
jaw  can  be  removed  in  this  manner  by  dividing  it  at  the  chin,  and 
after  separating  all  the  attachments  of  the  soft  parts  with  the  knife, 
drawing  out  each  half  at  a  time. 

To  correct  the  offen-sive  odor  and  disagreeable  taste  occasioned  by 
the  constant  discharge  of  fetid  matter,  washes  of  chloride  of  soda,  or 
chloride  of  zinc,  or  of  the  tincture  of  myrrh,  may  be  employed. 
Should  constitutional  symptoms  supervene,  tonics,  a  nutritious  diet, 
and  such  other  remedies  as  have  a  tendency  to  restore  the  general 
health,  are  of  the  greatest  service. 


CHAPTER  XIII. 


ABSORPTION   OR   GRADUAL    DESTRUCTION   OF  THE   ALVEOLAR 

PROCESSES. 

WHILE  treating  of  inflammation  and  tumefaction  of  the  gums,  the 
author  adverted  to  the  wasting  of  the  sockets  of  the  teeth,  taking 
occasion  to  express  a  doubt  that  such  operation  of  the  economy  ever 
manifested  itself  in  the  absence  of  all  local  disease. 

It  is  always  accompanied  by  a  slight  increase  of  redness,  tumefiction, 
and  a  shrinking  of  the  edges  of  the  gums  (ulatrophia)  ;  but  the  diseased 
action  here  is  so  inconsiderable  as  often  to  attract  little  attention. 
It  is  also  attended  by  a  slight  discharge  of  purulent  matter  from  between 
the  margin  of  the  gum  and  the  tooth  ;  but  the  quantity  is  so  small  that 
it  usually  escapes  observation.  The  alveolo-dental  periosteum  partici- 
pates also  in  the  diseased  action,  but  this  is  so  slightly  atfected  that 
the  tooth  often  remains  quite  firmly  articulated,  after  the  wasting  of 
its  socket  has  proceeded  even  so  far  as  to  expose  more  than  half  of  the 
root.  Indeed,  the  affection  is  so  closely  allied  to  chronic  inflammation 
and  tumefaction  of  the  gums,  as  scarcely  to  require  separate  considera- 
tion. 


ABSORPTION    OP    THE    ALVEOLI. 


245 


Fig.  52. 


The  progress  of  the  disease  is  usually  so  slow  that  ten,  fifteen,  or 
twenty  years  are  required  to  affect  very 
perceptibly  the  stability  of  the  teeth  in 
their  sockets.  The  commencement  of  this 
destructive  process  is  usually  first  observed 
around  the  cuspid  teeth ;  sometimes  it 
makes  its  first  appearance  on  the  alveoli 
of  the  palatine  roots  of  the  first  and  second 
upper  molars,  and.  occasionally  it  goes  on 
here  for  years  before  it  affects  the  sockets 
of  any  of  the  other  teeth. 

The  teeth,  after  their  roots  have  been  partially  exposed,  become,  as 
might  naturally  be  supposed,  more  susceptible  to  impression  from  heat 
and  cold,  and  more  easily  affected  by  acids,  or  saccharine  matters  ;  but 
this  is  about  the  only  manifest  inconvenience  experienced  from  the 
disease,  until  the  teeth  begin  to  loosen  in  their  sockets. 

In  Fig.  52  is  represented  a  case  in  which  the  roots  of  the  teeth  have 
become  considerably  exposed  by  the  gradual  wasting  of  their  sockets, 
—  the  destruction  being,  as  is  usual,  greatest  toward  the  median  line. 


CAUSES. 

The  cause  of  this  peculiar  affection  has  never  been  very  satisfactorily 
explained.  Some  have  supposed  that,  inasmuch  as  it  occurs  most  fre- 
quently in  persons  of  advanced  age,  it  results  from  a  decline  of  the 
vital  powers  of  the  body,  independently  of  local  causes.  But,  as  it  is 
often  met  with  in  middle-aged  persons  whose  constitutional  health  is 
unimpaired,  we  doubt  the  correctness  of  the  opinion.  In  all  cases 
which  have  come  under  our  observation,  whether  in  middle-aged  or 
V^ery  old  persons,  the  teeth  indicated  an  excellent  innate  constitution, 
whatever  may  have  been  the  state  of  the  general  health  at  the  time. 
In  every  instance  these  organs  were  possessed  of  great  density,  and 
this  fact  is  particularly  noticed  by  Mr.  Fox,  who  says : 

"  In  a  majority  of  cases  in  which  this  disease  occurs,  the  teeth  are 
perfectly  sound,  and  from  numerous  observations,  we  think  we  may  ven- 
ture to  assert,  that  persons  who  have  had  several  of  their  teeth  affected 
with  caries  in  the  earlier  part  of  life,  are  not  liable  to  lose,  by  an  ab- 
sorption of  their  sockets,  those  which  remain  sound ;  but,  where  the 
teeth  have  not  been  affected  with  caries  in  the  early  part  of  life,  persons, 
as  they  approach  the  age  of  fifty,  and  often  much  earlier,  have  their  teeth 
becoming  loose  from  absorption,  or  a  wasting  of  the  alveolar  process." 

Now  it  is  evident  that  teeth  endowed  with  the  power  of  resisting  to 
so  late  a  period  of  life  the  action  of  the  causes  of  decay,  to  which  all 
teeth  are  more  or  less  exposed,  must  be  possessed  of  extreme  density, 


246  ABSORPTION    OF    THE    ALVEOLI. 

and,  necessarily,  a  corresponding  low  degree  of  vitality.  In  view  of 
this  fact,  Ave  have  been  led  to  the  opinion  that  the  teeth  themselves 
may  act,  to  some  extent,  £^3  mechanical  irritants  to  the  more  highly 
vitalized  parts  with  which  they  are  immediately  connected,  causing  an 
increase  of  vascular  action  in  the  periosteum  of  the  thin  edges  of  the 
alveoli  and  margin  of  the  gums.  This  abnormal  condition  is  attended 
by  a  slight  secretion  of  purulent  matter  observed  between  the  edges  of 
the  gums  and  teeth.  It  is  to  the  corrosive  action  of  this  purulent  matter 
that  the  gradual  destruction  of  the  alveoli  has  by  some  been  attributed ; 
but  it  is  more  probably  a  result  of  the  obscure  disease  than  its  cause. 

We  were  for  a  long  time  inclined  to  ascribe  the  increase  of  vascular 
action  in  the  edges  of  the  gums  and  alveolo-dental  periosteum  to 
irritation  produced  by  the  pressure  of  the  teeth  against  the  alveolar 
septa;  but  having  met  with  many  cases  where  the  teeth  were  not 
crowded,  we  were  induced  to  enter  into  a  more  thorough  examination 
of  the  possible  causes,  and  the  foregoing  is  the  only  conclusion  to 
which  we  have  been  able  to  arrive.  This  affection  may  also  sometimes 
result  from  the  presence  of  salivary  calculus,  the  use  of  charcoal 
powder  as  a  dentifrice,  and  the  apj)lication  of  a  very  stiff  brush  for 
cleaning  the  teeth ;  but  when  caused  by  these  two  latter  agents,  the 
absorption  does  not  progress  to  such  a  degree  as  when  it  is  owing  to 
a  want  of  congeniality  between  the  tooth  and  the  more  highly  vitalized 
structures  surrounding  its  root. 

TREATMENT. 

From  what  has  been  said  concerning  the  cause  of  this  affection,  it 
is  obvious  that  a  cure  cannot  always  be  effected.  The  progress  of  the 
affection,  however,  may  sometimes  be  arrested.  The  first  step  in  the 
treatment  is  to  remove  all  irritants,  and  correct  the  nature  of  the  fluids 
of  the  mouth,  abnormal  in  character,  by  constitutional  treatment,  the 
use  of  lime-water,  and  a  detergent  dentifrice.  Should  such  means 
prove  ineffectual,  the  application  of  a  solution  of  iodine  and  creosote 
or  carbolic  acid  to  the  margins  of  the  gums  will  often  be  of  benefit  in 
retarding  the  absorption,  and  inducing  a  moi'e  healthy  action.  The 
secretion  of  the  purulent  matter,  to  the  action  of  which  some  attribute 
the  destruction  of  the  alveoli,  is  the  result  of  a  disease  in  the  alveolo- 
dental  periosteum  and  edges  of  the  gums,  arising  from  some  peculiar 
physical  condition  of  the  teeth,  the  progress  of  which  may  be  retarded 
by  cleaning  the  teeth  frequently  and  thoroughly,  using  the  precaution 
each  time  to  remove  the  purulent  matter  from  between  the  edges  of 
the  gums  and  teeth,  lest,  if  allowed  to  remain,  it  should  become  putres- 
cent, and  in  this  condition  act  as  an  irritant  to  the  gum.  For  this 
purpose  a  brush  with  elastic  bristles  should  be  used,  and  much  benefit 


HYPERTROPHY    OF    ALVEOLAR    CAVITIES.         247 

•will  be  derived  by  passing  floss  silk  several  times  a  day  up  and  down 
between  the  teeth,  and  applying  a  solution  of  nitrate  of  silver,  twenty 
grains  to  the  ounce  of  water,  by  means  of  a  camel's-hair  brush,  to  the 
inai-gins  of  the  gums.  When  salivary  calculus  causes  the  recession  of 
the  gum,  the  first  indication  is  the  removal  of  this  deposit.  As  the 
margin  of  the  gum  is  inflamed,  and  a  sulcus  or  pocket  formed  between 
it  and  the  tooth,  an  incision  should  be  made  from  the  bottom  of  this 
sulcus  upward,  and  the  tooth  surface  cleaned  and  polished.  This 
treatment  should  be  followed  by  the  application  of  carbolic  acid,  on  a 
thin  strip  of  orange  wood,  to  the  inner  surface  of  tbe  ciargin  of  the 
gum  to  promote  healthy  granulations. 


CHAPTER  XIV. 

HYPERTROPHY   OF   THE    WALLS    OF    THE    ALVEOLAR   CAVITIES. 

A  TOOTH  is  sometimes  slowly  forced  from  its  place  by  a  deposit 
of  bony  matter  in  the  bottom  or  on  the  side  of  the  socket.  Two, 
or  even  three  teeth,  may  be  gradually  displaced,  at  the  same  time,  by 
exostosis  of  the  alveoli.  The  deposition  usually  proceeds  so  slowly 
that  one  or  two  years  are  required  to  effect  a  very  perceptible  change 
in  the  situation  of  a  tooth.  The  upper  central  incisors  are  more  fre- 
quently afiected  than  any  of  the  other  teeth,  and  the  deposit  occurs 
oftener  at  the  bottom  than  on  the  sides  of  the  alveoli.  In  the  first 
case,  the  tooth  is  gradually  protruded  from  the  socket ;  in  the  other, 
it  is  either  pressed  out  of  the  arch,  or  against  one  of  the  adjoining 
teeth.  Irregularity  in  the  arrangement  of  the  teeth  is,  in  this  manner, 
sometimes  produced,  especially  when  more  than  one  socket  is  affected 
at  the  same  time.  The  central  incisors  are  sometimes  forced  aj)art ; 
at  other  times  they  are  forced  against  each  other,  and  caused  to  over- 
lap. The  deposition  of  bone,  however,  being  generally  confined  to  the 
bottom  of  the  sockets,  the  teeth  are  moi-e  frequently  thrust  from  their 
alveolar  cavities.  When  this  occurs  with  a  person  whose  upper  and 
lower  teeth  strike  directly  upon  each  other,  it  occasions  much  incon- 
venience; for  the  elongated  tooth  must  either  be  thrown  from  the 
circle  of  the  other  teeth,  or,  by  striking  its  antagonist,  prevent  the 
jaws  from  coming  together. 

CAUSES. 

So  little  is  known  concerning  the  cause  of  exostosis  of  the  sockets 
of  the  teeth,  that  it  may  seem  almost  useless  to  attempt  an  explanation. 


248  ATROPHY  OF  THE  TEETH, 

of  it.  That  it  results  from  some  irritation  of  the  lining  membrane  is 
very  generally  believed,  but  what  causes  the  irritation  does  not  seem 
to  be  well  understood.  "We  have  thought  that  it  might  sometimes  be 
produced  by  pressure  on  the  bottom  of  the  alveolus,  especially  when 
the  extremity  is  nearly  as  large  as  any  other  part  of  the  root  of  the 
tooth.  The  susceptibility  of  the  lining  membrane  to  morbid  impres- 
sions may  sometimes  be  so  great  that  the  pressure  of  a  very  conical 
root  may  be  sufficient  to  produce  this  effect ;  or,  it  may  be  produced 
by  the  pressure  of  a  tooth  which  joossesses  only  a  very  low  degree  of 
vitality.  But  in  connection  with  this  class  of  cases  must  Ite  taken 
another,  in  which  absence  of  all  pressure  would  seem  to  be  an  inciting 
cause  of  alveolar  exostosis ;  as  where  a  toQth  has  lost  its  antagonist 
tooth  or  teeth,  and  in  consequence  becomes  elongated.  A  diseased 
state  of  the  gums  can  have  no  agency  in  the  production  of  the  exosto- 
sis, for  it  most  frequently  occurs  in  individuals  whose  gums  are  per- 
fectly healthy  ;  and  if  it  were  the  result  of  any  constitutional  tendency, 
all  the  teeth  would  be  as  likely  to  be  affected  by  it,  as  those  we  have 
mentioned. 

TREATMENT. 

When  the  exostosis  is  on  the  side  of  the  alveolar  cavity,  the  tooth 
cannot  be  restored  to  its  natural  position  ;  but  when  it  is  in  the  bottom 
of  the  socket,  the  elongated  organ  may  from  time  to  time,  as  it  is 
forced  from  the  alveolus,  be  filed  off  even  with  the  other  teeth  ;  but  in 
doing  this,  care  should  be  taken  to  avoid  as  much  as  possible  the  un- 
pleasant jar  which  the  file  is  so  apt  to  cause,  and  ^vhich  might,  in  such 
cases,  excite  the  periosteum  to  increased  activity  and  a  more  rapid 
deposit.  This  wull  remove  the  deformity  and  prevent  its  displacement 
by  the  antagonizing  tooth.  By  this  simple  operation,  repeated  as  oc- 
casion may  require,  it  is  preserved  for  years,  and  rendered  almost  as 
useful  as  any  of  the  other  teeth. 


CHAPTER  XV. 

ATROPHY   OF   THE   TEETH. 


THAT  peculiar  structural  alteration  of  the  teeth  designated  atrophy, 
is  less  frequent  in  its  occurrence  than  any  other  disease  to  which 
these  organs  are  liable ;  but  as  the  progress  of  the  affection  usually 
terminates  with  the  action  of  the  causes  concerned  in  its  production,  it 
has  scarcely  been  deemed  of  sufficient  importance  to  merit  serious 


ATROPHY  OF  THE  TEETH.  249 

consideration.  Hence  its  etiology  and  pathology  have  not  been  very 
carefully  investigated.  Indeed,  most  writers  upon  the  diseases  of  the 
teeth  have  overlooked  the  affection  altogether  ;  while  a  few  have  merely 
alluded  to  it,  without  describing  the  characteristics  of  even  its  princi- 
pal varieties.  Whether  we  shall  now  be  able  to  throw  any  additional 
light  upon  the  subject,  or  establish  the  correctness  of  any  opinions 
already  advanced,  we  leave  to  others  to  determine. 

The  strict  applicability  of  the  term  atrophy  may,  perhaps,  be  con- 
sidered as  somewhat  questionable  ;  as  the  two  principal  varieties  of  the 
affection  consist  in  a  congenital  defect  in  some  portion  of  the  enamel 
of  two  or  more  teeth,  rather  than  in  the  wasting,  for  want  of  nourish- 
ment, of  any  of  the  dental  tissues.  This  term  would  seem  to  be  ren- 
dered still  nrore  inappropriate  by  the  fact  that  neither  of  the  varieties 
to  which  we  have  referred  occurs  subsequently  to  the  formation  of  the 
enamel.  But  as  the  congenital  form  of  the  disease  is  evidently  the 
result  of  altered  function  in  a  portion  of  one  or  more  of  the  formative 
organs  —  if  not  of  absolute  degeneration,  froni  vicious  nutrition  —  we 
are  disposed  to  regard  the  term  as  the  most  applicable  of  any  that  can 
be  applied  to  it. 

Maury  treats  of  atrophy  and  erosion  as  one  and  the  same  disease. 
But  in  describing  atrophy  he  notices  the  distinctive  peculiarities  by 
which  each  affection  is  characterized.*  In  describing  the  difference 
between  erosion  and  atrophy,  M.  Delabarre  says,  the  part  atrophied  is 
deformed  and  deprived  of  the  enamel,  and  that  the  teeth  are  yellow 
and  sensitive,  the  touch  of  the  finger  causing  pain  ;  but  in  erosion,  if 
the  crystals  of  the  enamel  are  not  wholly  destroyed,  the  bottom  of  the 
pits  are  of  a  white  color,  and  on  being  touched  no  disagreeable  sensa- 
tion is  experienced ;  if,  on  the  contrary,  the  crystals  are  destroyed  to 
the  dentine,  the  part  thus  denuded  is  irritable. 

In  an  article  on  erosion,  Maury  gives  a  very  accurate  description  of 
several  varieties  of  atrophy  of  the  teeth.  The  first,  he  represents  as 
consisting  of  deep  irregular  white,  or  light  yellow  spots,  situated  in  the 
enamel  of  the  tooth,  without  affecting  the  smoothness  of  its  surface. 
The  second,  as  characterized  by  small  crowded  holes,  or  irregular  de- 
pressions, resembling  quilting  ;  or  as  consisting  of  transverse  sinuosities, 
single  or  divided  by  prominent  lines,  which  are  sometimes  "yellow,  but 
of  the  color  of  the  enamel."  The  third  variety  affects  the  dentind  as 
well  as  the  enamel,  reducing  the  dimensions  of  the  crown  of  the  tooth 
sometimes  to  one-third  its  natural  size,  and  not  unfrequently  dividing 
it  by  a  deep  circular  groove  or  depression. 

None  of  the  phenomena  here  described  are  produced  by  the  action 
of  corrosive  agents,  or  are  the  result  of  chemical  decomposition  either 
*  Traits  Complet  de  I'Art  du  Dentiste,  pp.  99  and  100. 


250  ATROPHY  OF  THE  TEETH. 

of  the  enamel  or  dentine,  but  are  manifestly  dependent  upon  other 
causes.  The  term  erosion,  therefore,  cannot  with  propriety  be  applied 
to  either  variety  of  the  affection  just  noticed.  Although  Maury  has 
given,  under  the  term  erosion,  a  l)etter  description  of  the  principal 
varieties  of  dental  atrophy  than  any  other  writer,  he  has  omitted  some 
things  which  it  will  be  proper  to  mention.  In  treating  of  these  different 
varieties,  therefore,  we  shall  change,  somewhat,  the  order  in  which  he 
has  arranged  them. 

Odontatrophia  may  very  properly  be  divided  into  three  varieties. 
Each  has  characteristic  peculiarities  which  distinguish  it  from  either 
of  the  others.  Two  are  always  congenital,  and  the  other,  although 
most  frequently  congenital,  sometimes  occurs  subsequently  to  the  erup- 
tion of  the  tooth. 

First  variety. —  The  peculiarities  that  distinguish  this  variety  of 
atrophy  from  either  of  the  others  are,  that  it  never  impairs  the  uni- 
formity and  smoothness  of  the  surface  of  the  enamel,  and  is  character- 
ized by  one  or  more  white,  or  dark,  or  light  brown,  irregularly  shaped 
spots,  upon  the  labial  or  buccal  surface  of  the  tooth.  It  occurs  oftener 
than  the  third  variety,  and  less  frequently  than  the  second.  It  rarely 
appears  on  more  than  one  or  two  teeth  in  the  same  mouth,  though 
several  are  sometimes  marked  by  it.  It  is  seen  on  the  molars  more 
frequently  than  the  bicuspids,  and  much  oftener  on  the  incisors  of  the 
upper  jaw  than  any  of  the  other  teeth.  We  do  not  recollect  to  have 
ever  observed  it  on  the  cuspids  of  either  jaw,  nor  on  the  palatine  or 
lingual  surfaces  of  the  incisors. 

The  enamel  is  much  softer  on  the  affected  than  on  the  unaffected 
parts  of  the  touth,  and  may  be  easily  broken  and  reduced  to  powder 
with  a  steel  instrument.  It  seems  to  be  almost  wholly  deprived,  in 
these  places,  of  its  animal  constituents,  and  to  have  lost  its  connection 
with  the  subjacent  dentine.  The  size  of  the  atrophied  spots  are  almost 
as  variable  as  their  shape,  but  the  only  harm  resulting  from  them  is 
the  unsightly  aspect  they  sometimes  give  to  the  tooth. 

As  we  have  before  remarked,  this  variety  of  atrophy  is  sometimes 
accidental,  occurring  subsequently  to  the  eruption  of  the  tooth,  but  in 
a  large  majority  of  the  cases  it  is  congenital.  It  is  rarely  seen  on  a 
temporary  tooth.  In  all  the  cases  which  have  come  under  our  observa- 
tion, it  was  confined,  to  the  best  of  our  recollection,  to  the  teeth  of 
second  dentition. 

Second  variety.  —  This  may  be  very  properly  denominated  perforating 
or  pitting  atrophy  ;  it  gives  to  the  enamel  an  indented  or  pitted  appear- 
ance, the  irregular  depressions  or  holes  extending  transversely  across 
and  around  the  tooth.  The  pits  are  sometimes  more  or  less  distinctly 
separated  one  from  another  by  prominent  lines ;  at  other  times  they 


ATROPHY    OF    THE    TEETH.  251 

are  confluent,  and  form  an  irregular  horizontal  groove.  Sometimes 
they  penetrate  but  a  short  distance  into  the  enamel ;  at  other  times 
they  -extend  entirely  through  it  to  the  dentine.  Their  surface,  though 
generally  rough  and  irregular,  usually  presents  a  glossy  and  polished 
appearance  —  a  peculiarity  which  always  distinguishes  this  variety  of 
the  affection  from  erosion.  The  pits  often  have  a  dark-brownish  ap- 
pearance, though  sometimes  they  have  the  same  color  as  the  enamel  on 
other  parts  of  the  tooth. 

This  variety  of  atrophy  is  never  confined  to  a  single  tooth.  Two, 
four,  six,  or  more  corresponding  teeth  are  ahvays  affected  at  the  same 
time  in  each  jaw;  and  the  corresponding  teeth  on  either  side  precisely 
in  the  same  manner  and  in  the  same  place.  When  more  than  two  are 
marked,  the  distance  of  the  pits  from  the  coronal  extremity  of  the 
tooth  varies,  according  to  the  progress  made  in  the  formation  of  the 
enamel  at  the  time  of  the  operation  of  the  causes  concerned  in  the  pro- 
duction of  the  affection.  For  example,  when  the  line  of  pits  in  the 
central  incisors  is  situated  about  two  lines  from  their  cutting  edges,  it 
will  scarcely  be  one  line  from  the  cutting  edges  of  the  laterals,  and 
only  the  points  of  the  cuspids  will  be  marked.  When  the  indentations 
are  nearer  the  edges  of  the  central  incisors,  they  will  be  on  the  edges 
of  the  laterals,  and  the  cuspids  will  have  entirely  escaped. 

Sometimes  the  teeth  are  marked  with  two  or  three  rows  of  pits,  and 
when  this  is  the  case,  the  patient  has  either  two  or  three  relapses ;  or 
has  been  attacked  two  or  three  times  in  succession  with  some  disease 
capable  of  interrupting  the  progress  of  the  formation  of  the  enamel. 

Although  the  incisors  are  more  frequently  marked  with  these  inden- 
tations than  any  of  tlie  other  teeth,  the  cuspids,  bicusj^ids,  and  even 
the  molars,  are  sometimes  affected  with  them.  When  the  disease  at- 
tacks the  molars,  its  effects  are  generally  located  on  the  grinding  sur- 
face. The  permanent  teeth  are  more  liable  to  be  attacked  than  the 
temporary.  We  have  known  but  one  instance  in  which  the  latter  were 
affected  with  the  disease. 

This  variety  of  atrophy  occurs  oftener  than  either  of  the  others,  and 
though  it  sometimes  gives  to  the  teeth  a  disagreeable  and  unsightly 
appearance,  it  rarely  increases  their  liability  to  decay. 

Third  variety. — In  this  variety  of  atrophy  the  whole  or  only  a  part 
of  the  crowa  of  a  tooth  may  be  affected  ;  the  dentine  being  often  im- 
plicated as  well  as  the  enamel.  The  tooth  usually  has  a  pale-yellow- 
ish color,  a  shrivelled  appearance,  and  is  partially  or  wholly  divested 
of  enamel.  Sometimes  the  crown  is  not  more  than  one-half  or  one- 
third  its  natural  size.  Its  sensibility  is  usually  much  increased,  and 
its  susceptibility  to  pain  from  external  impressions  is  wonderfully  ex- 
cited by  acids.     It  is  also  more  liable  than  the  other  teeth  to  be 


252  ATROPHY  OF  THE  TEETH. 

attacked  by  caries.  The  root  of  the  tooth  is  sometimes,  though  rarely, 
affected,  and  presents  an  iri'egular  knotted  appearance. 

The  disease  is  often  confined  to  a  single  tooth,  but  it  more  frequently 
shows  itself  on  two  corresponding  teeth  in  the  same  jaw.  According 
to  our  observation,  the  bicuspids  are  more  liable  to  be  attacked  than 
any  of  the  other  teeth.  The  temporary  teeth  are  rarely  affected  with 
it.  This  variety  of  atrophy  occurs  less  frequently  than  either  of  the 
others;  and,  although  it  increases  the  liability  of  the  affected  organs 
to  caries,  tliey  sometimes  escape  until  the  twentieth  or  thirtieth  year 
of  age. 

In  the  description  which  we  have  given  of  the  three  varieties  of 
dental  atrophy,  we  may  have  omitted  to  mention  some  of  the  pecu- 
liarities belonging  to  each,  but  we  have  pointed  out  their  principal 
characteristics  with  sufficient  accuracy  to  enable  them  to  be  distin- 
guished one  from  another,  and  either  from  erosion. 

CAL'SES. 

The  first  variety  is  evidently  produced  by  some  cause  capable  either 
of  preventing  or  destroying  the  bond  of  union  between  the  enamel 
and  subjacent  dentine,  but  what  that  cause  is,  becomes  a  question 
which  it  may  be  difficult  to  answer.  •  Subsequently  to  the  eruption  of 
the  teeth,  it  may  be  occasioned  by  mechanical  violence,  but  we  have 
never  known  more  than  one  case  in  which  it  had  resulted  from  this 
cause,  and  that  was  occasioned  by  a  blow  upon  the  tooth. 

Now,  whether  the  bond  of  union  between  this  portion  of  the  enamel 
and  the  subjacent  dentine  was  immediately  destroyed  by  the  concussion 
of  the  blow,  or  whether  it  resulted  from  subsequent  inflammation  and 
the  death  of  the  intermediate  membrane,  is  a  question  which  may  not 
be  easily  answered.  If  it  were  destroyed  at  once  by  the  blow,  one 
might  be  led  to  suppose  that  the  change  in  the  color  of  the  enamel 
would  have  been  observed  immediately  ;  but  it  may  have  resulted 
from  some  subsequent  change  or  alteration  in  the  animal  constituents 
of  this  part  of  the  enamel,  following  as  a  consequence  of  the  injury 
produced  by  the  violence  of  the  blow.  These  are  questions,  however, 
which  the  present  state  of  our  knowledge  does  not  enable  us  to  solve. 
But  that  the  white  spot  in  this  case  resulted  as  a  consequence  of  the 
blow,  there  cannot  be  the  least  shadow  of  doubt. 

When  the  affection  is  congenital,  as  it  almost  always  is,  it  is  de- 
pendent upon  some  other  cause ;  possibly  upon  disease  in  the  pulp,  or 
intermediate  membrane,  which  constitutes  the  bond  of  union  between 
the  dentine  and  enamel,  subsequently  to  the  formation  of  the  latter. 
But  wdiat  the  determining  cause  is  of  the  disease,  whether  produced  in 
this  way  by  simple  local  irritation,  or  by  general  constitutional  dis- 


ATROPHY  OF  THE  TEETH.  253 

turbance,  we  are  not  prepared  to  say.  One  would  be  likely  to  suppose, 
if  the  atrophied  spots  were  occasioned  by  disease  of  the  pulp  or  inter- 
mediate membrane,  the  morbid  action  would  scarcely  confine  itself  to 
such  narrow  and  circumscribed  limits.  But,  whether  the  destruction 
of  the  intermediate  membrane  of  the  affected  parts  results  as  a  conse- 
quence of  actual  disease,  or  merely  from  vicious  nutrition,  or  whether 
from  unknown  causes  it  has  failed  to  be  developed  here,  it  is  certain 
that  the  fibres  of  this  portion  of  the  enamel  are  not  united  to  the  sub^ 
jacent  dentine  ;  thus,  not  receiving  a  supply  of  nutrient  fluid  or  vital 
principle,  their  animal  framework  partially  or  wholly  perishes,  leaving 
but  little  else  than  their  inorganic  constituents.  The  cause  of  this 
variety  of  congenital  atrophy,  it  must  be  confessed,  is  very  obscure; 
and,  in  the  absence  of  positive  knowledge,  we  can  only  infer  the  cause 
from  the  nature  of  the  affection.  If  it  does  not  result  from  one  or 
other  of  the  above-mentioned  causes,  it  is  difficult  to  imagine  in  what 
way  it  is  produced. 

The  cause  of  the  second  variety  of  odontatrophia  is,  we  think,  sus- 
ceptible of  a  more  satisfactory  explanation.  The  formative  organ  of 
the  enamel,  as  is  now  generally  admitted,  consists  of  a  membrane,  com- 
posed almost  wholly  of  short  hexagonal  corpuscles  or  fibres,  which  cor- 
respond in  shape  and  arrangement  to  the  fibres  of  the  enamel.  This 
membrane  is  accurately  moulded  to  the  crown  of  the  tooth,  and, 
according  to  Raschkow,  each  fibre  is  a  secretory  duct,  Avhose  peculiar 
function  it  is  to  secrete  the  fibre  of  the  enamel  corresponding  to  it.  It 
should  also  be  borne  in  mind  that  the  secretion  of  the  earthy  salts  of 
the  enamel  commences  at  the  coronal  extremity  of  the  tooth,  gradually 
proceeding  toward  the  base  of  the  crown.  Now  we  can  readily  con- 
ceive that  some  constitutional  disease  might  interruj^t  the  secretion  of 
the  earthy  salts  deposited  in  the  enamel-cells  or  secretory  ducts  of  the 
enamel  membrane,  for  the  formation  of  the  enamel  fibres ;  occurrini- 
at  the  time  when  this  process  is  going  on,  it  might  prevent  them  from 
being  filled,  and  cause  them  to  wither  or  waste  away,  giving  to  this 
portion  of  the  enamel  the  jDitted  appearance  which  characterizes  this 
variety  of  atrophy.  In  other  words,  the  secretion  of  the  inorganic  con- 
stituents of  the  enamel  being  interrupted  for  a  short  time  the  horizontal 
row  of  cells  in  the  enamel  membrane,  into  which  it  should  be  deposited, 
will  not  be  filled ;  consequently,  as  might  readily  be  supposed,  they 
will  waste  away,  leaving  a  circular  row  of  indentations  around  the 
crown  of  the.tooth.  But  as  soon  as  the  constitutional  disease  has  run 
its  course,  the  secretion  of  the  earthy  salts  will  be  resumed;  and  unless 
the  child  experiences  a  relapse,  or  has  a  second  attack  of  disease,  capa- 
ble of  interrupting  this  secretory  process,  the  other  parts  of  the  enamel 
will  be  well  formed. 


254  ATROPHY  OF  THE  TEETH. 

Some  writers  ascribe  the  formation  of  these  pits  in  the  enamel  to  the 
chemical  action  of  a  corrosive  fluid,  or  to  an  acidulated  condition  of 
the  fluid  contained  in  the  dental  sacs ;  but  they  have  evidently  con- 
founded this  afiection  with  erosion.  We  believe,  however,  it  almost 
always  occurs  as  a  consequence  of  some  eruptive  disease  or  catarrhal 
fever  occurring  during  the  "  enamelling  "  process  ;  and  there  are  many 
facts  which  go  to  sustain  the  correctness  of  this  opinion.  In  nearly 
all  the  cases  that  have  fallen  under  our  observation,  it  was  clearly 
traceable  to  measles,  scarlatina,  chicken-pox,  catarrhal  fever,  or  small- 
pox. It  may,  however,  occasionally  be  produced  by  other  constitutional 
diseases. 

The  third  variety  of  dental  atrophy,  so  far  as  our  observation  upon 
the  subject  has  permitted  us  to  form  an  opinion,  always  results  from 
altered  or  vicious  nutrition,  caused  by  disease  of  the  pulp  or  enamel 
membrane,  or  both,  during  the  secretion  of  the  dentine  or  enamel, 
accordingly  as  one  or  both  are  afiected.  "We  are  inclined  to  believe 
that  the  disease  in  the  dental  pulp  or  enamel  membrane  may  be  pro- 
duced either  by  local  or  constitutional  causes,  or  both.  But  the  infor- 
mation which  we  have  been  able  to  obtain  in  the  cases  that  we  have 
seen,  concerning  the  state  of  the  general  health,  and  that  of  the  mouth 
at  the  time  of  the  dentinification  of  the  pulp  and  the  secretion  of  the 
enamel,  has  not  been  as  satisfactory  as  we  could  have  wished. 

Since  writing  the  foregoing,  the  following  interesting  case  of  dental 
atrophy  has  fallen  under  our  observation : 

^Irs.  C.  called,  in  1850,  to  consult  us  concerning  her  daughter's 
teeth,  which,  from  congenital  defect,  pr^ented  a  most  unsightly  appear- 
ance. The  girl  was  between  nine  and  ten  years  of  age.  The  cutting 
edges  of  the  upper  central  incisors  were  badly  pitted  and  very  rough ; 
the  corresponding  teeth  in  the  lower  jaw  had  a  transverse  row  of  pita 
passing  around  them,  about  a  sixteenth  of  an  inch  below  their  cutting 
extremities.  Another  row  of  pits,  so  close  together  as  to  form  a  rough 
groove,  encircled  the  upper  central  incisors,  about  an  eighth  of  an  inch 
below  the  gum,  and  the  laterals  a  little  nearer  their  cutting  edges ; 
the  lower  incisors  were  similarly  marked,  but  not  quite  so  near  the 
gum.  The  enamel,  near  the  second  transverse  row  of  pits,  and  between 
it  and  the  cutting  edges  of  the  teeth,  was  thin  and  of  a  light-brown 
color.  A  little  above  the  first  row,  on  the  central  incisors,  were  two  or 
three  brown  or  opaque  spots.  The  first  permanent  molars  were  also 
encircled  with  a  row  of  indentations,  about  half-way  between  their 
grinding  surfaces  and  the  gums. 

On  inquiry,  we  learned  from  the  mother  that  the  child  had  a  light 
attack  of  measles  when  between  eleven  and  twelve  months  old,  of 


NECROSIS    OF    THE    TEETH.  255 

Bcarlet  fever  when  about  fifteen  or  sixteen  months  of  age,  and  dysen- 
tery at  about  the  twenty-first  or  twenty-second  month. 

Kow,  here  we  have  the  three  varieties  of  atrophy  on  the  same  teeth ; 
and  the  occurrence  of  constitutional  diseases  about  the  time  when  the 
affected  parts  of  the  teeth  must  have  been  receiving  their  earthy  salts, 
would  seem  to  establish  very  conclusively  the  connection  of  the  one 
with  the  other. 

TREATMENT. 

The  nature  of  this  affection  is  such  as  not  to  admit  of  cure.  The 
treatment,  therefore,  must  be  preventive  rather  than  curative.  All 
that  can  be  done  is  to  mitigate  the  severity  of  such  diseases  as  are  sup- 
posed to  produce  it,  by  the  administration  of  proper  remedies.  By 
this  means  their  injurious  efiect  upon  the  teeth  may,  perhaps,  be  par- 
tially or  wholly  counteracted. 

It  seldom  happens  that  atrophied  teeth  decay  more  readily  than 
others,  so  that  the  only  evil  resulting  from  the  affection  is  a  disfigura- 
tion of  the  organs.  "When  the  cutting  edges  of  the  incisors  only  are 
affected,  the  diseased  part  may  sometimes  be  removed  with  a  file  with- 
out injury  to  the  teeth. 


CHAPTER  XVI. 

NECROSIS   OF    THE    TEETH. 


BY  the  term  necrosis,  when  applied  to  a  tooth,  is  meant  the  death 
of  the  entire  organ,  or  of  the  crown  and  inner  walls  of  the  root; 
for  it  often  happens  that  a  degree  of  vitality  is  kej)t  up  in  the  outer 
portion  of  the  dentine  and  the  investing  cemeutum  by  the  peridental 
membrane  long  after  the  destruction  of  the  pulp  and  lining  membrane. 
When  other  bones  are  affected  with  necrosis,  the  dead  part  is  thrown 
off  and  the  loss  supplied  by  the  formation  of  new  bone.  But  the  teeth 
are  not  endowed  with  the  recuperative  power  which  the  process  of 
exfoliation  calls  for. 

The  density  of  a  tooth  is  not  sensibly,  if  at  all,  affected  by  the  mere 
loss  of  vitality ;  but  so  great  a  change  takes  place  in  the  appearance 
of  the  organ,  that  it  may  readily  be  detected  by  the  most  careless  ob- 
server. After  the  destruction  of  the  lining  membrane,  the  tooth 
gradually  loses  its  peculiar  semi-translucent  and  animated  appearance, 
assuming  a  dingy  or  muddy  brown  color;  and  this  change  is  more 
striking  in  teeth  of  a  soft  than  in  those  of  a  hard  texture.     The  dis- 


256  KECROSIS    OF    THE    TEETH. 

coloration,  too,  is  always  more  marked  when  the  loss  of  vitality  has 
resulted  from  a  blow,  than  when  produced  in  a  more  gradual  manner. 
The  discoloration  is  partly  owing  to  the  presence  of  disorganized  mat- 
ter in  the  pulp-cavity,  and  partly  to  the  absorption  of  this  matter  by 
the  surrounding  walls  of  dentine. 

After  the  destruction  of  the  lining  membrane,  the  tooth  may  receive 
a  sufficient  amount  of  vitality  from  tlie  alveolo-dental  periosteum  to 
prevent  it  from  exerting  a  manifest  morbid  influence  upon  the  parts 
Avith  which  it  is  immediately  connected.  Teeth  have  been  retained 
under  such  circumstances  with  apparent  impunity  for  fifteen  or  twenty 
years.  But  when  every  part  of  a  tooth  has  lost  its  vitality,  it  becomes 
an  extraneous  body.  When  this  happens,  inflammation  of  the  socket 
ensues,  the  gum  around  it  becomes  turgid  and  spongy,  and  bleeds  from 
the  slightest  injury,  and  the  organ  gradually  loosens  and  ultimately 
drops  out.  In  the  mean  time,  the  diseased  action  frequently  extends  to 
the  sockets  and  gums  of  the  adjoining  teeth. 

The  front  teeth,  being  more  exposed  to  injuries  from  violence,  are 
more  liable  to  necrosis  than  the  molars. 

CAUSES. 

Necrosis  of  the  teeth  may  be  produced  by  a  variety  of  causes,  such 
as  protracted  fevers,  the  long-continued  use  of  mercurial  medicines; 
by  caries,  and  by  external  violence.  The  immediate  cause,  however, 
when  not  occasioned  by  a  blow  sufficient  to  destroy  the  vascular  con- 
nection of  the  tooth  with  the  rest  of  the  system,  is  inflammation  and 
suppuration  of  the  lining  membrane ;  but  it  may  result  from  deficiency 
of  vital  energy  and  from  impaired  nutrition;  for  the  author  has  met 
with  several  cases  in  which  the  loss  of  vitality  could  not  be  accounted 
for  in  any  other  way. 

TREATMENT. 

When  a  tooth,  deprived  of  vitality,  is  productive  of  injury  to  the 
gums  and  to  the  adjacent  teeth,  it  should  be  immediately  removed; 
for,  however  important  or  valuable  it  may  be,  the  health  and  dura- 
bility of  the  others  should  not  be  jeopardized  by  its  retention. 

AYhen  necrosis  of  a  tooth  is  apprehended,  we  should  endeavor  to 
prevent  its  occurrence,  by  the  application  of  leeches  to  the  gums,  and 
by  gargling  the  mouth  with  suitable  astringent  washes.  If  this  plan 
of  treatment  is  adopted  at  an  early  period,  it  will  sometimes  prevent 
the  loss  of  vitality ;  but  if  long  neglected,  a  favorable  result  need  not 
be  anticipated. 

When  the  loss  of  vitality  is  confined  to  the  crown  and  inner  walls 
of  the  root,  if  the  former  is  not  seriously  impaired  by  caries,  it  may 


S'ECROSIS    OF    THE    TEETH.  257 

be  perforated,  and  the  pulp-cavity  and  root  cleansed  and  filled  in  the 
manner  as  directed  in  another  part  of  this  work.  If  the  necrosed  tooth 
is  an  incisor,  the  perforation  should  be  made  from  the  palatine  surface, 
provided  the  approximal  surfaces  are  sound.  But  previously  to  the 
introduction  of  a  filling,  the  decomposed  surface  of  the  walls  of  the 
pulp-cavity  should  be  completely  removed,  and  if  this  does  not  restore 
the  tooth  to  its  natural  color,  the  process  of  bleaching  should  be 
resorted  to. 

Bleaching  Necrosed  Teeth. — To  improve  the  appearance  of  a  necrosed 
tooth  which  has  become  discolored  from  the  dentinal  tubuli  absorbing 
the  coloring  matter  from  the  blood,  the  following  method  may  be  pur- 
sued :  First,  remove  all  decayed  matter  from  the  crown  cavity,  whert 
such  a  cavity  exists,  taking  care,  however,  to  leave  the  enamel  unin^ 
jured,  and  also  as  much  of  the  dentine  as  is  necessary  for  the  strength 
of  the  tooth.  Pursue  the  same  course  with  regard  to  the  canal  in 
the  root,  cleansing  this  carefully  by  means  of  a  syringe  and  tepid 
water,  after  the  removal  of  decomposed  matter  with  the  nerve  canal 
instruments.  When  the  discoloration  is  recent,  and  not  more  than  a 
red  tinge  in  degree,  such  treatment  as  has  been  described  may  prove 
sufficient ;  should  it  not  be,  however,  owing  to  the  length  of  time  the 
discoloration  has  existed,  and  the  hue  is  a  brown,  dark-brown  or  black, 
it  is  then  necessary  to  resort  to  such  agents  as  contain  chlorine.  Solu- 
tions of  chloride  of  soda,  chloride  of  lime,  chlorate  of  potash,  decompose 
organic  substances  by  removing  the  hydrogen  of  their  coloring  matter. 
One  of  the  most  reliable  of  these  preparations  is  the  solution  of  chloride 
of  soda,  known  as  "  Labarraque's  Disinfecting  Fluid,"  which  may  be 
introduced  on  a  pellet  of  cotton,  and  allowed  to  remain  in  the  tooth; 
from  thirty  to  sixty  minutes,  according  to  the  degree  of  discoloration 
present.  Repeated  applications  may  be  necessary  in  some  cases  before 
the  object  desired  is  accomplished.  To  prevent  the  caustic  action  of 
these  agents  on  the  soft  parts,  the  canal  in  the  root  should  be  partly 
filled  prior  to  their  introduction,  and  care  taken  to  prevent  their  com- 
ing in  contact  with  the  mucous  membrane  of  the  mouth.  The  chloride 
of  lime  is  introduced  in  the  same  manner  as  the  chloride  of  soda,  and 
is  allowed  to  remain  for  five,  ten,  or  fifteen  minutes  at  a  time,  and  its 
-application  repeated  if  necessary,  the  crown  cavity  during  the  interval 
being  protected  by  a  temporary  filling  of  Hill's  stopping. 
17 


258 


EXOSTOSIS    OF    THE    TEETH, 


CHAPTER  XVII. 


EXOSTOSIS   OF   THE    TEETH. 

THIS  disease  is  common  to  all  bones,  but  it  attacks  no  other  part  of 
a  fully  formed  tooth  than  the  root ;  for  in  the  cementum  alone, 
of  the  three  osseous  dental  tissues,  do  we  find  that  degree  of  vascularity 
which  is  a  necessary  condition  of  growth, —  normal  or  abnormal.  It 
usually  commences  at  or  near  the  extremity,  then  extends  upward, 
covering  a  greater  or  less  portion  of  the  external  surface.  It  some- 
times, however,  commences  upon  the  side  of  the  root  and  forms  a  large 
tubercle ;  at  other  times  the  deposit  of  the  new  bony  matter  is  spread 
over  its  surface,  often  uniformly,  but  more  frequently  unequally.  The 
osseous  matter  thus  deposited,  has  usually  the  color,  consistence,  and 
structure  of  the  cementum,  though  sometimes  it  is  a  little  harder  and 
assumes  a  yellower  tinge.  The  enlargement  is  in  fact  an  hypertrophied 
coudition  of  this  substance.  Those  singular  anomalies,  occasionally 
met  W'ith,  where  enamel,  dentine,  and  cementum  are  mixed  up  in  shape- 
less confusion,  are  no  exceptions  to  the  rule  that  exostosis  is  confined 
to  the  cementum  ;  for  though  classed  under  this  head,  these  cases  arise 
from  disruption  of  the  formative  membranes  (possibly  the  result  of 
(  violence),  each  secreting  its  pecu- 

^10-  S3.  liar  tissue.     The  hypertrophy  is 

probably  confined  to  the  dentine ; 
yet  it  is  quite  possible  for  the  den- 
tinal and  enamel  membranes  in 
their  then  vascular  coudition  to 
have  an  excess  of  development. 

The  deposit  of  osseous  matter 
is  sometimes  so  considerable,  that 
the  roots  of  two  or  more  teeth  are 
firmly  united  by  it.  Fig.  53  rep- 
resents several  examples  of  exo- 
dontosis  of  this  description.  One 
of  these  was  presented  to  the  author 
by  Drs.  Blandin  and  Reynolds, 
These,  with  many  other  remarkable 
cases,  including  one  presented  by  Dr.  Hawes,  in  which  three  teeth  are 
thus  united,  may  be  seen  in  the  Museum  of  the  Baltimore  College  of 
Dental  Surgery. 


of  Columbia,  South  Carolina. 


EXOSTOSIS    OF    THE    TEETH.  259 

An  extraordinary  case  of  dental  exostosis  was  sent  to  the  author  for 
examination,  by  Dr.  V.  M.  Swayze,  of  Easton,  Pa.  The  tooth  ajipa- 
rently  is  a  dens  sapientiae,  and  the  formation  of  the  exostosis  must  have 
commenced  "tvith  the  dentinificatioa  of  the  pulp.  It  had  spread  over 
every  part  of  the  tooth,  the  crown  as  well  as  the  root ;  it  had  ruptured 
and  penetrated  every  part  of  the  enamel  membrane,  but  had  not  wholly 
destroyed  the  function  of  this  organ,  as  nodules  of  enamel  are  seen  in 
various  parts  of  the  exostosis.  The  tumor,  including  the  tooth,  is  about 
as  large  as  a  common  sized  hickory  nut. 

Exodontosis  often  continues  for  a  long  time  without  producing  any 
inconvenience  whatever.  It  usually  first  manifests  itself  by  slight  sore- 
ness in  the  affected  tooth,  which  increases  as  the  root  becomes  enlarged, 
until  pain,  either  constant  or  periodical,  and  of  a  character  more  or 
less  severe,  is  experienced. 

The  most  remarkable  case  of  exodontosis  on  record  is  related  by 
Mr.  Fox.  The  subject  was  a  young  lady,  who,  at  the  time  she  came 
to  Mr.  F.,  had  suffered  so  much  and  so  long,  that  the  palpebrse  of  one 
eye  had  been  closed  for  nearly  two  months;  and  the  secretion  of  saliva 
had,  for  some  time,  been  so  copious,  that  it  flowed  from  her  mouth, 
whenever  opened.  She  had  tried  every  remedy  science  and  skill  could 
suggest,  without  experiencing  any  permanent  benefit,  and  was  only 
relieved  from  her  suffering  by  the  extraction  of  every  one  of  her  teeth. 

In  the  course  of  the  author's  practice,  he  has  removed  many  teeth 
affected  with  exostosis,  but  never  has  met  with  a  case  similar  to  that 
described  by  Mr.  F.  In  one  instance,  he  was  compelled  to  extract 
four  sound  teeth  and  nine  roots ;  yet  the  pain  was  not  at  any  time 
severe,  but  it  was  constant,  and  a  source  of  great  annoyance  to  the 
patient.  The  following  is  one  among  the  many  cases  which  have 
fallen  under  his  observation  : 

Mr.  S.,  of  Baltimore,  in  the  fall  of  1845,  called  upon  us  for  advice. 
Having  for  some  time  suffered  pain  in  the  first  left  superior  bicuspid, 
he  had  applied  two  years  before  to  a  dentist  for  the  purpose  of  having 
the  tooth  removed.  In  the  ojoeration,  the  root,  about  three-sixteenths 
of  an  inch  from  its  extremity,  was  fractured  and  left  in  the  socket. 
In  consequence  of  this,  the  gnawing  pain  with  which  he  had  for  a  long 
time  before  been  troubled,  continued,  and  at  the  expiration  of  twelve 
months,  the  gum  over  the  remaining  portion  of  the  root  became  very 
much  swollen,  puffing  out  the  lip  to  the  size  of  half  a  hen's  egg.  The 
tumor,  after  a  few  days,  was  opened,  and  a  large  quantity  of  dark- 
colored,  fetid,  purulent  matter  was  discharged,  which,  for  a  short  time, 
gave  considerable  relief.  The  tumor,  however,  was  re-formed,  and 
opened  some  four  or  five  times  in  as  many  months.  At  this  time  his 
gum  was  swollen,  and  the  upper  lip  puffed  out  in  the  manner  just  de- 


260  EXOSTOSIS    OF    THE    TEETH. 

scribed.  On  opening  the  turaor^  about  three  table-spoonfuls  of  black 
matter,  resembling  thin  tar,  escaped.  We  then  found,  upon  examina- 
tion, that  the  outer  wall  of  the  antrum,  immediately  over  the  remain- 
ing portion  of  the  root  of  the  first  bicusi:»id,  "vvas  destroyed,  and  there 
was  an  opening  through  it  large  enough  to  admit  the  forefinger.  Be- 
lieving that  the  extremity  of  the  root  left  in  the  socket  was  the  cause 
of  the  disease,  we  immediately  proceeded  to  extract  it,  which  we  suc- 
ceeded in  doing  after  removing  the  outer  wall  of  the  alveolus.  The 
root  was  found,  on  removal,  to-be  enlarged  by  exostosis  to  the  size  of 
a  very  large  pea.  The  operation  proved  perfectly  successful,  the  se- 
cretion of  purulent  matter  soon  ceased,  and  in  a  few  weeks  he  was 
completely  relieved  from  the  troublesome  affection  under  which  he 
had  so  long  labored. 

Several  years  ago,  Prof.  Gorgas,  while  demonstrating  practical 
anatomy  in  the  Baltimore  College  of  Dental  Surgery,  discovered  all 
the  teeth  in  the  mouth  of  one  of  the  subjects  (a  negro  girl  aged  about 
twenty-five  years)  to  be  in  an  exostosed  condition.  On  the  roots  of 
one  of  the  superior  molar  teeth  the  deposit  of  osseous  matter  measured 
three-fourths  of  an  inch  in  diameter ;  this  tooth,  with  the  portion  of 
process  forming  its  cavity,  is  now  in  the  museum  of  the  college. 

CAUSES. 

Tlie  primary  cause  of  this  disease  does  not  appear  to  be  well  un- 
derstood. Most  writers  concur  in  attx'ibutiug  the  proximate  cause  to 
irritation  of  the  periosteum  of  the  root;  but  this  is  not,  as  some  sup- 
pose, necessarily  dependent  upon  any  morbid  condition  of  the  crown 
itself,  for  it  often  attacks  teeth  that  are  perfectly  sound.  It  seems 
rather  to  be  attributable  to  some  peculiar  constitutional  diathesis. 

TREATMENT. 

The  disease  having  established  itself  does  not  admit  of  cure,  and 
when  it  has  progressed  so  far  as  to  be  productive  of  pain  and  incon- 
venience to  the  patient,  the  loss  of  the  affected  teeth  becomes  inevitable. 
When  the  enlargement  is  very  considerable  and  confined  to  the  ex- 
tremity of  the  root,  and  has  not  induced  a  correspondent  enlargement 
of  the  alveolus  around  the  neck  of  the  tooth,  the  extraction  of  the 
affected  organ  is  often  attended  with  difiiculty,  and  can  only  be  accom- 
plished by  removing  a  portion  of  the  socket,  or  fracturing  it. 

Some  are  of  the  opinion,  however,  that  the  deposit  of  osseous  matter 
may  be  arrested  and  absorption  excited  so  as  to  make  room  for  that 
already  deposited  by  the  administration  of  iodide  of  potassium. 


DENUDING    or    THE    TEETH,  261 


T 


CHAPTER  XVIII. 

DENUDING   OF   THE   TEETH. 

HIS  is  one  of  the  most  remarkable  affections  to  whicli  the  teeth 
J-  are  liable.  It  consists  in  the  gradual  wasting  of  the  enamel  on 
the  labial  surfaces,  attacking  first  the  central  incisors,  tlien  the  laterals, 
afterward  the  cuspids  and  bicuspids,  extending  sometimes  to  the  first 
and  second  molars.  It  usually  forms  a  continuous  horizontal  groove, 
as  regularly  and  smoothly  constructed  as  if  it  had  been  made  with  a  file. 
(See  Fig.  54.)    After  it  has  removed  the  enamel,  it  commits  its  ravages 

Fig.  54.  Fig.  55. 


upon  the  subjacent  dentine,  sometimes  penetrating  to  the  pulp-cavity.  It 
rarely  changes  the  color  of  the  enamel,  but  the  dentine,  after  it  becomes 
exposed,  assumes  first  a  light,  and  afterward  a  dark-brown  color;  retain- 
ing, however,  a  smooth  and  polished  surface.  This  destructive  process 
<ioes  not  always  commence  at  merely  one  point  on  the  labial  surface 
of  the  central  incisors,  as  just  described;  it  sometimes  attacks  several 
l)oints  simultaneously.  (See  Fig.  55.)  As  it  spreads,  these  unite,  and 
idtimately  a  deep  excavation  is  formed,  with  walls  so  smooth  and  highly 
polished  that  the  tooth  presents  the  appearance  of  having  been  scooped 
out  with  a  broad,  square,  or  round-pointed  instrument. 

The  progress  of  the  affection  is  exceedingly  variable.  It  is  some- 
times so  rapid  that  the  dentine  becomes  exposed  within  two  or  three 
years  from  the  commencement  of  the  disease ;  at  other  times  its  effect 
upon  the  enamel  is  scarcely  perceptible  for  the  first  six  or  eight  years 
after  it  makes  its  appearance.  In  the  case  of  a  lady  whose  teeth  were 
thus  affected,  the  denuding  process  did  not  perforate  the  enamel  for 
nearly  twenty  years.  The  dentine,  after  it  is  denuded  of  enamel,  is 
generally  quite  sensitive,  and  very  susceptible  to  heat  and  cold. 

CAUSES. 

The  cause  of  this  singular  affection  has  never  been  satisfactorily 
explained.  It  was  first  noticed  by  Mr.  Hunter,  who  calls  it  decay  by 
denudation,  and  supposes  that  it  is  a  disease  inherent  in  the  tooth 


262  DENUDING    OF    THE    TEETH. 

itself,  and  uot  dependent  on  circumstances  in  after  life ;  for  the  reason 
that  it  attacks  certain  teeth  rather  than  others,  and  is  often  confined 
to  a  particular  tooth. 

Mr.  Boll  thinks  Mr.  Hunter  has  confounded  this  affection  with  an- 
other, similar  in  its  appearance,  but  arising  from  a  wholly  different 
cause.  Mr.  Hunter  states  that  he  has  seen  instances  where  it  appeared 
as  if  the  outer  surface  of  the  dentine,  which  is  in  contact  with  the 
inner  surface  with  the  enamel,  had  first  been  lost,  so  that  the  cohesion 
between  the  two  had  been  destroyed  ;  and  as  if  the  enamel  had  been 
separated  for  want  of  support,  for  it  terminates  abruptly.  Upon  which 
Mr.  Bell  remarks  :  "  Mr.  Hunter  describes  very  accurately  the  result 
of  superficial  absorption  of  the  bony  structure ;  a  circumstance  which 
I  have  occasionally  seen,  though  more  rarely  than  the  present  abrasion 
of  the  enamel,  with  which  it  cannot  for  a  moment  be  considered  as 
identical.  In  one  case  the  enamel  is  gradually  and  slowly  removed  by 
a  regular  and  uniform  excavation ;  in  the  other,  the  abruptness  and 
irregularity  of  the  edges  show  that  it  had  broken  away  at  once,  from 
having  lost  its  subjacent  support.  The  cause  of  the  former  is  external; 
in  the  latter  it  is  within  the  enamel." 

Mr.  Bell,  in  attempting  to  correct  one  error,  has  fallen  into  another, 
equally  great  and  palpable.  He  attributes  the  breaking  in  of  the 
enamel  to  absorption  of  the  subjacent  dentine,  instead  of  ascribing 
it  to  decomposition  by  chemical  agents,  which  is  the  true  cause.  In 
almost  every  instance,  where  the  author  has  found  the  edges  of  the 
enamel  in  the  condition  described  by  Messrs.  Hunter  and  Bell,  he  has 
also  observed  that  the  surface  of  the  exposed  dentine  was  decayed. 
But  the  breaking  in  of  the  enamel  is  not  the  affection  now  under  con- 
sideration. That  is  the  result  of  caries  of  the  subjacent  dentine ;  this, 
a  sort  of  spontaneous  abrasion. 

Mr.  Bell  is  unfortunate,  also,  in  the  suggestions  which  he  throws  out 
in  regard  to  the  cause  of  the  disease.  "  Whatever  may  be  the  cause, — 
and  at  present  I  confess  myself  at  a  loss  to  explain  it,  —  the  horizontal 
direction  in  which  it  proceeds  may,  I  think,  be  connected  with  the 
manner  in  which  the  enamel  is  deposited  during  its  formation  ;  for  it 
will  be  recollected  that  it  first  covers  the  apex  of  the  tooth,  and  gra- 
dually invests  the  crovvn  by  successive  circular  depositions ;  it  is,  there- 
fore, not  improbable  that,  from  some  temporary  cause,  acting  dilring 
its  deposition,  certain  circular  portions  may  be  more  liable  to  mechan- 
ical abrasion,  or  other  injury,  than  the  rest." 

This  conjecture,  though  it  may  seem  somewhat  plausible,  is  far  from 
satisfactory.  If,  as  he  supposes,  certain  circular  portions  of  the  enamel 
are  less  perfectly  formed  than  others,  and  consequently  rendered  more 
liable  to  the  disease,  it  would  not  be  wholly  confined  to  the  anterior 


DENUDING    OF    THE    TEETH.  263 

surface  of  the  tooth,  but  would  extend  entirely  around  it,  and  as  soon 
as  these  imperfectly  formed  circular  portions  were  destroyed,  its  ravages 
would  cease. 

Mr.  Fox  frankly  acknowledges  his  inability  to  assign  any  cause  for 
this  affection;  but  conjectures  that  it  is  dependent  upon  some  solvent 
quality  of  the  saliva.  Were  this  supposition  correct,  every  part  of  the 
tooth  would  be  alike  subject  to  its  attack. 

Other  writers  suppose  it  is  occasioned  by  the  friction  of  the  lips. 
But  this  hypothesis  is  destitute  of  the  least  semblance  of  plausibility ; 
for  the  narrowness  and  depth  of  the  grooves  are  sometimes  such  as  to 
preclude  the  possibility  of  the  contact  of  the  lips  with  their  surfaces. 

Some  eminent  practitioners,  again,  attribute  it  to  the  use  of  tooth- 
brushes. That  this  may  increase  the  size  of  the  horizontal  groove  is 
more  than  probable  ;  that  it  may  even  in  some  cases  determine  the 
commencement  of  the  groove,  is  just  possible.  But  no  conceivable 
action  of  the  brush  could  be  an  inciting  cause  of  that  form  of  the  dis- 
ease shown  in  Fig.  55.  The  true  explanation  must  meet  both  cases. 
Hence  the  author  has  been  led  to  adopt  the  opinion  that  the  loss  of 
substance  which  characterizes  the  affection  is  produced  by  the  action 
of  acidulated  buccal  mucus.  In  every  other  part  of  the  mouth  this 
fluid  is  mixed  with  saliva,  and  the  acid  it  contains  so  much  diluted  as 
to  prevent  it  from  acting  on  other  portions  of  the  teeth.  Dr.  E.  Parmly 
reports  a  case  in  which  the  natural  teeth,  set  upon  an  artificial  piece, 
were  attacked  in  the  same  manner. 

TREATMENT. 

As  a  preventive,  Mr.  Fox  recommends  the  avoidance  of  whatever 
tends  to  produce  it ;  but,  unfortunately,  he  leaves  his  readers  entirely 
in  the  dark  upon  this  subject.  In  advanced  stages  of  the  affection,  the 
author  has  often  succeeded  in  arresting  the  progress  by  widening  the 
groove  at  the  bottom,  and  afterwards  filling  it  with  gold.  This,  in  the 
majority  of  cases,  will  pi'ove  successful.  The  patient  should  be  cau- 
tioned against  the  use  of  stifi'-bristled  tooth-brushes,  and  should  not, 
in  using  any  kind,  make  too  much  movement  across  the  front  teeth, 
but  rather  up  and  down.  Should  the  groove  become  discolored,  it 
will  be  proper  to  use  occasionally  a  little  fine  rotten-stone  or  prepared 
chalk  on  a  small  stick  of  some  hard  wood. 


264  CHEMICAL    ABEASIOX    OP    THE    TEETH. 


CHAPTER  XIX. 

CHEMICAL   ABRASION   OF   THE   TEETH. 

THE  chemical  abrasion  of  the  cutting  edges  of  the  front  teeth  is  an 
affection  of  very  rare  occurrence.  It  commences  on  the  central 
incisors,  jiroceeding  thence  to  the  laterals,  the  cuspids,  and  sometimes, 
though  very  rarely,  to  the  first  bicuspids.  Teeth  thus  affected  have, 
when  the  jaws  are  closed,  a  truncated  appearance  ;  the  upper  and 
lower  teeth  do  not  come  together,  and  they  are  rather  more  than  or- 
dinarily susceptible  to  the  action  of  acids,  or  of  heat  and  cold.  In 
other  respects,  little  or  no  inconvenience  is  experienced  until  the  crowns 
of  the  affected  teeth  are  nearly  destroyed. 

Its  progress,  as  in  the  case  of  abrasion  of  the  labial  surfaces,  is 
exceedingly  variable.  It  sometimes  destroys  half  or  two-tliirds  of  the 
crowns  of  the  central  incisors  in  two  or  three  years ;  at  other  times 
seven  or  eight  years  are  required  to  produce  the  same  effect.  In  one 
case  which  came  under  our  own  observation,  the  abrasion  had  extended 
to  the  bicuspids,  and  the  central  incisors  of  both  jaws  were  so  much 
wasted,  that  on  closing  the  mouth  they  did  not  come  together  by 
nearly  three-eighths  of  an  inch;  yet  two  years  only  had  elapsed  since 
its  commencement.  In  another  case,  where  it  had  been  going  on  for 
seven  years,  it  had  not  extended  to  the  cuspids,  and  the  space  between 
the  upper  and  lower  incisors  did  not  exceed  an  eighth  of  an  inch. 

The  subjects  of  these  two  were  gen- 
^^^'-  '^^-  tlemen,  —  the  first  aged  about  twen- 

ty-eight, and  the  other  twenty-one. 
Mr.  Bell  gives  an  interesting  case 
■^  (Fig.  5Q)  of  a  gentleman  whose 
teeth  were  thus  affected  :  "  About 
fourteen  months  since  (1831),  this 
gentleman  perceived  that  the  edges 
of  the  incisors,  both  above  and  below,  had  become  slightly  Avorn  down, 
and,  as  it  were,  truncated,  so  that  they  could  no  longer  be  placed  in 
contact  with  each  other.  This  continued  to  increase  and  extend  to 
the  lateral  incisors,  and,  afterward,  successively  to  the  cuspids  and 
bicuspids.  There  has  been  no  pain,  and  only  a  trifling  degree  of  un- 
easiness, on  taking  acids,  or  any  very  hot  or  cold  fluids,  into  the  mouth. 
When  I  first  saw  these  teeth,  they  had  exactly  the  appearance  of  hav- 
ing been  most  accurately  filed  down  at  the  edges,  and  then  perfectly 


CHEMICAL    ABEASIOX    OF    THE    TEETH.  265 

and  beautifully  polished ;  and  it  has  now  extended  so  far  that  when 
the  mouth  is  closed,  the  anterior  edges  of  the  incisors  of  the  upper  and 
lower  jaws  are  nearly  a  quarter  of  an  inch  asunder.  The  cavities  of 
those  of  the  upper  jaw  must  have  been  exposed,  but  for  a  very  curious 
and  beautiful  provision ;  they  have  become  gradually  filled  by  a  de- 
posit of  new  bony  matter,  perfectly  solid  and  hard,  but  so  transparent 
that  nothing  but  examination  by  actual  contact  could  convince  an 
observer  that  they  were  actually  closed.  This  appearance  is  exceed- 
ingly remarkable,  and  exactly  resembles  the  transparent  layers  which 
are  seen  in  agatose  joebbles,  surrounded  by  a  more  opaque  mass.  The 
surface  is  uniform,  even,  and  highly  polished,  and  continues,  without 
the  least  break,  from  one  tooth  to  another.  It  extends  at  present  to 
the  bicuspids,  is  perfectly  equal  on  both  sides,  and  when  the  molars 
are  closed,  the  opening,  by  this  loss  of  substance  in  front,  is  observed 
to  be  widest  in  the  centre,  diminishing  gradually  and  equally  on  both 
sides  to  the  last  bicuspids." 

CAUSES. 

"With  regard  to  the  cause  of  this  most  extraordinary  affection,  Mr. 
Bell,  referring  to  the  case  which  he  describes,  says,  he  is  "wholly  at  a 
loss  to  offer  even  a  conjecture.  It  cannot  have  been  produced  by  the 
friction  of  mastication,  for  these  teeth  have  never  been  in  contact  since 
the  commencement  of  the  affection  ;  nor  does  it"  arise  from  any  appa- 
rent mechanical  cause,  for  nothing  is  employed  to  clean  the  teeth  ex- 
cept a  soft  brush.  Absorption  will  equally  fail  to  account  for  it,  for 
not  only  would  this  cause  operate,  as  it  always  does,  irregularly ;  but 
we  find  that,  instead  of  these  teeth  being  the  subjects  of  absorption,  a 
new  deposition  of  bony  matter  is,  in  fact,  going  on,  to  fill  the  pulp- 
cavities  which  would  otherwise  be  exposed." 

Mr.  Bell  is  correct  in  supposing  that  it  is  not  the  result  either  of 
mechanical  action  or  absorption.  If,  then,  neither  of  these  agencies 
are  concerned  in  its  production,  it  must  be  the  result  of  some  chemical 
action  ;  though  not  of  the  salivary  fluids  of  the  mouth,  for,  if  so,  every 
part  of  the  exterior  surfaces  of  the  teeth  would  be  acted  on  alike.  This 
affection,  as  well  as  the  one  last  noticed,  the  author  is  disposed  to  attrib- 
ute to  the  action  of  acidulated  mucus.  The  anterior  surfaces  of  the 
upper  front  teeth  not  being  so  frequently  washed  by  the  saliva,  the 
mucous  secretions  of  the  upper  lip  are  often  permitted  to  remain  on 
these  portions  of  the  teeth  for  a  considerable  length  of  time ;  and  to 
the  presence  of  these,  when  in  an  acidulated  condition,  we  believe  the 
denuding  process  to  be  attributable ;  while  the  abrasion  of  the  cutting 
edges  of  the  incisors  and  cuspids  i^  caused  by  an  acid  mucus,  secreted 
from  the  mucous  follicles  of  the  end  of  the  tongue,  which  is  brought 


266         MECHANICAL    ABRASIOX    OF    THE    TEETH. 

in  contact  with,  the  cutting  extremities  of  the  front  teeth  almost  con- 
stantly. 

Dr.  Nuhn,  a  German  physician,  describes  a  gland  which  he  has 
recently  discovered  in  the  interior  of  the  tip  of  the  tongue.  It  is  re^Dre- 
sented  as  having  a  number  of  ducts  opening  through  the  mucous  mem- 
brane over  it.  It  is  thought  to  be  a  mucous  gland,  and  it  may  be  that 
this  gland,  in  peculiar  diatheses,  secretes  the  acidulated  mucus  which 
may  cause  the  affection  under  consideration.  Be  this  hypothesis  correct 
or  not,  it  is  evidently  the  result  of  the  action  of  a  chemical  agent ;  and 
that  this  is  furnished  by  the  end  of  the  tongue  is  rendered  more  than 
probable  from  the  fact  that  it  is  brought  in  contact  with  the  cutting 
edges  of  the  teeth  almost  every  time  the  mouth  is  opened. 

TREATMENT. 

If  the  tendency  to  an  acidulated  condition  of  the  mucous  secretions 
of  the  mouth  could  be  overcome  or  counteracted,  the  progress  of  this 
affection  of  the  teeth,  perhaps,  might  be  arrested.  But  the  permanent 
cure  of  an  obscure  abnormal  condition  of  any  secretion  is  a  tedious, 
difficult,  and  often  impossible  thing.  It  may  requix'e  hygienic  and  con- 
stitutional treatment,  such  as  comes  more  within  the  province  of  the 
family  physician  than  of  the  dentist.  But  we  know  of  no  treatment 
that  will  control  or  arrest  this  sin^iular  disease. 


CHAPTER  XX. 

MECHANICAL    ABRASION    OF    THE    TEETH. 

WERE  it  true,  as  declared  by  Richerand,  that  the  loss  of  the  enamel 
occasioned  by  friction  is  repaired  by  a  new  growth,  it  would  never 
suffer  permanent  loss  from  mechanical  abrasion.  But  enamel  and  den- 
tine, once  formed,  pass  beyond  the  sphere  of  that  reparative  power 
found  in  other  bony  tissues  where  red  blood  circulates  freely.  Xew 
enamel  is  therefore  never  formed  after  the  eruption  of  the  tooth ;  and 
new  dentine  only  upon  the  surface  of  the  lining  membrane,  which  is 
exceedingly  vascular. 

The  teeth  rarely  suffer  loss  of  substance  from  friction  when  the  inci- 
sors of  the  upper  jaw  shut  in  front  of  those  of  the  lower.  It  is  only 
when  the  former  fall  directly  upon  the  latter,  that  mechanical  abrasion 
of  the  cutting  edges  can  take  place,  and  when  this  happens,  they  some- 
times suffer  great  loss  of  substance.     The  crowns  of  these  teeth  are 


INJUEIES    FEOM    MECHANICAL    VIOLENCE.        267 

occasionally  worn  entirely  off,  while  those  of  the  molars  and  bicuspids 
are,  comparatively,  little  affected.  The  lateral  motions  of  the  jaw, 
beino- in  these  cases  unrestricted — and  this  motion  beino;  of  course 
greater  at  the  anterior  than  at  the  posterior  part  of  the  mouth  —  it 
necessarily  happens  that  the  front  teeth  suffer  the  most  abrasion. 
Sometimes  all  the  teeth  are  worn  off  alike  ;  at  other  times,  owing  to 
the  peculiar  manner  in  which  the  jaws  come  together,  the  abrasion  is 
confiued  to  a  few. 

Mr.  Bell  believes  that  certain  kinds  of  diet  tend,  more  than  others, 
to  produce  abrasion  of  teeth :  in  proof  of  which  he  tells  us  that  sailors, 
who,  the  greater  portion  of  their  lives,  live  on  hard  biscuits,  have  only 
a  small  part  of  the  crowns  of  their  teeth  remaining.  But  the  antago- 
nism of  the  teeth  has  much  more  to  do  with  it  than  the  nature  of  the 
food  ;  though  of  course,  when  they  do  strike  in  such  a  way  as  to  wear 
the  cutting  surfaces,  very  hard  or  gritty  articles  of  food  would  make 
the  abrasion  more  rapid. 

When  the  front  teeth  of  the  lower  jaw  strike  against  the  palatine 
surface  of  those  of  the  upper,  the  latter  are  sometimes  worn  away  more 
than  three-fourths,  and  in  some  instances  entirely  up  to  the  gums.  We 
Lave  seen  the  teeth  of  some  individuals  so  much  abraded,  in  this  way, 
that  little  of  the  crown  remained,  except  the  enamel  on  the  anterior 
surface. 

The  wearing  away  of  the  crowns  of  the  teeth  would  expose  the  lining 
membrane,  were  it  not  that  Nature,  in  anticipation  of  the  event,  sets 
up  an  action  by  which  the  pulps  are  transformed  into  a  substance 
called  osteo-dentme,  which  is  analogous  in  structure  to  cementum.  By 
this  beautiful  operation  of  the  economy,  the  painful  consequences  that 
would  otherwise  result  are  wholly  prevented. 


CHAPTER  XXI. 


FRACTURES     AND     OTHER     INJURIES     OF     THE     TEETH     FROil 
MECHANICAL    VIOLENCE. 

THE  injuries  to  which  teeth  are  subject  from  mechanical  violence 
are  so  variable  in  their  character  and  results  as  to  render  a 
detailed  description  impossible.  The  same  amount  of  violence  inflicted 
upon  a  tooth  does  not  always  produce  the  same  effect.  The  nature 
and  extent  of  the  injury  will  depend  as  much  upon  the  physical  con- 
dition of  the  teeth,  the  state  of  the  constitutional  health,  and  the  sus- 


268        INJURIES    FROM'   MECHANICAL    VIOLENCE. 

ceptibility  of  the  body  to  morbid  impressions,  as  upon  the  violence  of 
the  blow.  Thus,  a  blow  sufBciently  severe  to  loosen  a  tooth  might  not, 
in  one  case,  be  productive  of  any  j^ermanent  bad  consequences  ;  while 
in  another,  it  might  cause  the  death  of  the  organ  and  inflammation  of 
the  adjacent  parts,  as  well  as  necrosis  of  the  alveolus. 

A  tooth  of  compact  texture,  and  in  a  healthy  mouth,  may  be  deprived 
of  a  portion  of  its  substance  without  any  serious  injury;  but  a  similar 
loss  of  substance  in  a  tooth  not  so  dense  in  structure  would  be  likely 
to  produce  inflammation  and  suppuration  of  the  lining  membrane, 
and  possibly  of  the  alveolo-dental  periosteum.  Hence,  in  order  to 
form  a  correct  opinion  of  the  result  of  injuries  of  this  sort,  we  must 
take  into  consideration  not  only  the  character  of  the  tooth  upon  which 
the  blow  has  been  inflicted,  but  also  the  state  of  the  mouth  and  the 
health  of  the  individual. 

If  the  tooth  is  not  loosened  in  its  socket,  any  injury  resulting  from 
a  loss  of  a  small  portion  of  the  enamel,  or  even  of  the  dentine,  may 
be  prevented  by  smoothing  the  fractured  surface  with  a  file,  that  the 
juices  of  the  mouth  and  particles  of  extraneous  matter  may  not  be 
retained  in  contact  with  it.  But  if  the  tooth  is  loosened,  and  inflam- 
mation of  the  investing  membrane  has  supervened,  leeches  should  be 
applied  to  the  gums,  and  the  mouth  washed  several  times  a  day  with 
some  astringent  lotion,  until  the  inflammation  subsides.  For  more 
detailed  treatment,  the  reader  is  referred  to  the  chapter  on  perios- 
titis. 

When  a  tooth  has  been  displaced  from  its  socket  by  a  blow,  and  its 
vascular  connection  with  the  general  system  destroyed,  necrosis  must, 
as  an  almost  necessary  consequence,  be  the  result.  An  imperfect  union 
between  the  tooth  and  alveolus  may  sometimes  be  re-established  by 
the  effusion  of  coagulable  lymph,  and  the  formation  of  an  imperfectly 
organized  membrane ;  but  the  tooth  will  ever  after,  from  the  slightest 
cold,  or  derangement  of  the  digestive  organs,  be  liable  to  become  sore 
to  the  touch,  and  in  most  cases  will  ultimately  assume  a  muddy  brown, 
unhealthy  appearance. 

The  author  has,  on  several  occasions,  replaced  teeth  that  had  been 
knocked  from  their  sockets ;  and  in  some  instances  the  operation  was 
attended  with  success.  The  subject  in  one  case  Avas  a  healthy  boy,  of 
about  thirteen  years  of  age,  who,  while  playing  bandy,  received  a 
blow  from  the  club  of  one  of  his  playmates,  which  knocked  the  left 
central  incisor  of  the  upper  jaw  entirely  out  of  its  socket.  He  saw  the 
boy  about  fifteen  minutes  after  the  accident.  The  alveolus  was  filled 
with  coagulated  blood.  This  he  sponged  out,  and,  after  having  bathed 
the  tooth  in  tepid  water,  carefully  and  accurately  replaced  it  in  its 
socket,  and  secured  it  there  by  silk  ligatures  attached  to  the  adjacent 


INJUEIES    FROM    MECHAISTICAL    VIOLENCE.        269 

teeth.  On  the  following  day  the  gums  around  the  tooth  were  con- 
siderably inflamed,  to  reduce  which  inflammation  he  directed  an 
application  of  three  leeches  and  the  frequent  use  of  diluted  tincture 
of  myrrh  as  a  wash  for  the  mouth.  At  the  expiration  of  four  weeks 
the  tooth  became  firmly  fixed  in  its  socket,  but  from  the  effusion  of 
coagulable  lymph,  the  alveolar  membrane  was  thickened,  and  the 
tooth,  in  consequence,  protruded  somewhat.  A  slight  soreness,  on 
taking  cold,  has  ever  since  been  experienced. 

Dr.  Noyes,  of  Baltimore,  mentioned  to  the  author  a  case  of  a  some- 
what similar  character.  The  subject  was  a  boy  about  ten  years  of 
age.  One  of  his  front  teeth  was  forced  from  its  socket  by  a  fall.  It 
was  replaced  shortly  after,  and  in  a  few  weeks  became  firm  in  its 
alveolus.     Mr.  Bell  also  mentions  a  case  attended  with  a  like  result. 

The  alveolar  processes  and  jaw-bones  are  sometimes  seriously  in- 
jured by  mechanical  violence.  In  1843,  the  author  was  requested  by 
the  late  Dr.  Baker,  of  Baltimore,  to  visit,  with  him,  a  lady  who,  by 
the  upsetting  of  a  stage,  had  her  face  severely  bruised  and  lacerated. 
All  that  portion  of  the  lower  jaw  which  contained  the  six  anterior 
teeth  was  splintered  ofi",  and  was  only  retained  in  the  mouth  by  the 
gums  and  integuments  with  which  it  was  connected.  The  wounds  of 
her  face  having  been  properly  dressed,  the  detached  portion  of  the 
jaw  was  carefully  adjusted  and  secured  by  a  ligature  passed  around 
the  front  teeth-  and  first  molars,  and  by  a  bandage  on  the  outside, 
around  the  chin  and  back  part  of  the  head.  Her  mouth  was  washed 
five  or  six  times  a  day  with  diluted  tincture  of  myrrh.  The  third  day 
after  the  accident.  Dr.  Baker  directed  the  loss  of  twelve  ounces  of 
blood ;  and,  in  five  or  six  weeks,  with  no  other  treatment  than  the 
dressing  of  the  wounds,  she  perfectly  recovered. 

It  often  happens  that  the  crown  of  a  tooth  is  broken  off  at  the  neck. 
We  have  known  the  crowns  of  four,  and  in  one  case  of  thirteen,  teeth 
to  be  fractured  by  a  single  blow.  The  subject  of  the  last  case  was  a 
fireman,  who,  in  1835,  received  an  accidental  blow  on  his  mouth  from 
the  head  of  an  axe,  which  broke  off  the  crowns  of  all  the  upper  and 
lower  incisors,  two  cuspids,  and  three  of  the  bicuspids  of  the  inferior 
maxilla.  The  subject  in  the  other  case  was  a  boy  about  twelve  years 
of  age,  who,  from  a  similar  accident,  occasioned  by  running  up  sud- 
denly behind  a  man  who  was  chopping  wood,  had  the  crowns  of  his 
'upper  incisors  broken  off.  In  both  of  these  cases  the  inflammation 
which  supervened  was  so  great  as  to  render  the  removal  of  the  roots 
necessary.  The  crowns,  roots,  and  alveolar  processes  are  sometimes 
ground  to  pieces,  or  the  teeth  driven  into  the  very  substance  of  the 
jaw.     Mr.  Bell  says  he  once  found  a  central  incisor  so  completely 


270  CARIES    OF    THE    TEETH. 

forced  into  the  bone,  that  he  thought  it  to  be  the  remains  of  a  root ; 
but,  on  removing  it,  found  it  to  be  an  entire  tooth. 

AVhen  the  crown  of  a  tooth  has  been  broken  off  by  a  blow,  and  de- 
structive inflammation  results,  the  root  should  be  extracted.  We 
have  sometimes  engrafted  an  artificial  crown  on  a  root  after  the  natu- 
ral crown  has  been  destroyed  by  mechanical  violence ;  but  it  is  very 
necessary  that  the  inflammation  should  be  entirely  subdued  previous 
to  the  operation  of  pivoting.  If  the  tooth  is  to  be  replaced  with  an 
artificial  substitute  attached  to  a  plate,  the  root  should  be  first  ex- 
tracted. In  some  cases,  however,  the  root  may  be  filled  and  be  per- 
mitted to  remain ;  but  the  practice  is  usually  a  bad  one. 


CHAPTER  XXII. 

CARIES    OF    THE    TEETH. 


THE  doctrine,  as  promulgated  by  Fox,  and,  subsequently,  advocated 
by  Bell,  and  other  European  writers,  that  the  diseases  of  the  teeth 
ai'e  the  same  as  those  which  attack  other  osseous  structures  of  the 
body,  is  now  almost  universally  conceded  to  be  incorrect.  With  the 
exception  of  exostosis  and  necrosis,  the  pathological  condition  of  these 
organs  do  not  bear  the  slightest  analogy  to  those  of  other  bones.  They 
are  not  produced  by  the  same  causes,  nor  can  they  be  cured  by  the 
same  remedies. 

In  the  treatment  of  diseases  of  the  teeth  we  rely  mainly  upon  art ; 
in  diseases  of  other  osseous  tissues  the  resources  principally  to  be  relied 
on  are  found  in  the  recuperative  powers  of  the  economy.  This  differ- 
ence is  clearly  seen  between  caries  in  the  teeth  and  in  the  bones. 
Nature  alone  can  rej^air  the  ravages  of  the  one,  art  alone  of  the  other. 
Exostosis,  which  is  a  disease  common  to  bone  and  teeth,  is  found  only 
in  the  cementum,  which  is  the  connecting  link  between  dentine  and 
osseous  tissue;  whilst  diseases  of  the  dentine  and  enamel  form  a  dis- 
tinct class,  requiring  treatment  altogether  peculiar  to  themselves. 

The  teeth  are  more  liable  to  be  attacked  by  caries  than  by  any  other 
disease,  and  this  will  now  claim  our  attention. 

Caries  of  a  tooth  is  the  chemical  decomposition  of  the  earthy  salts 
of  the  affected  part,  sometimes,  but  not  always,  accompanied  by  disor- 
ganization of  the  animal  framework  of  this  portion  of  the  organ. 
There  is  no  affection  to  which  these  organs  are  liable  more  frequent  in 
its  occurrence,  or  fatal  in  its  tendency,  than  this.  It  is  often  so  insidi- 
ous in  its  attacks,  and  rapid  in  its  progress,  that  every  tooth  in  the 


CARIES    OF    THE    TEETH.  271 

mouth  is  involved  in  irreparable  ruin  before  even  its  existence  is  sus- 
jDected. 

Its  presence  is  usually  first  indicated  by  an  opaque  or  dark  spot  on 
the  enamel;  and,  if  this  be  removed,  the  subjacent  dentine  will  exhibit 
a  black,  dark-brown,  or  whitish  appearance.  It  usually  commences 
on  the  outer  surface  of  the  dentine  of  the  crown,  beneath  the  enamel, 
at  some  point  where  it  is  imperfect,  or  has  been  fractured  or  otherwise 
injured ;  from  thence  it  proceeds  toward  the  centre  of  the  tooth,  in- 
creasing in  circumference  until  it  reaches  the  pulp-cavity. 

If  the  diseased  part  is  oi  a  soft  and  humid  character,  the  enamel, 
after  a  time,  usually  breaks  in,  disclosing  the  ravages  the  disease  has 
made  on  the  subjacent  dentine.  But  this  does  not  always  hap2:)en  ;  the 
form  of  the  tooth  sometimes  remains  nearly  perfect  until  its  whole 
interior  structure  is  destroyed. 

No  portion  of  the  crown  or  neck  of  a  tooth  is  exempt  from  this 
disease ;  yet  some  parts  are  more  liable  to  be  first  attacked  than  others  ; 
as,  for  example,  the  depressions  in  the  grinding  surfaces  of  the  molars 
and  bicuspids,  the  approximal  surfaces  of  all  the  teeth,  the  posterior 
or  palatine  surfaces  of  the  lateral  incisors,  and,  in  short,  wherever  an 
imperfection  of  the  enamel  exists. 

The  enamel  is  much  harder  than  the  dentine,  and  is  by  far  less 
easily  acted  on  by  the  causes  that  i)roduce  caries.  .  It  is  sometimes, 
however,  the  first  to  be  attacked,  and  when  this  happens,  the  disease 
develops  itself  more  frequently  on  the  labial,  or  buccal  surface,  near 
the  gum,  than  in  any  other  locality ;  often  commencing  at  a  single  point, 
and  at  other  times  at  a  number  of  points.  "When  the  enamel  is  first 
attacked,  it  is  usually  called  erosion  ;  but  as  this  tissue  does  not  contain 
so  much  animal  matter  as  the  subjacent  dentine,  the  diseased  part  is  often 
washed  away  by  the  saliva  of  the  mouth ;  while  in  the  dentinal  part 
of  the  tooth,  it,  in  most  instances,  remains,  and  may  be  removed  in 
distinct  laminae,  after  the  earthy  salts  have  been  decomposed. 

In  very  hard  teeth,  the  decayed  part  is  of  a  firmer  consistence,  and 
of  a  darker  color,  than  in  soft  teeth.  Sometimes  it  is  black  ;  at  other 
times  of  a  dark  or  light  brown  ;  and  at  other  times,  again,  it  is  nearly 
white.  As  a  general  rule,  the  softer  the  tooth,  the  lighter,  softer,  and 
more  humid  the  caries.  The  color  of  the  decayed  part,  however,  may 
be,  and  doubtless  is,  in  some  cases,  influenced  by  other  circumstances  ; 
perhaps  by  some  peculiar  modification  of  the  agents  concerned  in  the 
production  of  the  disease. 

The  disease,  then,  not  being  the  result  of  any  vital  action,  the  appli- 
cability of  the  term  caries  may  be  questioned  ;  but,  as  it  has  been  very 
generally  sanctioned,  and  as  we  know  of  no  better  name,  we  shall  con- 
tinue its  use.     Mr.  Bell  has  substituted  the  term  gangrene,  under  the 


272  CAEIES    OF    THE    TEETH. 

belief  that  it  conveys  a  more  correct  idea  of  the  true  nature  of  the 
affection.  The  applicability  of  a  term,  almost  synonymous  with  this, 
is  also  suggested  by  Mr.  Hunter:  in  speaking  of  the  affection,  he  says, 
that  it  "appears  to  deserve  the  name  of  mortilicatiou."  Mr.  Fox  speaks 
of  the  decay  of  the  teeth  as  a  disorder  which  terminates  in  mortifica- 
tion ;  but  he  designates  it  by  the  name  of  caries.  We  prefer  this  term, 
inasmuch  as  that  of  gangrene,  or  mortification,  may  be  applied  to  an- 
other condition  of  the  teeth  —  necrosis  —  with  as  much  propriety  as  the 
one  now  under  consideration.  Moreover,  the  term  gangrene,  or  morti- 
fication, is  commonly  used  to  signify  the  death  of  a  soft  part,  and  not 
a  diseased  condition  of  bony  tissue.  Surgical  writers  usually  regard 
gangrene  in  soft  tissues  as  analogous  to  necrosis  in  osseous  tissues ; 
and  ulceration  in  the  first  analogous  to  caries  in  the  last.  But  necrosis 
and  caries  in  the  teeth  differ  in  causes,  symptoms,  sequelae  and  treat- 
ment, from  affections  of  the  same  name  in  other  bones,  in  consequence 
of  the  great  difference  in  their  structure,  function,  and  mode  of  connec- 
tion with  the  adjacent  tissues. 

Commencing  externally  beneath  the  enamel,  the  disease  proceeds, 
as  before  stated,  toward  the  centre  of  the  tooth,  destroying  layer  after 
layer,  until  it  reaches  the  lining  membrane,  leaving  each  outer  stratum 
softer,  and  of  a  darker  color,  than  the  subjacent  one. 

The  terms  deep-seated,  superficial,  external  and  internal,  simple  and 
complicated,  have  been  applied  to  the  disease.  These  distinctions  are 
unnecessary,  since  they  only  designate  different  stages  of  the  same 
affection.  By  complicated  decay  is  meant  caries  which  has  penetrated 
to  the  pulp-cavity  of  the  tooth,  accompanied  by  inflammation  and 
suppuration  of  the  lining  membrane,  and  the  death  of  the  organ.  The 
lining  membrane,  however,  is  not  always  inflamed  by  exposure,  nor  is 
inflammation  invariably  followed  by  suppuration. 

The  roots  of  the  teeth  frequently  remain  firm  in  their  sockets  for 
years  after  the  crowns  and  necks  have  been  destroyed,  showing  that 
they  are  less  liable  to  decay  than  the  crowns;  but  nature,  after  the 
destruction  of  the  last,  as  if  conscious  that  the  former  are  of  no  further 
use,  exerts  herself  to  expel  them  from  the  system,  which  is  effected  by 
the  gradual  wasting  and  filling  up  of  their  sockets.  After  this  opera- 
tion of  the  economy  has  been  accomplished,  they  are  frequently  re- 
tained in  the  mouth  for  months,  and  even  for  years,  by  their  periosteal 
connection  with  the  gums.  This  effort  of  nature  is  confined  more  to 
the  back  than  to  the  front  teeth  ;  it  often  happens  that  the  last  remain, 
after  the  destruction  of  their  crowns,  for  many  years,  and  sometimes 
without  much  apparent  injury  to  the  parts  within  which  they  are  con- 
tained. 


CAEIES    OF    THE    TEETH.  273 

DIFFERENCES   IN   THE   LIABILITY   OF    DIFFERENT    TEETH   TO    DECAY. 

Having  explained  at  some  length,  in  a  preceding  part  of  this  work, 
the  manner  in  which  the  physical  condition  of  the  teeth  is  influenced, 
it  will  not  now  be  necessary  to  dwell  upon  this  portion  of  the  subject. 
It  will  only  be  requisite  to  state,  therefore,  that  teeth  which  are  well 
formed,  well  arranged,  and  of  a  firm  texture,  seldom  decay,  and  Avhen 
they  are  attacked,  the  progress  of  the  disease  is  not  rapid  ;  whereas, 
those  that  are  imperfect  in  their  formation,  and  of  a  soft  texture,  are 
more  susceptible  to  the  action  of  the  causes  which  produce  it ;  and 
when  assailed,  if  the  progress  of  the  affection  is  not  arrested  by  art, 
they  usually  fall  speedy  victims  to  its  ravages.  Just  in  proportion  as 
the  dentinal  structure  of  the  teeth  is  hard  or  soft,  the  shape  of  the 
organs  perfect  or  imperfect,  their  arrangement  regular  or  irregular,  is 
their  liability  to  caries  diminished  or  increased. 

The  density,  shape,  and  arrangement  of  the  teeth  are  influenced  by 
the  state  of  the  general  health,  and  that  of  the  mouth,  at  the  time  of 
their  dentinification.  If,  at  this  period,  all  the  functions  of  the  body 
are  healthily  performed,  these  organs  will  be  compact  in  their  struc- 
ture, perfect  in  their  shape,  and  usually  regular  in  their  arrangement. 
That  the  teeth  should  be  thus  influenced  will  not  appear  strange,  when 
we  consider,  as  Richerand  remarks,  "that  there  exists  amongst  all  the 
parts  of  the  living  body  intimate  relations,  all  of  which  correspond  to 
each  other,  and  carry  on  a  reciprocal  intercourse  of  sensations  and 
affections.  Hence,  if  there  is  a  morbid  action  in  one  part,  other  parts 
sympathize  with  it,  rallying,  as  if  sensible  of  the  mutual  dependence 
existing  between  them,  all  their  energies  to  rescue  their  neighbor  from 
the  power  of  disease." 

Increased  action  in  one  portion  of  the  system  is  generally  followed 
by  diminished  action  in  some  other  part ;  thus,  for  example,  gastritis 
may  be  produced  by  constipation  of  the  bowels ;  puerperal  fever,  by 
diminished  action  in  the  heart,  with  an  increased  action  in  the  uterus, 
etc.  Hence,  we  may  conclude,  that  if  the  body,  at  an  early  age,  be 
moi'bidly  excited,  its  functions  will  be  languidly  performed  —  the  pro- 
cess of  assimilation  checked  —  the  regular  and  healthy  supply  of  earthy 
matter  in  the  bones  interrupted  —  and,  consequently,  that  the  teeth  which 
are  then  formed  will  be  defective.  Other  parts  of  the  body,  in  which 
constant  changes  are  going  on,  if  thus  affected  at  these  early  periods, 
may  afterward  recover  their  healthful  vigor  ;  but  if  the  teeth  are  badly 
formed,  they  must  ever,  because  of  their  low  degree  of  vascularity, 
continue  so ;  kence  they  will  be  more  liable  to  decay  than  when  den- 
tinified  under  other  and  more  favorable  circumstances. 

Capillary  bloodvessels  form  a  large  part  of  every  organ,  the  charac- 
18 


274  CARIES    OF    THE    TEETH. 

teristic  tissue  of  each  being  strictly  extra-vascular  (literally,  ouiude  of 
the  vessels).  "Where  the  bloodvessels  are  most  abundant,  as  in  the  ner- 
vous and  muscular  structures,  growth  and  change  take  place  rapidly 
and  constantly ;  since  almost  every  particle  of  the  extra-vascular  or 
intei-stitial  tissue  is  in  contact  with  the  circulating  fluid,  the  function 
of  which  is  to  supply  material  for  growth  and  carry  ofi'  waste  matter. 
Hence  such  organs  have  great  recuperative  power,  and  are  modified 
by  the  varying  conditions  of  the  body.  But  the  dentine  and  enamel 
of  the  teeth  are  vascular  only  during  the  period  of  development. 

These  structures,  once  formed,  pass  beyond  the  reach  of  the  capilla- 
ries, except  the  layer  of  dentine  in  contact  with  the  dental  pulp,  Hence, 
the  dental  pulp  may  deposit  new  bone  as  a  barrier  against  caries  ;  but 
the  carious  dentine  itself  is  incapable  of  self-restoration. 

"  That  the  teeth  acquire  this  disposition,"  says  Mr.  Fox,  "  to  decay, 
from  some  want  of  healthy  action  during  their  formation,  seems  to  be 
proved  by  the  common  observation,  that  they  become  decayed  in  pairs ; 
that  is,  those  which  are  formed  at  the  same  time,  being  in  a  similar 
state  of  imperfection,  have  not  the  power  to  resist  the  causes  of  the 
disease,  and  therefore,  at  nearly  about  the  same  period  of  time  exhibit 
signs  of  decay ;  while  those  which  have  been  formed  at  another  time, 
when  a  more  healthy  action  has  existed,  have  remained  perfectly  sound 
to  the  end  of  life." 

Most  writers  are  of  opinion,  that  the  power  of  the  teeth  to  resist  the 
various  causes  of  decay  is  sometimes  weakened  by  a  change  brought 
about  in  their  physical  condition  through  the  agency  of  certain  remote 
causes,  such  as  the  profuse  administration  of  mercury,  the  existence  of 
fevers,  and  all  severe  constitutional  disorders. 

Mr.  Fox  says:  "That  he  has  had  occasion  to  observe,  that  great 
changes  take  place  in  the  economy  of  the  teeth  in  consequence  of  con- 
tinued fever  ;  and  that  the  decay  of  the  teeth  is  often  the  consequence 
of  certain  states  of  the  constitution." 

Mr.  Bell  remarks:  "That  amongst  the  remote  causes  (of  decay)  are 
those  which  produce  a  deleterious  change  in  the  constitution  of  the 
teeth  subsequent  to  their  formation ;  one  of  the  most  extensive,  in  its 
effects,  is  the  use  of  mercury.  To  the  profuse  administration  of  this 
remedy  in  tropical  diseases,  we  may,  we  think,  in  a  great  measure, 
attribute  the  injury  which  a  residence  in  hot  climates  so  frequently 
inflicts  on  the  teeth." 

Severe  constitutional  disorders,  and  the  administration  of  certain 
kinds  of  medicine,  do  not,  as  Messrs.  Fox  and  Bell  suppose,  act  directly 
on  the  teeth,  by  altering  their  physical  condition,  and  thus  rendering 
them  more  susceptible  to  the  action  of  corrosive  agents ;  but  they  are 


CARIES    OF    THE    TEETH.  275 

indirectly  affected  in  proportion  as  tlie  secretions  of  the  mouth  are 
vitiated  and  their  corrosive  properties  increased. 

The  following  considerations  establish,  to  our  mind,  the  truth  of 
what  we  have  just  stated.  Artificial  teeth  of  bone  or  ivory,  which  can 
undergo  no  such  changes  as  those  mentioned  by  Mr.  Bell,  decay  more 
rapidly  after  the  profuse  administration  of  medicine,  or  during  the 
existence  of  any  disease  that  tends  to  vitiate  the  secretions  of  the  mouth, 
than  at  other  times.  Furthermore,  teeth  of  so  dense  a  texture  as  to 
be  capable  of  resisting  the  action  of  the  acidulated  buccal  fluids  are 
not  affected  by  constitutional  disease;  yet  they  are  just  as  liable  as 
those  of  a  spongy  texture,  to  any  structural  disease  communicated  from 
the  general  system. 

The  following  is  the  result  of  our  own  observations :  the  gums  and 
alveolar  processes  are  sometimes  destroyed  by  the  use  of  mercury,  so 
that  all  the  teeth  loosen  and  drop  out,  without  being  affected  by  caries. 
The  teeth  of  persons,  in  whom  a  mercurial  diathesis  has  been  a  long 
time  kept  up,  or  who  have  been  for  years  suffering  from  dyspepsia, 
phthisis,  fevers,  or  other  severe  constitutional  disorders,  often  continue 
perfectly  sound ;  while  other  teeth,  under  similar  circumstances,  fre- 
quently decay.  jSTow,  all  this  goes  to  prove,  not  that  changes  are  effected 
in  the  structural  condition  of  the  teeth,  whereby  their  predisposition  to 
decay  is  increased,  but  that  there  are  differences  in  the  capabilities  of 
different  teeth  to  resist  the  action  of  the  secretions  of  the  mouth,  made 
acrid  by  the  affections  just  enumerated. 

The  author  is  well  aware  that  he  differs  from  some  writers  on  this 
point,  as  well  as  from  received  popular  opinion.  The  views  which  he 
has  here,  presented,  are  not  the  result  of  mere  closet  reflections,  but  of 
long  and  attentive  obsers^ation.  He  has  noted  the  effects  of  mercury, 
and  of  other  medicines,  as  well  as  of  constitutional  diseases  of  the 
severest  and  most  protracted  kinds,  and  he  has  always  observed  that 
—  occurring  after  the  development  of  the  teeth  — it  was  only  as  they 
impaired  the  healthy  qualities  of  the  fluids  of  the  mouth  that  they 
affected  these  organs.  In  fact,  their  density,  their  exposed  situation, 
their  functions,  all  would  seem  to  indicate  that  such  changes  as  take 
place  in  other  parts  of  the  body  are  not  only  unnecessary,  but  many 
of  them  are  impossible,  and  designedly  so,  that  they  may  more  fully 
answer  their  purpose. 

Dr.  Good  says  "  that  caries  of  the  teeth  does  not  appear  to  be  a  dis- 
ease of  any  particular  age  or  temperament,  or  state  of  health."  It  is 
true  it  is  not  a  disease  of  any  particular  state  of  health,  farther  than 
that  certain  constitutional  affections  exert  a  deleterious  influence  upon 
the  secretions  of  the  mouth,  and  thus  become  indirect  causes  of  decay 
of  these  organs.     That  it  is  not  a  disease  of  any  particular  age  seems 


276  CARIESOFTHETEETH. 

to  contradict  common  experience,  for  it  comparcdivehj  seldom  happens 
that  caries  appears  after  the  age  of  forty.  The  reason  of  ^vhich  is 
obvious.  Teeth  of  a  loose  texture,  or  otherwise  imperfect,  cannot  re- 
sist the  action  ■  of  the  causes  of  decay,  to  which  all  teeth  are,  up  to 
this  period  of  life,  more  or  less  exposed ;  while  those  which  from  their 
greater  density  remain  unaffected  thus  long,  are  generally  enabled,  by 
the  increased  solidity  they  gradually  acquire,  to  resist  them  through 
life.  Teeth  sometimes,  though  rarely,  decay  at  fifty,  or  even  at  a  later 
period  ;  but  caries  of  the  teeth,  generally,  may  be  said  to  be  confined 
to  youth  and  middle  age. 

The-  formation,  an-angement,  and  physical  condition  of  the  teeth 
are  sometimes  influenced  by  hereditary  diathesis,  affecting  the  parts 
concerned  in  their  2:iroduction,  or  the  general  system.  That  a  morbid 
condition  of  the  system,  on  the  part  of  either  parent,  often  predisposes 
their  progeny  to  like  affections,  is  an  axiom  fully  recognized  in  pathol- 
ogy, and  a  fact  of  which  we  have  many  fearful  proofs. 

Mr.  Bell,  in  treating  of  what  he  calls  the  hereditary  predisposition 
of  the  teeth  to  decay,  remarks:  "Tliat  it  often  happens  that  this  ten- 
dency exists  in  either  the  whole  or  a  great  part  of  a  family  of  children 
where  one  of  the  parents  had  been  similarly  affected ;  and  this  is  true 
to  so  great  an  extent  that  we  have  commonly  seen  the  same  tooth,  and 
even  the  same  part  of  a  tooth,  affected  in  several  individuals  of  the 
family,  and  at  about  the  same  age.  In  other  instances,  where  there 
are  many  children,  amongst  whom  there  exists  a  distinct  division  into 
two  i:)ortious,  some  resembling  the  father,  and  some  the  mother,  in 
features  and  constitution,  we  observe  corresponding  differences  in  the 
teeth,  both  as  it  regards  their  form  and  texture  and  their  tendency  to 
decay." 

That  there  is  an  hereditary  tendency  in  the  teeth  to  decay,  cannot, 
we  think,  be  denied.  But  we  believe  it  to  be  the  result  of  the  trans- 
mission of  a  similarity  of  action  in  the  parts  concerned  in  the  produc- 
tion of  these  organs ;  so  that  the  teeth  of  the  child  are,  in  form  and 
structure,  like  those  of  the  parent  whom  it  most  resembles,  and  from 
whom  it  has  inherited  the  diathesis.  The  teeth  of  the  child,  if  shaped 
like  those  of  the  parent,  possessing  a  like  degree  of  density,  and  simi- 
larly arranged,  are  equally  liable  to  disease ;  when  exposed  to  the 
action  of  the  same  causes,  they  are  affected  in  like  manner,  and,  usually, 
at  about  the  same  period  of  life.  Such  being  the  fact,  is  it  unreason- 
able to  conclude  that  judicioiis  early  attention  may  so  influence  the 
formation  and  arrangement  of  the  teeth  that  their  liability  to  disease 
may  be  diminished  ?  Whilst  denying  the  direct  action  of  medicine 
and  sickness  upon  the  dental  tissues,  except  through  the  agency  of  the 
buccal  secretions,  we  admit  their  powerful  influence  ;    first,  through 


CAEIES    OF    THE    TEETH.  277 

hereditary  transmission  of  an  impaired  constitution^  secondly,  by  their 
action  upon  the  process  of  development,  if  given  while  the  teeth  are 
being  formed.  It  is,  then,  to  the  differences  in  the  physical  condition 
and  manner  of  arrangement  of  these  organs  —  whether  in  different 
individuals  or  in  the  same  mouth — that  the  differences  in  their  liability 
to  decay  is  attributable. 

Dr.  John  Allen  remarks:  "The  nutritious  substances  in  the  food 
that  we  take  are  intended  to  build  up  all  parts  of  the  system  —  the 
hard  tissues  as  well  as  the  soft  tissues.  Of  the  food  intended  to  build 
up  these  organisms,  certain  portions  make  bone  and  teeth,  ISTow  the 
particles  of  matter  are  deposited  atom  by  atom,  and  the  system  is 
gradually  built  up.  When  we  take  food  into  the  system,  it  is  con- 
verted into  blood.  This  blood  is  conveyed  through  all  parts  in  little 
corpuscles,  which  are  freighted  with  the  proper  constituents  to  sustain 
and  build  up  these  organisms.  These  little  corpuscles  convey  such 
constituents  as  are  necessary  for  the  production  of  bone,  teeth,  flesh, 
and  the  fat,  and  these  various  substances  are  deposited  just  where  they 
should  be,  Now  it  is  essentially  necessary  that  we  have  these  little 
vesicles  freighted  with  the  proper  constituents,  and  duly  freighted. 
How  shall  we  know  this  ?  By  taking  the  food  just  in  the  proportion 
that  it  is  provided  for  us  by  our  Creator,  and  as  it  comes  from  nature's 
laboratory. 

"Now  we  take  this  ground  from  the  fact  that,  as  a  nation,  we  have 
worse  teeth  than  any  other  on  the  earth.  Now  why  is  this?  Simply 
because  we  change  the  proportions  of  these  various  constituents,  that 
our  Creator  has  provided  for  us,  by  separating  away  what  has  been 
put  there  for  the  building  up  of  the  hard  tissues. 

"To  prove  this,  let  us  look  to  other  nations.  They  that  do  not  change 
the  proportions  of  the  various  constituents  that  enter  into  their  bodies 
io  not  have  decayed  teeth. 

"  There  is  a  constant  change  going  on,  and  particles  of  matter  are 
deposited  atom  by  atom,  and  the  system  kept  fully  charged  with  the 
mineral  elements  of  which  these  structures  are  built  up.  When  you 
look  at  nations  that  do  not  change  the  proportions,  you  see  no  decayed 
teeth,  and  the  history  of  these  nations  proves  that  their  teeth  are  sound 
and  beautiful  to  old  age.  What  is  the  condition  in  our  country  ?  We 
do  change  these  proportions.  We  do  ignore  the  mineral  elements  pro- 
vided for  us,  and  we  do  have  decayed  teeth.  We  find  that  there  are 
over  twenty  millions  of  teeth  swept  from  our  population  every  year. 
We  do  not  take  the  material  into  our  system  that  carries  back,  atom 
by  atom,  and  keeps  the  hard  tissues  built  up  until  the  old  particles 
pass  away.  The  old  particles  pass  away  after  they  have  served  their 
purpose,  and  new  ones  then  take  their  places. 


278  CARIES    OF    THE    TEETH. 

"  It  is  estimated  that  every  child  uses  half  a  barrel  of  flour  every 
year;  and  it  is  estimated  that  there  are  forty  pounds  of  the  bone-forraing 
material  thrown  out  from  every  barrel  that  we  use.  The  child  takes  its 
food  on  fine  flour,  and  is  deprived  of  twenty  pounds  in  a  year  of  this 
mineral  element,  which  should  be  taken  into  the  system  in  order  to 
nuike  those  hard,  flinty  substances  that  our  Creator  intended.  Now, 
by  the  time  that  child  is  twenty  years  of  age,  it  has  been  de^n-ived  of  four 
hundred  pounds  of  the  elements  Avhich  should  have  been  taken  into  the 
system,  and  would  have  kept  it  charged  sufficiently  to  have  preserved 
these  substances  hard  and  flinty,  as  they  should  be. 

"We  sweep  from  our  American  population  over  twenty  millions  of 
teeth  every  year,  and  this  should  prove  the  theory  that  our  tissues  do 
undergo  a  change,  and  that,  particle  by  particle,  they  pass  away.  As 
it  is  now,  the  teeth  are  becoming  worse  and  worse  every  year ;  and  not 
only  this,  but  it  becomes  hereditary,  and  is  transmitted  from  parent  to 
child." 

CAUSES   OF   CARIES. 

Caries  of  the  teeth  has  been  attributed  to  a  great  variety  of  causes. 
To  notice,  in  detail,  the  various  opinions  advanced  by  American,  Eng- 
lish, French,  and  German  writers  ui^on  this  subject  would  be  incon- 
sistent with  the  plan  of  an  elementary  treatise  like  this,  and  unprofit- 
able to  the  reader. 

Fauchard,  Auz6be,  Bourdet,  Lecluse,  Jourdain,  and  most  of  the 
French  writers  of  the  eighteenth  century  on  the  diseases  of  the  teeth, 
as  well  as  nearly  all  of  the  more  modern  French  authors,  though  their 
views  with  regard  to  the  causes  of  dental  caries  are  exceedingly  vague 
and  confused,  exj^ress  the  belief  that  the  disease  is,  for  the  most  part, 
the  result  of  the  action  of  chemical  agents ;  such,  for  example,  as 
vitiated  saliva,  the  putrescent  remains  of  particles  of  food  lodged 
between  the  teeth,  or  in  their  interstices,  acids,  and  a  corrupted  state 
of  the  fluids  conveyed  to  these  organs  for  their  nourishment.  They 
also  mention  certain  states  of  the  general  health,  mechanical  injuries, 
sudden  transitions  of  temperature,  etc.,  as  conducing  to  the  disease. 
A  similar  explanation,  too,  of  the  cause  is  given  by  Salmon,  the  author 
of  a  Compendium  of  Surgery,  published  in  London,  in  1644. 

The  existence  of  an  acid  in  the  mouth  capable  of  decomposing  the 
teeth  is  conclusively  proven  by  Dr.  S.  K.  Mitchell,  in  a  letter  addressed 
by  him  to  T.  C.  Hope,  M.D.,  of  Edinburgli,  dated  October  10,  1798. 
The  fact  may  be  demonstrated  by  a  very  simple  experiment,  which 
consists  in  moistening  a  piece  of  litmus  paper  with  the  buccal  fluids 
obtained  from  between  the  teeth,  where  they  have  been  retained  until 
they  have  become  vitiated.     If  this  be  done,  the  paper  will  be  turned 


CAEIES    OF    THE    TEETH.  279 

red.  If,  then,  these  fluids,  when  in  a  vitiated  condition,  are  possessed 
of  acid  pro^Derties,  they  must  necessarily  exert  a  deleterious  action 
upon  the  teeth,  by  decomposing  and  breaking  down  their  calcareous 
molecules,  or,  in  other  words,  causing  their  decay. 

The  acid  detected  by  Dr.  Mitchell  was  the  septic  (nitrous),  but  the 
acetic,  lactic,  oxalic,  muriatic  and  uric  have  been  detected  in  the 
saliva,  in  certain  states  of  the  general  health.  Donn^,  who  has  ana- 
lyzed the  fluids  of  the  mouth  with  great  care,  says,  "  The  saliva,  in  its 
normal  state,  is  alkaline,  but  the  secretions  of  the  mucous  membrane 
of  the  mouth  are  acid."  It  is  highly  probable,  therefore,  that  the  acids 
■which  have  been  detected  in  the  first  of  these  fluids,  may  have  been 
principally  derived  from  the  latter.  Acidity  of  the  saliva  may,  however, 
occur  in  certain  morbid  conditions  of  the  general  system.  Donn6  says 
he  has  observed  it  in  patients  affected  with  gastritis,  and  in  children 
with  aphthte.  It  is  to  the  action  of  these  acids  uj)on  those  parts  of  the 
teeth  against  which  they  are  long  retained,  that  caries  is  principally 
attributable. 

The  doctrine  that  the  decay  of  the  teeth  is  the  result  of  the  action 
of  external  corrosive  agents  was  first  distinctly  promulgated  to  the 
dental  profession  of  the  United  States,  about  the  year  1821,  by  Drs. 
L.  S.  and  Eleazer  Family,  These  agents  may  consist  of  menstrua, 
formed  by  the  decomposition  of  acetous  fermentation  of  the  remains 
of  certain  aliments  lodged  in  the  interstices  of  the  teeth ;  or  of  the 
fluids  of  the  mouth,  especially  the  mucous,  in  a  vitiated  or  acidulated 
condition ;  or  of  acids  administered  during  sickness,  or  used  as  condi- 
ments. According  to  the  tables  of  elective  aflSnity,  there  are  but  four 
acids  which  precede  the  phosphoric  in  their  affinity  for  lime :  namely, 
the  oxalic,  sulphuric,  tartaric,  and  succinic.  It  may  hence  be  argued 
that  none  of  the  other  acids  are  capable  of  decomposing  the  teeth,  or 
of  injuring  them  in  any  other  way,  but  daily  observation  proves  the 
erroneousness  of  this  conclusion.  It  has  been  shown  by  experiment 
that  all  the  acids,  both  vegetable  and  mineral,  act  more  or  less  readily 
upon  these  organs.*  But  we  are  disposed  to  believe  that  caries  of  the 

*  The  following  experiments,  made  by  Dr.  A.  Westcott,  in  1843,  assisted  by  Mr. 
Dairy mple,  were  repeated  some  years  later,  before  tbe  class  of  the  Baltimore  Den- 
tal College : 

"  1st.  Both  vegetable  and  mineral  acids  act  readily  upon  the  bone  and  enamel 
of  the  teeth. 

"  2d.  Alkalies  do  not  act  upon  the  enamel  of  the  teeth  ;  the  caustic  potash  will 
readily  destroy  the  bone  by  uniting  with  its  animal  matter. 

"3d.  Salts  whose  acids  have  a  stronger  affinity  for  the  lime  of  the  tooth,  than 
for  the  basis  with  which  they  are  combined,  are  decomposed,  the  acids  acting 
upon  the  teeth. 

"4th.  Vegetable  substances  have  no  effect  upon  the  teeth  till  after  fermenta- 


280  CARIES    OF    THE    TEETH. 

teeth  results  more  frequently  from  the  action  of  some  acid  contained 
in  the  mucous  fluids  of  the  mouth,  than  from  that  of  acid  medicines  or 
condiments,  or  even  from  such  acids  as  may  be  generated  by  the  ace- 
tous fermentation  of  particles  of  certain  kinds  of  food  lodged  between 
the  teeth.  The  author  is  of  opinion,  therefore,  that  if  all  the  functional 
operations  of  the  body  were  always  healthily  performed,  caries  of  the 
teeth  would  seldom  occur;  for,  in  this  ease,  the  alkalinity  of  the  saliva 
would  be  sufficient  to  neutralize  the  acidity  of  the  mucous  fluids  of  the 
buccal  cavity,  as  well  as  any  other  acids  generated  in  the  mouth. 

The  foregoing  theory  of  the  cause  of  dental  caries  explains  the 
rationale  of  the  treatment  at  present  adopted  for  arresting  its  progress. 
By  the  removal  of  the  decomj)osed  j^art  and  filling  the  cavity  with  an 
indestructible  material,  the  contact  of  those  agents  upon  the  chemical 
action  of  which  the  disease  depends,  is  prevented,  and  the  further  pro- 
gress of  the  decay  arrested. 

Among  the  indirect  causes  of  caries,  the  following  may  be  enume- 

tion  fakes  place,  but  all  such  as  are  capable  of  acetic  fermentation,  act  readily 
after  this  acid  is  formed. 

"5th.  Animal  substances,  even  while  in  a  state  of  confirmed  putrefaction,  act 
very  tardily,  if  at  all,  upon  either  the  bone  or  enamel.  On  examining  the  teeth 
subjected  to  such  influence,  the  twentieth  day  of  the  experiment,  no  visible  phe- 
nomena wore  presented,  except  a  slight  deposit  upon  the  sux-face  of  a  greenish 
slimy  matter,  somewhat  resembling  the  green  tartar  often  found  upon  teeth  in 
the  mouth. 

"To  give  a  more  definite  idea  of  the  deleterious  agents  to  which  the  teeth  are 
exposed,  and  their  consequent  liability  to  be  affected  by  them,  we  will  notice  the 
effect  produced  by  a  few  of  the  individual  substances  which  are  more  or  less  lia- 
ble to  be  brought  in  contact  with  the  teeth, 

"  Acetic  and  citric  acids  so  corroded  the  enamel  in  forty-eight  hours,  that  much 
of  it  was  easily  removed  with  the  finger-nail. 

"Acetic  acid,  or  common  vinegar,  is  not  only  in  common  use  as  a  condiment, 
but  is  formed  in  the  mouth  whenever  substances  liable  to  fermentation  are  suf- 
fered to  remain  about  the  teeth  for  any  considerable  length  of  time. 

"Citric  acid,  or  lemon-juice,  though  less  frequently  brought  in  contact  with 
the  teeth,  acts  upon  them  still  more  readily. 

"  Malic  acid,  or  the  acid  of  apples,  in  its  concentrated  state,  also  acts  promptly 
upon  the  teeth. 

"Muriatic,  sulphuric,  and  nitric  acids,  though  largely  diluted,  soon  decompose 
the  teeth  :  these  are  in  common  use  as  tonics. 

"Sulphuric  and  nitric  ethers  have  a  similar  deleterious  effect,  as  also  spirits 
of  nitre:  these  are  common  diffusible  stimulants  in  sickness. 

"  Supertartrate  of  potash  destroyed  the  enamel  very  readily.  This  article  is 
frequently  used  to  form  an  acidulated  beverage. 

"  Raisins  so  corroded  the  enamel  in  twenty-four  hours,  that  its  surface  presented 
the  appearance  and  was  of  the  consistency  of  chalk. 

"  Sugar  had  no  effect  till  after  acetous  acid  was  formed,  but  then  the  effect  waa 
the  same  as  from  this  acid  when  directly  applied." 


CAEIES    OF    THE    TEETH.  28] 

rated :  depositions  of  tartar  upon  the  teeth ;  a  febrile  or  irritable  state 
of  the  body ;  a  mercurial  diathesis  of  the  general  system ;  artificial 
teeth  improperly  inserted,  or  made  of  bad  materials ;  roots  of  teeth  ; 
irregularity  in  the  arrangement  of  the  teeth  ;  too  great  pressure  of  the 
teeth  against  each  other — in  short,  everything  that  is  productive  of 
irritation  to  the  alveolo-dental  membrane,  or  to  the  gums. 

The  doctrine  here  advocated  is  one,  which,  we  confess,  we  were  for 
a  long  time  unwilling  to  believe,  because  it  was  opposed  to  all  our 
earlier  preconceived  notions  upon  the  subject ;  but  long  and  attentive 
observation  has  forced  us  to  acknowledge  its  truth. 

PREVENTION    OF   CAEIES. 

It  is  an  old  adage,  no  less  true  than  trite,  that  "  an  ounce  of  pre- 
vention is  better  tliau  a  pound  of  cure,"  and  in  the  present  instance 
it  may  be  applied  with  its  full  force.  Were  more  attention  paid  to 
the  practical  instruction  thus  conveyed,  many  of  the  diseases  of  the 
teeth  might  be  avoided.  Most  of  the  remarks  that  might  be  made  on 
this  subject  have  been  anticipated ;  consequently,  it  will  only  be 
necessary  to  observe,  that  if  the  teeth  are  well  formed  and  well  ar- 
ranged, all  that  will  be  required  is  to  keep  them  clean ;  if  any  irregu- 
larity occurs,  it  should  be  remedied  by  the  means  before  described. 

For  cleansing  the  teeth,  when  they  are  in  a  sound  condition  and 
free  from  calcareous  deposits,  the  gums  healthy,  and  the  secretions  of 
the  mouth  normal  in  character,  the  regular  and  frequent  use  of  pure 
water  by  means  of  a  proper  brush  and  waxed  floss  silk  will,  in  most 
cases,  be  sufficient.  But  when  the  enamel  is  stained  and  discolored, 
and  the  secretions  of  the  mouth  inclined  to  acidity,  with  a  tendency  to 
calcareous  deposits,  then  the  employment  of  a  dentifrice  is  necessary. 

Dentifrice,  from  dens,  a  tooth,  and  frico,  fricare,  to  rub,  is  a  medicinal 
preparation,  in  the  form  of  a  powder,  for  cleansing  the  teeth.  An 
almost  numberless  variety  of  dentifrices  are  in  use,  and  many  of  them 
highly  injurious.  In  the  preparation  of  an  agent  of  this  kind,  the 
object  should  be  to  obtain  a  compound  pleasant  to  the  taste,  altogether 
free  from  acids  and  acrid  substances,  and  soluble  or  insoluble,  accord- 
ing to  the  nature  of  the  case  in  which  it  is  to  be  used  ;  one  capable  of 
neutralizing  and  removing  acrid  and  fermenting  matters  secreted  be- 
tween the  teeth,  and  also  allaying  irritation.  A  dentifrice,  then, 
should  be  anti-acid,  and,  moreover,  a  powder  ;  and  the  more  simple 
the  preparation  the  better.  A  preparation  composed  of  orris  root,  pre- 
pared chalk,  and  pure  Castile  or  white  Windsor  soap,  to  which  may 
be  added  very  finely  powdered  cuttle-fish  bone  or  pximice-stone,  for  the 
removal  of  calcareous  matter,  when  there  is  a  tendency  to  deposits  of 
this  nature,  will  answer  every  pur-pose.     When  the  gums  are  in  a 


282 


CARIES    OF    THE    TEETH. 


healthy  condition,  there  is  no  use  for  such  ingredients  iu  a  dentifrice 
as  Peruvian  bark  or  myrrh,  and  as  for  liquid  dentifrices,  they  are  of 
very  little  use,  for  the  object  in  using  the  brush  is  friction,  and  as  these 
liquid  preparations  are  generally  lubricating  alkaline  substances,  they 
cause  the  brush  to  pass  so  easily  over  the  teeth  as  to  render  it  almost 
useless.  In  many  cases,  an  unhealthy  condition  of  the  gums  is  owing 
to  the  irritation  produced  by  local  irritants,  and  their  removal  is  all 
that  is  needed  to  restore  them  to  health.  Soap  alone  will  not  cleanse 
the  teeth,  for  it  prevents  friction  ;  and  charcoal,  notwithstanding  its 
detergent  and  anti-septic  properties,  is  injurious  as  a  dentifrice,  or  as 
an  ingredient  of  one,  on  account  of  its  insinuating  itself  under  the  free 
margin  of  the  gum,  and  causing  it  to  recede  from  the  neck  of  the 
tooth,  no  matter  how  finely  it  may  be  pulverized.  Either  of  the  fol- 
lowing dentifrices  may  be  used : 


B 

Prepared  chalk, 

•  Si^- 

Powdered  orris  root, 

•  liv. 

Powdered  cinnamon, 

•  3iv- 

Sup.  carb.  of  soda, 

-  ^ss. 

White  sugar,       .     . 
Oil  of  lemon,      .     . 

•  Si- 

.    gtt.   XV 

Oil  of  rose,          .     . 

.    ETtt.  ij. 

R.  Prepared  chalk,       .     .   ? 
Powdered  orris  root 
Pumice  stone,      .     . 


5'J- 


Ingredients  in  both  prescriptions 
to  be  thoroughly  pulverized  and  well 
mixed. 

The  importance  of  keeping  the  teeth  clean  cannot  be  too  strongly 
impressed  upon  the  mind  of  every  individual.  Proper  attention  to 
the  cleanliness  of  these  organs  contributes  more  to  their  health  and 
preservation  than  is  generally  supposed.  Against  caries  it  is  a  most 
powerful  prophylactic.  "Where  the  teeth,"  says  Dr.  L.  S.  Parmly, 
"  are  kept  literally  clean,  no  disease  will  ever  be  perceptible.  Their 
structure  will  equally  stand  the  summer's  heat  and  winter's  cold,  the 
changes  of  climate,  the  variation  of  diet,  and  even  the  diseases  to 
which  the  other  parts  of  the  body  may  be  subject  from  constitutional 
causes." 

The  configuration  and  arrangement  of  some  teeth  is  such,  however, 
as  to  preclude  the  possibility  of  keeping  them  clean ;  but  this  should 
not  deter  any  one  from  using  the  proper  means,  for  if  disease  is  not 
wholly  prevented,  they  will,  at  least,  contribute  very  greatly  to  the 
preservation  of  the  organs. 


PART    THIRD. 


S  U  E  G  E  E  Y. 


283 


CHAPTER  I. 

SUEGEEY. 

BESIDES  the  operations  of  general  surgery  which  are  performed 
upon  the  mouth  in  common  with  other  parts  of  the  body,  Dental 
Science  gives  specific  directions  for  those  operations  of  special  surgery 
demanded  in  the 

1.  Treatment  of  dental  caries ; 

2.  Extraction  of  teeth ; 

3.  Correction  of  irregularities  in  their  arrangement. 

The  treatment  of  caries  stands  first  in  order  and  importance  because 
of  the  usefulness  of  the  organs  to  be  saved;  the  universality  of  the 
disease ;  also,  the  complex  and  difficult  nature  of  the  operations  required. 
The  caries  may  be  slight  and  superficial ;  or  it  may  be  more  or  less 
deep-seated ;  lastly,  it  may  penetrate  even  to  the  pulp-cavity.  The 
difficulties  of  treatment  increase  in  the  same  order,  and  in  this  order 
they  \s'ill  be  taken  up.  Caries,  when  superficial,  may  be  arrested  by 
the  same  means  used  for  deeper  caries ;  but,  in  a  large  number  of 
cases,  it  will  require  for  its  removal  only  the  use  of  files  and  enamel- 
chisels.  These  instruments  are  also  often  used  preparatory  to  the 
operations,  necessary  for  the  arrest  of  deep-seated  caries;  hence  the 
use  of  the  file  and  enamel-chisel  demands  our  first  consideration. 

FILING  TEETH. 

There  is  no  operation  in  dental  surgery  against  which  a  stronger 
or  more  universal  prejudice  prevails  than  that  of  filing  the  teeth ;  yet, 
when  judiciously  and  skilfully  performed,  there  is  no  one  more  bene- 
ficial or  effectual  in  arresting  the  progress  of  caries.  Although  pro- 
ductive of  much  good,  it  is,  in  the  hands  of  unskilful  operators,  a 
soui'ce  of  incalculable  injury. 

Dr.  John  Harris  says,  "Filing  the  teeth  is  one  of  the  most  important 
and  valuable  resources  of  the  dental  art;  it  is  one  that  has  stood  the  test 
of  experience,  and  is  of  such  acknowledged  utility,  as  to  constitute  of 

285 


286  SURGERY. 

itself,  in  the  treatment  of  superficial  caries  on  the  lateral  surfaces  of 
the  teeth,  one  of  the  most  valuable  operations  that  can  be  performed 
on  these  organs.  And  even  after  caries,  in  the  localities  just  men- 
tioned, has  progressed  so  far  as  to  render  its  removal  by  this  means 
impracticable  or  improper,  the  use  of  the  file,  in  most  cases,  is  still 
necessary,  in  order  to  the  successful  employment  of  other  remedial 
agents.  But  in  either  case  a  failure  to  accomplish  the  ol)ject  for 
which  it  is  used  would  only  be  equivalent  to  doing  nothing  at  all. 

"The  use  of  the  file,  then,  may  very  justly  be  considered  a  sine  qua 
non  for  the  removal  of  superficial  caries  from  the  sides  of  the  teeth 
which  come  in  contact  with  each  other,  as  can  be  attested  by  thou- 
sands of  living  witnesses ;  and  in  preparing  the  way,  in  deep-seated 
caries,  for  the  thorough  removal  of  the  disease,  and  filling,  success- 
fully, the  cavity  thus  formed. 

"  In  a  paper  written  by  myself,  some  eleven  or  twelve  years  ago, 
upon  this  subject,  I  contended  that  filing  the  teeth  was  not  necessarily 
productive  of  caries,  and  my  subsequent  experience  and  observations 
have  only  tended  to  confirm  the  correctness  of  the  opinion  which  I 
then  advanced,  and  I  cherish  the  belief  that  this  opinion  will  not,  at 
this  time,  conflict  with  the  views  of  the  more  enlightened  of  my  pro- 
fessional brethren. 

"  But  when  reference  is  had  to  the  physical  peculiarities  of  the  teeth, 
it  will  at  once  be  perceived  that  they  present  a  strange  departure  from 
the  laws  that  govern  and  control  all  other  parts  of  the  body ;  and  these 
organs,  when  diseased,  can  only  be  restored  to  health  and  usefulness  by 
art,  unaided  by  the  sanitar}'  powers  of  nature.  Hence  it  is,  that  most 
of  the  operations  upon  them  will  not,  like  those  in  general  surgery, 
admit  of  mediocrity  in  their  performance. 

*  ■^  ■^  ^  *  :);  :Jc  ^ 

"  Tlie  fact  that  the  crowns  of  the  teeth  are  covered  with  enamel,  is 
alone  sufficient  evidence  of  its  importance  and  utility  in  shielding  and 
protecting  the  bony  structure  which  it  envelops  from  mechanical  and 
morbid  influences  ;  so  that  it  would  seem  that  its  removal  or  loss  would 
necessarily  expose  the  organs  to  certain  destruction.  But  we  have 
satisfactory  evidence  that  teeth,  after  having  suffered  the  loss  of  large 
portions  of  the  enamel,  have  been  restored  to  health,  and  preserved  for 
many  years,  and  often  through  life. 

"  The  rapidity  with  which  caries  progresses  after  the  exposure  of 
the  bone  by  the  loss  of  the  enamel,  depends  upon  the  physical  pecu- 
liarities of  the  teeth,  and  upon  local  and  constitutional  influences  ; 
hence  the  difficulty,  and  oftentimes  impossibility,  of  obtaining  the  object 
for  which  dental  operations  are  instituted,  while  such  influences  are 
suffered  to  exist.     If  special  regard  is  not  had  to  the  curative  iudica- 


SURGERY.  287 

tions,  most,  if  not  all  the  operations  upon  the  teeth,  which  have  for 
their  object  their  ultimate  preservation,  are  sure,  to  a  greater  or  less 
extent,  to  augment  all  of  the  previously  existing  local  affections,  hy 
increasing  the  irritability  of  the  parts,  and  by  rendering  them  more 
susceptible  of  being  acted  ujDon  both  by  local  and  constitutional  causes. 

"Without  indulging  in  further  prefatory  remarks,  I  shall  proceed 
to  notice  more  particularly  the  subject  under  consideration.  And  I 
would  here  observe,  that  an  experience  obtained  from  twenty-three 
years'  constant  practice,  has  fully  convinced  me,  not  only  of  the  pro- 
priety, but  of  the  absolute  necessity  in  the  treatment  of  caries  in  the 
lateral  surfaces  of  the  teeth,  of  employing  the  file.  There  is  no  instru- 
ment so  well  adapted  as  this  for  the  removal  of  the  disease  when  situ- 
ated in  these  parts  of  the  teeth,  especially  when  the  organs  are  in  close 
proximity  with  each  other;  or  for  the  removal  of  rough  and  weakened 
edges  of  the  enamel  in  deep-seated  caries,  and  for  making  sufficient 
space  or  room  for  the  removal  of  the  diseased  parts  preparatory  to 
plugging. 

"It  maybe  laid  down  as  a  rule,  from  which  exceptions  should  never 
be  taken,  that  the  file  should  not  be  used  while  the  teeth  or  their  con- 
tiguous parts  are  suffering  general  or  local,  acute  or  chronic,  inflamma- 
tion. Therefore,  when  this  is  the  case,  the  treatment  of  the  general 
and  local  affections  should  precede  the  operation  of  filing.  Upon  the 
removal  of  all  the  acute  or  chronic  diseases  of  the  mouth  greatly  de- 
pends the  success  of  the  dentist  in  the  treatment  of  affections  of  the 
teeth  calling  for  the  employment  of  the  file.  As  much  importance, 
therefore,  is  to  be  attached  to  an  enlightened  and  discriminating  judg- 
ment as  to  tact  in  the  performance  of  the  operation. 

"In  fact,  the  removal  of  all  local  causes  of  irritation  —  such  as 
dead  roots  of  teeth,  teeth  occasioning  alveolar  abscesses,  or  such  as 
exert  a  morbid  influence  upon  the  surrounding  parts,  and  all  deposi- 
tions of  salivary  calculus  or  other  foreign  matter  —  should  precede  all 
other  operations  upon  these  organs. 

"  The  length  of  time  necessary  for  the  restoration  of  the  parts  con- 
tiguous to  the  teeth  may  vary  from  a  few  days  or  weeks  to  as  many 
months,  depending  upon  the  nature  and  extent  of  the  disease,  the 
general  health  of  the  patient,  and  the  constitutional  as  well  as  local 
treatment  to  which  they  are  subjected. 

*'  In  assuming  the  position  that  filing  the  teeth  does  not,  of  necessity, 
cause  them  to  decay,  it  is  by  no  meians  to  be  inferred  that  the  opera- 
tion can,  in  all  cases,  and  under  all  circumstances,  be  performed  with 
advantage  or  even  impunity.  Its  effects,  like  those  of  most  other  opera- 
tions upon  the  teeth,  when  the  curative  indications  are  disregarded,  or 
not  properly  carried  out,  are  most  injurious.     The  employment  of  the 


288  SURGERY. 

file  at  an  improper  time  and  in  an  improper  manner,  increases  the 
liability  of  teeth  to  decay  ;  it  augments  the  irritability  of  all  tlie  parts 
adjacent  to  them,  and  consequently  their  susceptibility  of  being  acted 
upon  by  local  and  constitutional  causes. 

"The  principal,  and,  I  believe,  only  objection,  urged  against  filing 
the  teeth,  is  based  upon  the  erroneous  opinion,  that  the  loss  of  any  part 
of  the  enamel  of  these  organs  must  necessariiy  result  in  their  destruc- 
tion. But,  if  this  be  true,  ■why  is  it,  as  I  have  on  another  occasion 
asked,  that  the  negroes  of  Abyssinia  have  such  sound  teeth  as  they  are 
represented  to  have ;  since  it  has  long  been  a  custom  with  them  to  file 
all  their  front  teeth  to  points,  so  as  to  make  them  resemble  the  teeth 
of  a  saw  or  those  of  carnivorous  animals?  Of  course,  large  portions 
of  the  enamel  and  much  of  the  bony  structure,  must  be  removed  in 
the  oj)eration,  yet  we  are  credibly  informed  that  their  teeth  seldom 
decay.  The  same  may  be  said  of  the  Brahmins  of  India,  who,  from 
remote  ages,  have  been  in  the  habit  of  using  the  file ;  principally,  I 
believe,  for  separating  their  teeth,  yet  they  too  are  noted  for  having 
fine  teeth.  I  might  refer  to  the  people  of  other  countries,  with  whom 
the  same  practice  has  long  had  an  existence,  but  it  is  unnecessary  to  go 
abroad  for  proof,  when  we  have  such  an  abundance  of  it  at  home,  to 
establish  the  propriety  and  absolute  necessity  for  the  practice  I  am  now 
advocating. 

"With  the  people  just  referred  to,  it  is  evident  that  they  file  prin- 
cipally for  the  purpose  of  ornamenting  their  teeth  ;  we  use  it  only  as 
a  remedial  agent  in  the  treatment  of  disease.  The  reason  why  their 
teeth  are  not  so  subject  to  disease  as  are  those  of  the  inhabitants  of 
civilized  countries,  is  attributable  to  the  difference  in  their  habits  of 
life,  mode  of  living,  and  to  the  absence  of  the  causes  productive  of 
the  various  diseases  peculiar  to  civilization  and  refinement. 

"ISTotwithstanding  the  utility  and  value  of  the  operation,  filing  the 
teeth  may  be  regarded  as  a  predisposing  cause  of  caries.  If  this  be 
ti'ue,  it  may  be  asked,  why  file  at  all  ?  I  answer,  in  this  country, 
owing  to  the  prevalence  of  the  immediate  or  direct  cause  of  caries, 
the  operation  is  only  jierformed  as  remedial,  for  the  purpose  of  re- 
moving actual  disease  or  as  preparatory  to  plugging.  It  does  not,  of 
necessity,  follow  that  caries  of  the  teeth,  after  having  been  judiciously 
removed  or  treated,  although  the  organs  be  predisposed  to  the  disease, 
will  ever  again  occur.  The  general  system  often  escapes  the  develop- 
ment of  those  diseases  to  which  it  is* predisposed  through  life ;  so  also  do 
the  teeth.  If  the  operation  be  properly  performed,  and  the  filed  surfaces 
kept  thoroughly  clean,  a  recurrence  of  the  disease,  notwithstanding 
the  increased  predisposition  thus  induced,  will  never  take  place.  The 
immediate  cause  of  dental  caries  being  the  contact  of  corrosive  agents 


SURGERY.  289 

with  the  teeth,  the  necessity  for  tliis  precaution  is  obvious.  The  bony 
structure  of  these  organs  is  more  easily  acted  upon  by  such  causes 
than  the  enamel ;  for  this  reason,  when  it  becomes  necessary  to  expose 
it  with  a  file,  for  the  removal  of  disease,  it  should  be  done  in  such  a 
way  as  to  admit  of  its  being  kept  thoroughly  and  constantly  clean ; 
so  that,  if  it  afterward  becomes  carious,  it  will  be  owing  altogether  to 
inattention  of  the  patient.  In  view  of  this,  whenever  it  becomes  neces- 
sary to  file  the  teeth,  whether  for  the  complete  removal  of  caries,  or 
as  only  preparatory  to  plugging,  we  should  always  impress  upon  the 
patient  the  importance  of  cleansing  the  surfaces  thus  operated  upon 
at  least  three  or  four  times  every  day.  The  future  preservation  of 
the  organs  will  depend  upon  the  constant  and  regular  observance  of 
this  precaution,  especially  when  they  are  of  a  soft  or  chalky  texture, 
for  they  are  then  far  more  easily  acted  upon  by  decomposing  agents 
than  when  hard. 

"  The  cases  requiring  the  use  of  the  file  vary  so  much  that  it  woukf 
be  difficult  to  lay  down  precise  directions  with  regard  to  the  extent  to 
which  the  operation  should  be  carried.  This  must  be  determined  by 
the  judgment  of  the  operator.  The  design  of  the  operation  may  be 
defeated  either  by  filing  too  much  or  too  little.  Either  extreme  should 
be  avoided ;  but  it  is  my  opinion  that  by  far  the  greater  number  of 
unsuccessful  results  are  attributable  rather  to  the  too  moderate  than  to 
the  too  great  use  of  this  instrument,  especially  where  the  circumstances 
of  the  case  have  nothing  to  do  in  determining  the  result. 

"  It  is  not  my  object  to  describe  the  manner  in  which  teeth  should 
be  filed,  but  merely  to  offer  a  few  general  remarks  on  the  advantages 
that  result  from  it  when  the  operation  is  judiciously  performed ;  also 
to  show  that  it  is  from  the  abuse  of  the  file,  in  the  hands  of  the  igno- 
rant and  inexperienced  practitioner,  that  its  merits  have  been  so  often 
erroneously  estimated.  It  will  be  perceived,  from  the  foregoing  re- 
marks, that  its  utility  depends  upon  carrying  out  all  the  curative  indi- 
cations, and  that  it  should  never  be  resorted  to  except  in  the  absence 
of  disease  in  the  parts  with  which  these  organs  are  immediately  con- 
nected. Therefore,  to  estimate  the  merits-of  the  operation  correctly, 
we  should  know  all  the  circumstances  under  which  it  has  been  per- 
formed, the  conapetency  of  the  operator,  and  whether  he  was  permitted 
the  free  exercise  of  his  judgment.  The  dentist  is  often  called  upon  to- 
render  his  services  where,  from  the  timidity  or  ignorance  of  his  pa- 
tient, he  is,  if  he  consents  to  operate  at  all,  so  restricted  in  the  appli- 
cation of  his  remedies,  that  little,  if  anything,  more  than  temporary 
relief  can  be  afforded.  And  cases  may  occasionally  occur  in  which, 
from  unforeseen  circumstances,  even  after  the  most  skilful  manage- 
19 


290 


SURGERY. 


ment,  the  dentist  may  be  disappointed  in  his  expectations,  and  fail  in 
the  attainment  of  the  object  lor  which  his  services  were  solicited." 

It  is  scarcely  necessary  to  give  any  directions  with  regard  to  the 
manner  of  holding  the  file.  In  filing  the  front  teeth  and  those  on  the 
right  side  of  the  mouth,  the  operator  should  stand  to  the  right  and  a 
little  behind  the  patient,  in  order  to  steady  the  head,  as  it  rests  against 
the  back  of  the  operating  chair,  with  his  left  arm ;  while  with  the  fin- 
gers of  the  left  hand  the  lips  are  raised  and  the  teeth  properly  exposed 
for  the  operation.  In  filing  the  teeth  on  the  left  side  of  the  mouth,  it 
may  be  necessary  for  the  operator  to  stand  upon  the  left  side  of  his 
patient.  The  file,  firmly  grasped  between  the  thumb  and  middle  finger 
of  the  right  hand,  with  the  end  of  the  forefinger  resting  upon  its  outer 
end,  should  be  moved  backw^ard  and  forward  in  a  direct  line,  as  any 
deviation  from  this  would  immediately  snap  the  instrument.  The  first 
opening  between  the  teeth,  when  the  api^roximal  edges  of  the  two  are 
carious,  should  be  made  with  a  flat  file,  about  one-fourth  of  a  line  in 
thickness,  cut  on  both  sides  and  both  edges ;  this  done,  a  file  cut  on 
one  side  and  both  edges  should  be  employed  for  the  completion  of  the 
operation.  If  only  one  tooth  is  decayed,  the  operation  may  be  com- 
menced and  completed  with  a  safe-sided  file.  The  file,  during  the  ope- 
ration, should  be  frequently  dipped  in  tepid  water,  to  prevent  it  becom- 
ing heated  or  clogged  while  in  use ;  especially  should  the  water  be 
warm  or  tepid  where  the  teeth  are  sensitive.  When  the  files  become 
so  much  clogged  that  the  water  or  a  brush  will  not  cleanse  them,  a 
brass  or  steel  scratch-brush  may  be  used,  or  they  may  be  dipped  in 
sulphuric  or  chlorohydric  acid,  and  then  washed  with  the  greatest  care 
to  remove  every  trace  of  acid. 

Fig.  57. 


Fig.  57  represents  various  forms  of  the  thin  separating  file. 

To  secure  the  success  of  the  operation,  it  is  sometimes  necessary  to 
file  away  a  considerable  portion  of  the  tooth ;  but  in  doing  this,  the 
operator  should  be  careful  not  to  destroy  the  symmetry  of  the  labial 
.surface.  The  aperture,  anteriorly,  should  only  be  Avide  enough  to 
admit  of  a  free  oblique  or  diagonal  motion  of  a  safe-sided  file  of  about 


SURGERY. 


291 


one-fourth  of  a  line  in  thickness.  In  this  way,  one-fourth  or  more  of 
a  tooth  may  be  removed  without  materially  altering  its  external  ajD- 
pearance.  But  a  tooth  should  not  be  filed  entirely  to  the  gum ;  a 
shoulder  should  be  left,  to  prevent  its  approximation  to  the  adjoining 
tooth.  Sometimes  the  decay  is  of  such  size  and  so  situated,  that  it 
may  be  removed  by  means  of  enamel  chisels,  with  less  alteration  in 
the  external  or  labial  surface  of  the  tooth.  These  vexy  valuable  instru- 
ments will  also  be  found  useful  for  rapid  cutting  preparatory  to  the 
slower  action  of  the  file.  A  rounded  form  can  be  given  by  them  to 
the  inner  angles  of  the  teeth,  for  which  purpose  they  may  either  follow 
or  take  the  place  of  the  file. 

Fig.  58. 

h 


n 


Fig.  58  represents  a  set  of  enamel  chisels,  straight  and  curved,  by 
which  the  operation  of  removing  a  portion  of  the  crown  of  a  tooth 
can  be  performed  much  more  rapidly  than  by  the  file,  and  also  with 
more  comfort  to  the  patient. 

When  operating  upon  the  front  teeth  with  the  enamel  chisel,  the 
instrument  should  be  firmly  grasped  in  the  hand,  and  its  edge  applied 
to  the  surface  of  the  portion  to  be  removed,  while  at  the  same  time  the 
point  of  the  thumb  uses  as  a  fulcrum  the  cutting  edge  of  the  tooth  or 
the  one  adjoining. 

For  operating  upon  the  bicuspid  and  molar  teeth,  heavier  enamel 
chisels  are  required  than  in  the  case  of  the  front  teeth,  and  Avith  either 
straight  or  oblique  cutting  edges.  The  curved  form  of  chisel  is  useful 
when  the  moutli  is  small,  and  it  is  difiicult  to  reach  the  point  desired 
with  the  straight  form. 

When  the  decay  occupies  a  large  portion  of  the  approximal  surface, 
and  has  penetrated  into  the  tooth  to  a  considerable  depth,  destroying 
the  enamel  anteriorly,  and  causing  it  to  present  a  ragged  and  uneven 


292 


SURGERY. 


Fig.  59. 


^; 


'^^iLJLJL^' 


J 


edge,  it  will  be  nocc^sary  to  form  ii  wider  exterior  aperture  than  mere 
regard  for  appearauee  would  dictate.  When  the  aj)proxiinal  i^urfaces 
of  the  two  I'ront  teeth  are  alil'cted  with  caries,  about  an  equal  jjortion 
should,  if  circumstances  permit,  and  it  is  necessary  to  cut  away  tooth 
substance,  be  filed  or  cut  from  each  tooth.  In  the  case  of  delicate 
front  teeth,  or  teeth  slightly  loose  in  their  sockets,  it  will  be  well  before 
filing  to  mould  a  small  piece  of  gutta-percha  around  or  against  the 
inner  surfaces  of  the  tooth  to  be  filed  and  several  adjoining  ones.  It 
gives  support  to  frail  teeth,  and  greatly  lessens  the  danger  of  irritation 
from  the  motion  imparted  by  the  file  to  teeth  which  are  not  firmly  set 
in  their  sockets.  Some  use  for  this  purpose  plaster;  but  we  think  the 
gutta-percha,  as  suggested  by  Prof.  Gorgas,  will  be  found  altogether 
more  conveniently  applied  and  more  agreeable  to  the  patient. 

Fig.  59  represents  a  front  view  of  the  superior  incisors  and  cuspids 
after  having  been  filed,  showing  the  shoulder  left  near  the  gum  ;  which, 
however,  should  not  have  the  sharp  angle 
represented  in  the  drawing.  To  prevent 
this,  the  operation  may  be  completed  with  a 
round-edged  separating  file,  or  else  with  a 
delicate  mouse-tail  file. 
After  asuflScient  portion  of  the  tooth  has  been  filed  away,  the  sur- 
face should  be  made  as  smooth  as  possible  with  a  very  fine  or  half 
worn  file,  or  with  Arkansas  stone,  finishing  with  pumice-stone  or  pow- 
dered silex,  applied  upon  a  piece  of  cord,  tape,  or  suitably  shaped  piece 
of  hard,  tough  wood.  All  edges  and  sharji  corners  should  be  rounded 
and  made  smooth,  and  when  the  operation  is  completed,  the  patient 
should  be  directed  to  keep  the  filed  surfaces  perfectly  clean ;  for  if  the 
mucous  secretions  of  the  mouth  or  extraneous  matter  is  permitted  to 
adhere  to  them,  a  recurrence  of  the  disease  will  take  place. 

In  Fig.  GO  is  represented  a  poste- 
rior view  of  the  superior  incisors  and 
cuspids  after  having  been  filed ;  also, 
of  the  bicuspids  and  molars  after 
having  been  subjected  to  the  same 
operation. 

In  separating  the  bicuspids  by 
filing,  a  space  should  be  made  some- 
what in  the  form  of  the  letter  V;  it 
should  not,  however,  form  an  acute 
angle  at  the  gum.  For  its  forma- 
tion, a  file  shaped  like  a  clockma- 
ker's  pinion-file,  or  one  that  is  oval 
on  one  side  and  flat  on  the  other,  will  be  found  most  suitable.     A 


Fig.  go. 


SURGERY. 


293. 


space  shaped  in  this  maimer  will  prevent  the  approximation  of  the 
sides  of  the  teeth,  and  if  filling  be  necessary,  it  will  enable  the  operator 
to  do  it  in  the  most  perfect  manner. 

When  the  separation  of  the  molar  teeth  in  this  manner  becomes  ne- 
cessary, the  same  shaped  space  should  be  formed.  But  as  these  teeth 
are  situated  far  back  in  the  mouth,  it  cannot  often  be  done  with  a 
straight  file  ;  to  obviate  this  difficulty,  an  instrument,  with  which  every 
dentist  is  acquainted,  denominated  a  file-carrier,  is  usually  employed. 
But  in  consequence  of  the  difficulty  of  procuring  instrum.ents  of  this 
kind  exactly  suited  to  holding  files  of  the  right  shape,  the  author,  a 
number  of  years  ago,  sent  some  file  patterns  to  Stubs'  manufactory,  in 
England,  and  had  files  made,  which  he  found  to  answer  his  fullest 
expec^tations.    These  files  (Fig.  61)  are  shaped  something  likea  pinion- 

■  Fig.   G1. 


file:  they  are  an  inch  and  a  half  long,  and  have  a  handle  of  about  six 
inches  in  length,  bent  in  such  a  manner  that  the  instrument  may  be 
tised  between  the  molar  teeth  without  interfering  with  the  corners  of 
the  mouth.  They  are  in  pairs  —  one  for  the  right  and  one  for  the  left 
side  of  the  mouth.  Two  patterns  are  represented  ;  the  upper,  in  con- 
sequence of  the  handle  being  on  a  line  with  the  file,  works  more  easily 
than  the  lower  one. 

A  great  variety  of  V-shaped  separating  files  are  now  to  be  found  in 
the  dental  dej)ots,  from  English,  French,  and  American  manufacturers. 
Fig.  62  will  give  a  correct  idea  of  some  of  these  shapes. 

Fig.  62. 


294 


SURGERY. 


Fig.  63   represents   a  very  useful   file-carrier  invented   by  Dr.   A. 
Westcott :  eis  a  spring,  and  through  the  arms  a  and  h  there  are  square 


Fig.  G3. 


■»i|i|.''l!iwll!IIIMII|i|!l|li!lllliriilllWV 


mortices  to  receive  the  ends  of  the  file  and  to  keep  it  from  turning. 
The  arm  6  comes  off  at  an  obtuse  angle.  The  file  is  prepared  by 
making  each  end  square,  corresponding  with  the  size  of  the  mortices 
in  the  arms,  and  is  adjusted  to  the  carrier  by  first  putting  one  end  of 
tlie  file  into  the  arm  a,  and  pressing  down  the  other  end  into  the  mor- 
tice b;  the  spring,  constituting  that  j)ortion  of  the  instrument  between 
the  arms,  yields  sufficiently  to  admit  of  this.  It  is  so  constructed  that 
the  handle  is  brought  on  a  line  with  the  file  ;  consequently  two  are 
required,  one  for  each  side  of  the  mouth. 

Fig.  64. 


Fig.  64  represents  an  excellent  file-carrier,  in  which  the  file  can  with 
ease  be  set  at  any  required  angle,  and  will  suit  either  side  of  the 
mouth. 

Fig.  65. 


Fig.  65  represents  one  of  the  best  forms  of  file-carrier  in  use,  in- 


FILLING    TEETH.  295 

vented  by  Dr.  W.   G.  Redman.     This   instrument   may   be   readily 
changed  from  one  side  to  the  other,  and  retains  the  file  very  firmly. 

Fig.  66. 


Fig.  66  represents  another  form  of  file-carrier  to  which  the  file  is 
very  readily  adjusted. 

For  separating  the  teeth  to  obtain  space  for  the  free  use  of  the  in- 
struments employed  in  preparing  and  filling  cavities  on  the  approximal 
surfaces,  the  reader  is  referred  to  the  chapter  on  filling  teeth. 


CHAPTER  II. 

FILLING   TEETH. 


THIS  is  one  of  the  most  difficult  operations  the  dentist  is  called 
upon  to  perform  ;  it  often  baffles  the  skill  of  opei^ators  who  have 
been  in  practice  many  years.  It  is  advisable  only  under  certain  cir- 
cumstances, and  when  the  operation  is  performed  without  due  regard 
to  these,  it  may  be  productive  of  injury  rather  than  benefit.  It  is  the 
only  certain  remedy  that  can  be  applied  for  arresting  the  progress  of 
deep-seated  caries ;  but  to  be  effective,  it  must  be  executed  in  the  most 
thorough  and  perfect  manner.  The  preservation  of  a  tooth  may  be 
regarded  as  certain  when  well  filled,  and  with  a  suitable  material,  if  it 
be  afterward  kept  constantly  clean.  At  any  rate,  it  will  never  again 
be  attacked  by  caries  in  the  same  place. 

On  this  highly  important  operation.  Dr.  E.  Parmly  thus  remarks: 
"  If  preservation  is  as  good  as  a  cure,  this  is  as  good  as  both ;  for  the 
operation  of  filling,  when* thoroughly  performed,  is  both  preservation 
and  cure.  And  yet  it  must  never  be  forgotten,  that  this  assertion  is 
true  only  in  those  instances  in  which  the  operation  is  well  and  properly 
done ;  and  perhaps  it  is  imperfectly  and  improperly  performed  more 
frequently  than  any  other  operation  on  the  teeth. 

"  There  are  reasons  for  this  fact,  into  which  every  ambitious  and 
honorable  practitioner  will  carefully  inquire.  Although  the  books 
are  explicit  on  this  point,  I  deem  it  sufficiently  important  to  deserve  a 
few  additional  remarks.  The  following  considerations  are  essential, 
and,  therefore,  indispensable  to  success  in  this  department  of  practice. 


296  FILLING    TEETH. 

Firstly.  The  instruments  used  must  be  of  the  proper  construction  and 
variety.  Secondhj.  The  metal  employed  must  be  properly  prepared  as 
well  as  propei'ly  introduced.  Thirdhj.  The  cavity  which  receives  the 
metal  must  be  so  shaped  as  to  retain  it  in  such  a  manner  as  to 
exclude  not  only  solids,  but  all  fluids,  and  even  the  atmosphere  itself. 
Fourthly.  The  surface  of  the  metal  must  be  left  in  such  condition  as  to 
place  it  beyond  the  reach  of  injury  from  food  and  other  mechanical 
agents  with  which  it  necessarily  comes  in  contact.  Fifthly.  The  tooth 
tlius  filled  should  be  free  from  pain  and  every  known  cause  of  internal 
inflanimatiou." 

It  is  important  that  the  operation  be  pei-formed  before  the  disease 
has  reached  the  pulp-cavity ;  after  this,  the  permanent  preservation  of 
the  tooth  may  be  regarded  as  more  or  less  questionable.  Still,  under 
favorable  circumstances,  the  author  believes  it  may,  in  the  majority  of 
cases,  be  performed  with  success.  But,  as  the  propriety  and  manner  of 
filling  a  tooth  after  the  pulp  has  become  exposed,  will  hereafter  come 
up  for  special  consideration,  as  well,  also,  as  the  operation  of  filling  the 
pulp-cavity  after  the  destruction  of  the  puljD,  it  will  not  be  necessary 
to  enlarge  upon  these  subjects  at  this  time. 

A  tooth  is  sometimes  exceedingly  sensitive  when  the  nerve  is  not  ex- 
posed ;  but,  in  the  majority  of  cases,  this  need  not  deter  the  operator 
from  removing  the  decayed  j)Sivt  and  filling  the  cavity,  for  the  inflam- 
mation of  the  dentine  may  be  confined  to  a  thin  lamina  directly 
beneath  the  carious  matter,  and  the  only  inconvenience  it  will  occa- 
sion the  patient,  will  be  a  little  suffering  during  the  operation,  and 
slight  momentary  pain  for  a  few  days,  whenever  anything  hot  or  cold 
is  taken  into  the  mouth.  But  when  the  sensibility  is  so  great,  owing 
to  the  inflammation  extending  deep  into  the  structure  of  the  dentine, 
that  the  patient  cannot  bear  the  removal  of  the  diseased  part,  as  occa- 
sionally occurs,  it  may  be  allayed  by  the  application  of  chloride  of 
zinc  to  the  cavity  of  the  tooth,  for  from  three  to  six  minutes.  When 
this  is  done,  care  should  be  taken  to  prevent  it  from  coming  in  contact 
with  any  of  the  soft  .parts  of  the  mouth,  on  account  of  its  active  escha- 
rotic  properties.  The  fortieth  or  fiftieth  part  of  a  grain  of  arsenic  is 
sometimes  applied,  and  allow^ed  to  remain  from  one  to  three  hours  ;  but 
there  is  great  danger  of  destroying  the  vitality  of  the  pulp  by  the  use 
of  this  agent,  even  though  it  be  permitted  to  remain  for  only  a  few 
hours.  Cobalt  is  said  to  be  less  dangerous  and  equally  efficacious. 
Tannin  or  tannic  acid  in  alcoholic  solution,  or  in  creosote  and  glycerin, 
are  valuable  applications  for  this  pathological  condition  of  the  dentine. 
Nitrate  of  silver,  chromic  acid,  and  the  terchloride  of  gold  are  also 
Used  for  the  same  purpose  —  the  nitrate  being  applied  in  either  a  solid 
form  or  in  a  concentrated  solution ;  and  while  it  affects  the  dentine  to  a 


FILLING    TEETH.  297 

<^reater  depth  than  either  the  tannic  acid  or  chloride  of  zinc,  yet  its 
action  is  not  so  painful  as  the  latter. 

Creosote  and  carbolic  acid  are  extensively  used  for  this  condition  of 
dentine,  and  are  among  the  safest  of  these  agents. 

Friction,  by  means  of  a  burnisher,  is  also  recommended  as  being  effect- 
ual where  the  position  of  the  sensitive  surface  will  permit  of  its  use. 

Chloroform  applied  to  the  cavity  on  a  small  piece  of  cotton  will  often 
give  a  temporary  insensibility,  and  has  the  merit  of  being  quite  harm- 
less;  which  cannot  be  said  of  chloride  of  zinc,  arsenic,  or  cobalt  —  the 
first  sometimes  acting  injuriously  upon  the  dentine,  the  two  latter  upon 
the  dental  pulp.  The  safest  and  perhaps  best  way  of  meeting  the  difii- 
culty  is  to  have  the  excavators  very  sharp  and  well  tempered,  and  to  cut 
firmly  and  decidedly, — for  the  scraping  of  a  dull  instrument  is  quite  as 
painful  as  the  cut  of  a  sharp  one, —  and,  after  removing  irritants  from  the 
sensitive  surface  and  properly  preparing  the  cavity  to  fill  it  with  a  non- 
conducting substance,  such  as  Hill's  stopping,  prepared  gutta-percha,  or 
os-artificiel,  which  is  allowed  to  remain  until  the  dentine  is  restored  to  a 
normal  condition.  Should  it,  however,  be  necessary  to  fill  the  cavity 
with  a  more  permanent  material,  such  as  metal,  and  the  inflammation 
is  confined  to  a  portion  of  the  dentine,  this  may  be  protected  by  a  layer 
of  the  non-conducting  material,  and  the  metal  introduced  over  it. 

Again,  this  acute  sensitiveness  of  dentine  is  due  to  the  presence  of 
nerve  fibres,  as  conjectured  by  Dr.  Maynard,  and  demonstrated  by 
Prof.  Johnston;  therefore,  we  shall  save  the  patient  much  suffering 
by  making  the  first  strokes  of  the  instrument  in  such  direction  as  to 
sever  these  fibres,  as  recommended  by  Dr.  Maynard. 

MATERIALS    EMPLOYED    FOR   FILLING   TEETH. 

Among  the  articles  which  have  been  employed  for  filling  teeth,  are 
gold,  platina,  silver,  tin,  lead;  fusible  alloys  of  tin,  lead,  bismuth,  and 
cadmium  ;  amalgams,  gutta-percha,  oxy chloride  of  zinc,  and  various 
preparations  of  the  gum  resins.  Of  these  no  single  on§  can  be  said  to 
unite  all  the  requirements  of  a  perfect  material  for  filling,  which  may 
be  enumerated  :  1.  Resistance  to  the  mechanical  action  of  mastication. 
2.  Resistance  to  the  chemical  action  of  the  mouth.  3.  Facility  of  in- 
troduction and  consolidation.  4.  Harmony  of  color.  5.  Absence  of  all 
galvanic,  chemical,  or  vital  action  upon  the  teeth  or  the  general  system. 
6.  Absence  of  all  heat-conducting  property. 

Gold  Foil.  —  To  the  use  of  this  material,  when  properly  prepared, 
there  is  the  least  possible  objection :  perfectly  answering  the  first,  second, 
and  fifth  requirements  ;  to  a  great  extent  the  third,  if  in  skilful  hands; 
but  deficient  in  the  fourth  and  sixth.  It  is  the  only  one,  in  the  opinion 
of  the  author,  which  should  ever  be  employed  for  the  permanent  filling 


298  FILLING    TEETH. 

of  teeth.  No  better  material  is  wanted  for  the  operation.  A  tooth 
may  be  so  filled  with  it  as  to  secure,  iu  almost  every  case,  its  permanent 
preservation.  It  ehould,  however,  be  perfectly  pure,  be  beaten  into 
thin  leaves,  and  well  annealed,  by  the  manufacturer,  before  it  is  used. 
"When  prepared  in  this  manner,  it  may  be  pressed  into  all  the  inequal- 
ities of  the  cavity,  and  rendered  so  firm  and  solid  as  to  be  irai^ermeable 
to  the  fliuids  of  the  mouth.* 

Although  there  may  be  no  difference  iu  the  purity  of  the  gold  and 
the  thickness  of  the  leaves,  yet  a  marked  difference  will  be  found  to 
exist  in  the  malleability  and  toughness  of  the  foil  of  different  beaters. 
The  art  of  preparing  gold  for  filling  teeth  is  an  exceedingly  nice  and 
difficult  oue,  and  is  believed  to  have  attained  greater  perfection  in  the 
United  States  than  in  any  other  country ;  at  least  this  fact  is  so  generally 
admitted,  that  many  of  the  most  eminent  European  practitioners  pro- 
cui-e  nearly  all  they  use  from  Mr.  Charles  Abbey,  of  Philadelphia,  the 
oldest  manufacturer  in  America.  There  are,  however,  many  other 
gold-beaters  in  the  United  States  who  manufacture  gold  foil  of  a  very 
excellent  quality. 

The  thickness  of  the  leaves  is  determined  by  the  number  of  grains 
each  contains,  and  is  designated  by  numbers  on  the  books,  between  the 
leaves  of  which  they  are  placed,  after  having  been  properly  annealed. 
These  numbers  range  from  4  to  20.  The  Aveight  of  the  leaves,  gen- 
erally, varies  two  grains,  so  that  the  numbers  run  4,  6,  8, 10,  and  so  on 
up  to  20.  A  book  containing  a  quarter  of  an  ounce  of  No.  4,  will  have 
thirty  leaves  in  it.  Some  dentists  use  foil  varying  in  numbers  from 
4  up  to  20,  and  even  of  late  to  120,  while  others  confine  themselves  to 
a  single  number.  If  but  one  number  of  the  non-adhesive  be  used,  4 
"will,  perhaps,  be  found  better  than  any  other.  The  author  has  used 
Nos.  4,  6,  8,  10,  and  15,  but  he  prefers  the  first,  and  is  decidedly  of 
opinion,  that  in  a  large  majority  of  cases,  a  better  filling  can  be  made 
Avith  it  than  any  of  the  others.  There  may  be  cases  in  which  higher 
numbers  can  be  more  advantageously  employed  ;  as  for  instance  in 
root  filling,  and  in  cavities  which  are  either  very  large  or  very  small. 

Adhesive  Gold  Foil.  —  This  is  a  preparation  of  leaf  gold  which 
possesses  the  property  of  cohesion  to  such  a  degree  that  the  leaves 

*  It  would  seem  from  what  Fauchard  says  upon  the  subject  (Le  Chirurgien 
Dentiste,  tome  2,  pp.  68-70),  that  this  metal,  to  some  extent  at  least,  has  been 
used  for  filling  teeth  for  a  long  time.  Although  he  gives  the  preference  to  tin 
and  lead,  on  account  of  the  greater  malleability  of  these  raetals,  he  speaks  of 
gold  as  being  used  by  other  dentists.  But  the  operation  of  filling  teeth,  at  the 
time  this  author  wrote,  was  very  imperfectly  understood,  and  the  gold  then  em- 
ployed for  the  purpose  must  have  been  so  badly  prepared  as  to  render  its  use 
e-iceedingly  difficult. 


FILLING    TEETH.  299 

readily  and  firmly  unite  on  being  pressed  together  with  moderate 
force. 

Although  one  or  t\A'o  others  claim  priority  in  the  discovery  of  the 
advantages  now  derived  from  the  use  of  adhesive  gold  foil,  yet  the 
credit  is  certainly  due  to  Dr.  Robert  Arthur,  as  he  was  not  only  the 
first  to  demonstrate  the  applicability  of  this  form  of  gold  in  filling 
teeth,  but  in  a  series  of  well  written  articles  *  he  overcame  the  objec- 
tions which  were  at  first  urged  against  it,  and  proved  that  its  great 
cohesive  property  rendered  it  a  valuable  adjunct  in  the  preservation  of 
the  teeth.  This  form  of  foil  is  so  adhesive  that  any  number  of  pieces 
may  be  welded  one  to  another ;  thus  a  part,  or  even  the  whole  of  the 
crown  of  a  tooth,  may  be  built  up  with  it.  The  same  property  may 
also  be  imparted  to  foil  manufactured  in  the  ordinary  way,  by  re- 
annealing.  This  property  is  peculiarly  valuable  in  many  cases  where 
it  becomes  necessary  to  build  up  a  large  portion  of  the  crown  of  a 
tooth  ;  but  when  it  is  used,  instruments  having  serrated  points  are  re- 
quired, like  those  employed  in  the  use  of  crystal  or  sponge  gold. 

Crystal  or  Sponge  Gold  has  been  employed  by  dentists  for  filling 
teeth  for  a  number  of  years.  The  author  has  used  it  in  a  number  of 
cases  with  very  satisfactory  results.  Since  the  publication  of  the  fifth 
edition  of  this  work,  the  properties  of  crystal  or  sponge  gold  have  been 
more  thoroughly  and  extensively  tested,  and  the  result  has  fully  con- 
firmed the  favorable  opinion  entertained  by  us  with  regard  to  its  value. 
Those  who  have  had  most  experience  in  the  use  of  it  say  it  is  superior, 
in  many  cases,  to  foil.  The  author  is  acquainted  with  several  of  the 
most  skilful  operators  in  the  United  States,  who  have  used  it  almost 
exclusively  in  their  practice  for  several  years ;  and  has  seen,  fillings 
made  by  some  of  these  gentlemen,  which  for  beauty  and  solidity  he 
does  not  think  could  be  surpassed.  He  has  also  himself  made  some 
fillings  with  this  material,  which  he  believes  it  would  be  impossible  to 
make  wdth  ordinary  gold  foil.  This  form  of  gold  has  a  spongy  texture, 
being  composed  of  crystals,  and  widely  differs  from  foil  or  leaf  gold. 
The  crystals  possess  the  property,  wdien  pressed  firmly  against  each 
other,  of  welding  and  becoming  as  solid  and  almost  as  incapable  of 
disintegration  or  crumbling  as  a  piece  of  bullion  or  coin.  This  prop- 
erty enables  a  skilful  manipulator  to  supply  almost  any  loss  which 
a  tooth  may  have  sustained,  even  to  the  building  up  of  an  entire 
crown.  Still,  it  will  never  supersede  the  use  of  adhesive  and  non-adhe- 
sive gold  foils,  as  there  are  many  eases  in  which  leaf  gold  can  be  used 
more  advantageously  and  with  more  facility.  Nor  will  the  employment 
of  it,  in  the  opinion  of  the  author,  ever  become  universal ;  for  the 

*  A  Treatise  on  the  Use  of  Adhesive  Gold  Foil,  18-57. 


300  FILLING    TEETH. 

reason  that  more  care  and  skill  are  required  to  make  a  good  filling 
with  it  than  with  leaf  gold,  especially  when  the  cavity  in  the  tooth  is 
difficult  of  access.  Filling  with  crystal  gold  is  more  tedious  than  the 
same  operation  with  ordinary  foil.  Again,  the  necessity  of  excluding 
saliva  from  the  filling  during  the  operation  is  imperative;  for  the 
slightest  moisture  destroys  the  adhesiveness  of  the  material,  upon  which 
depends  the  success  of  the  operation. 

Experiments  have  been  made  with  silver,  platina,  and  aluminium ; 
but  with  unsatisfactory  results.  They  are  less  malleable  than  gold, 
and  therefore  cannot  be  made  so  thin  ;  at  the  same  time  they  have  not 
the  softness  of  tin  ;  hence  tliey  work  harshly  under  the  plugger.  But 
for  this,  platina  would  prove  a  very  valuable  material.  An  additional 
objection  to  silver  is  its  liability  to  undergo  chemical  change,  being  in 
this  respect  greatly  inferior  to  pure  tin.  The  peculiarity  of  aluminium, 
in  this  relation,  is  the  impossibility  of  welding  its  leaves  by  jiressure : 
even  under  the  gold-beater's  hammer  it  forms  loose  scales,  which  no 
annealing  can  make  adherent. 

Tin  Foil. —  This,  when  chemically  pure  and  properly  prepared,  is 
less  objectionable  for  filling  teeth  than  most  of  the  articles  hereafter 
enumerated.  Under  favorable  cii'cumstances,  if  skilfully  introduced, 
it  will  prevent  the  recurrence  of  caries.  But  if  the  fluids  of  the 
mouth  are  vitiated,  it  soon  oxidizes  and  turns  black  ;  and  then,  instead 
of  preventing,  it  rather  promotes  a  recurrence  of  the  disease.  This, 
with  the  author,  has  constituted  an  insuj)erable  objection  to  its  use. 
As  an  excuse  for  its  employment,  however,  many  operators  say  that, 
in  consequence  of  its  greater  softness,  it  can  oftentimes  be  employed 
for  filling  a  badly-shaped  and  large  cavity  where  gold  cannot  be  used. 
We  do  not,  however,  regard  this  as  a  valid  objection ;  for  any  tooth 
that  can  be  filled  with  tin,  can  be  equally  well  filled  with  gold.  Others 
again  employ  it  because  many  of  their  patients  are  not  able  to  pay 
for  a  more  costly  material.  Now,  if  a  tooth  is  worth  filling  at  all,  it 
is  worth  filling  in  a  proper  manner,  and  with  a  suitable  material,  and 
it  would  be  more  creditable  to  the  operator  to  divide  the  expense  with 
his  poor  patient,  than  to  use  an  article  that  may  never  benefit  him. 

Lead  is  far  more  objectionable  than  tin,  as  it  is  more  easily  decom- 
posed by  the  secretions  of  the  mouth  ;  its  introduction  into  the  stomach 
might  be  productive  of  serious  injury  to  the  general  health  of  the 
patient.  But,  happily,  this  article  is  now  seldom  used,  except  by  the 
most  ignorant  and  lowest  class  of  empirics. 

U  Areet\s  and  Wood's  Metals. —  D'Arcet's  metal,  an  alloy  of  tin, 
lead,  and  bismuth,  was  once  empirically  used  in  a  fused  state.  But 
two  serious  objections  compelled  its  abandonment.  The  high  tempera- 
ture (212°)  caused  great  pain  and  excited  inflammation.     If  from 


FILLING    TEETH.  301 

this  cause  the  tooth  was  not  lost,  the  shrinkage  of  the  metal  on  cooling 
admitted  moisture  into  the  cavity,  and  the  decay  progressed. 

The  attention  of  the  profession  has  recently  been  called  to  a  some- 
what similar  alloy,  discovered  by  Dr.  B.  Wood.  The  feature  of  Dr. 
Wood's  discovery  is  the  remarkable  property  of  cadmium  in  reducing 
the  fusion  point  of  the  fusible  alloys.  This  overcomes  in  good  measure 
the  first  objection  against  D'  Arcet's  metal,  and  the  second  perhaps 
altogether.  It  may  be  introduced  in  properly  sized  pieces,  cold  ;  then 
made  plastic  and  pressed  to  place  with  blunt  instruments  suitably 
shaped  and  heated  to  the  proper  temperature.  Over  a  sensitive  pulp 
a  layer  of  non-conducting  asbestos  may  be  interposed.  We  cannot 
speak  from  any  experience  in  its  use,  but  should  think  that  it  might 
be  experimented  with  in  certain  cases,  where  the  use  of  gold  is  inad- 
missible, and  where  there  is  little  or  no  danger  of  irritation  from  the 
elevated  temperature  necessary  to  its  use. 

Amalgam,  also  known  by  the  name  of  mineral  cement,  or  litJiodeon, 
is  now  comjDOsed  of  about  equal  parts,  by  weight,  of  banca  tin,  silver, 
jjure  as  coin,  and  a  little  platinum.  These  metals  are  melted  iu  a  cru- 
cible and  poured  into  ingots,  which  are  then  cut  up  with  a  file  into 
filings.  These  filings  are  mixed,  after  the  cavity  in  the  tooth  is  pre- 
pared for  the  filling,  with  about  thirty-three  and  one-third  per  cent, 
of  distilled  mercury,  and  incorporated  to  the  consistency  of  a  thick 
paste.  The  mass  is  then  thoroughly  washed  with  alcohol,  to  which  is 
added  a  few  drops  of  a  strong  solution  of  chloride  of  zinc.  The  ex- 
cess of  mercury  is  then  removed  by  twisting  the  mass  in  a  piece  of 
chamois  skin  or  strong  muslin.  It  is  also  recommended  to  press  the 
mass  quite  thin,  after  it  is  removed  from  the  chamois  skin,  with  a 
strong  pair  of  flat  pliers,  in  order  to  remove  still  more  of  the  mercury. 
When  this  is  done,  it  may  be  necessary,  in  introducing  the  amalgam 
into  the  cavity,  to  heat  the  point  of  the  condensing  instrument,  in 
order  to  soften  the  material  and  bring  to  the  surface  any  excess  of 
mercury  which  may  yet  remain  in  it.  The  cavity  should  be  prepared 
with  as  much  care  as  for  a  gold  filling,  and  moisture  prevented  from 
coming  in  contact  with  it.  When  the  cavity  approaches  near  to  the 
pulp,  some  non-conducting  substance  should  be  applied  between  the 
amalgam  and  the  bottom  of  the  cavity.  After  the  filling  has  become 
sufficiently  hard,  its  surface  should  be  carefully  finished  by  filing  and 
burnishing. 

Fig.  67  represents  a  set  of  what  are  known  as  Arrington's  amalgam 
instruments. 

The  objections  urged  against  amalgam  are,  that  it  oxidizes  and 
blackens ;  that  the  tooth  structure,  with  which  it  remains  in  contact, 
becomes  discolored  ;  that  it  contracts  in  hardening,  allowing  the  secre- 


302 


FILLING    TEETH. 


tious  to  make  their  way  around  the  filling.     The  use  of  amalgam  is 
contra-indicated  in  all  teeth  which  can  be  filled  with  either  gold  or 

Fig.  67. 
MK        .4=>^         t^X      Q 


tin  foil ;  in  the  front  teeth  on  account  of  its  color ;  in  approximal  sur- 
face cavities  of  bicuspids  and  molars,  as  these  cavities  are  the  most 
difficult  to  properly  protect,  and  hence  should  not  be  filled  with  any 
but  the  best  matei'ial  in  use;  in  pulp  cavities;  in  contact  with  gold 
fillings.  On  the  other  hand,  the  use  of  amalgam  is  indicated  in  teeth, 
the  crowns  of  which  are  mere  shells  —  so  far  gone  that  nothing  else 
will  answer,  and  it  is  desirable  to  preserve  them  for  a  short  time. 

That  it  is  a  very  convenient  material ;  can  be  put  where  gold  can- 
not; becomes  very  hard,  and  may  last  for  many  years,  we  doubt  not; 
but  nothing  we  have  seen,  read,  or  heard,  can  persuade  us  that  the 
profession  would  not  have  been  benefited  if  mercurial  amalgams  had 
never  been  known. 

Gum  Elastic,  at  one  time  much  used,  is  now  seldom  employed,  except 
as  a  temporary  filling  when  the  pulp  of  the  tooth  is  exposed ;  even  for  this 
purpose  it  requires  to  be  often  renewed,  as  it  is  soon  dissolved  by  the  saliva. 

An  alcoholic  solution  of  Gum  Samlarach  or  Mastic  is  sometimes 
used  to  retain  arsenical  preparations  in  the  cavity  for  the  destruction 
of  a  nerve.  A  piece  of  cotton  saturated  with  the  solution  is  readily 
introduced,  hardens  quickly,  and  may  keep  its  place  for  several  days 
if  required. 

Guita-Percha  and  HilVs  Stopping. — Gutta-percha  is  an  excellent 
material  for  temporary  fillings.  It  may  be  made  harder,  whiter, and  less 
contractile  by  incorporating  with  it  some  very  fine  powder  of  felspar, 
silex,  lime,  or  magnesia.  A  very  excellent  preparation  known  as 
Hill's  stopping  is  made  by  mixing  gutta-percha  with  as  much  of  the 
following  powder  as  it  will  hold  without  becoming  brittle  :  quicklime, 


FILLING-    TEETH.  303 

two  parts,  very  fine  quartz  and  felspar,  one  part  each.  Of  all  tem- 
porary fillings  this  is  probably  the  best  yet  known.  Prepared  gutta- 
percha and  Hill's  stopping  are  introduced  by  first  warming  on  a  por- 
celain or  metal  slab,  over  an  alcohol  lamp,  until  the  mass  is  plastic 
enough  to  be  readily  pressed  into  the  cavity  and  to  adhere  to  its  walls. 
As  soon  as  the  cavity  is  filled,  an  instrument,  having  a  condensing 
point  large  enough  to  cover  the  entire  surface  of  the  filling,  should  be 
applied  and  kept  in  position  until  the  mass  has  become  cool. 

The  surface  of  the  filling  is  then  cut  down  and  burnished,  after 
which  a  little  chloroform  may  be  applied  by  means  of  a  camel's-hair 
brush,  to  complete  the  finishing  process. 

Os-Artificiel — Oxychloride  of  Zinc. — A  mixture  of  chloride  of  zinc  and 
oxide  of  zinc  has  been  lately  much  used  under  the  various  names  of  oxy- 
chloride of  zinc,  os-artificiel,  osteo-dentine,  osteo-plastic,  mineral  paste,  etc. 
Quackery  has  seized  it  with  eagerness,  and  plastered  up  many  teeth  with 
a  mortar  even  more  conveniently  used  than  amalgam.  Although  in 
some  few  cases  it  may  resist  the  action  of  the  secretions  of  the  mouth,  it 
will  not  answer  for  a  permanent  filling.  The  friction  of  mastication  soon 
destroys  it,  so  that  for  temporary  fillings  it  answers  a  better  purpose  in 
approximal  surface  cavities  than  in  those  on  the  grinding  surfaces. 
Frequently  it  crumbles  away  in  a  few  weeks  or  months.  Still,  as  a 
temporary  filling,  it  may,  if  employed  with  caution  and  judgment,  be 
found  useful,  and  for  certain  cases  very  valuable.  It  has  been  recently 
used  with  success  for  filling  the  pulp  cavities  of  the  teeth,  possessing, 
for  such  a  purpose,  an  advantage  over  gold  in  being  a  non-con- 
ducting substance.  It  answers  a  good  jourpose  when  placed  in  contact 
with  sensitive  dentine,  which  is  owing  to  the  escharotic  action  of  the 
zinc,  as  well  as  its  non-conducting  property.  It  has  also  been  applied 
successfully  to  exposed  nerves,  and  gold  introduced  over  it.  In  using 
os-artificiel,  the  cavity  is  prepared  as  usual ;  then  a  small  quantity  of 
the  liquid  (chloride  of  zinc)  is  dropped  upon  a  piece  of  glass  or  por- 
celain, and  enough  of  the  powder  (oxide  of  zinc)  added  to  make  a 
paste  so  thick  that  the  surface  will  not  appear  watery.  The  cavity  is 
then  perfectly  dried  and  protected  from  saliva  and  the  material  quickly 
introduced,  after  which  it  is  kept  free  from  moisture  for  ten  or  twenty 
minutes.  When  sufficiently  hard,  the  surface  is  finished  by  scraping 
and  polishing.  The  longer  the  surface  is  kept  dry  the  harder  this 
material  becomes.  Coating  the  surface  with  sandarach  varnish  will 
afibrd  protection  for  some  time. 

INSTRUMENTS    FOR   FORMING   THE   CAVITY. 

For  the  removal  of  the  diseased  part  of  the  tooth,  and  the  formation 
of  a  cavity  for  the  proper  reception  and  retention  of  a  filling,  a  variety 


304 


FI  T.T.I  XG    TEETH, 


of  instruments  are  required,  which  should  be  constructed  of  tlie  best 
steel,  and  so  tempered  as  to  prevent  them  from  either  breaking  or 
bending.  Their  points  should  be  so  shaped  that  tliey  may  be  con- 
veniently applied  to  any  part  of  a  tooth,  and  made  to  act  readily  upon 
the  portion  which  it  is  necessary  to  remove. 

Fig.  G8. 


The  instruments  employed  for  this  purpose  are  called  excavators. 
Fig.  68  represents  a  few  of  the  many  forms  of  excavators  in  use. 
They  may  be  formed  either  with  handle  and  point  in  one  i^iece  or 
fitted  to  separate  handles  made  of  wood,  ivory,  pearl  or  cameo  ;  or  ba 
made  to  fit  into  one  common  socket  handle.  Those  having  separate 
handles  are  more  convenient  than  the  others,  but  it  would  be  well  for 
every  practitioner  to  be  provided  with  a  number  of  each  kind.  Steel- 
handled  excavators  are  cheaper  than  wooden  or  ivory  handled  ones ; 
but  if  small  they  are  not  so  easily  grasped,  and  if  large  they  become 
too  heavy.  The  handle  best  suited  for  delicate  manipulation  is  made 
of  cocoa  or  ebony,  largest  an  inch  above  the  ferule,  and  tapering  both 
ways.  The  principle  of  construction  is  to  give  sufficient  size  for  the 
fingers  to  hold  it  securely,  and  to  lessen  the  weight  at  the  end  of  the 
handle.  Socket  handles  are  useful  for  those  who  wish  compactness  of 
apparatus ;  also  for  those  who  are  in  the  habit  of  pointing  their  own 
instruments.     Fig.  69  represents  such  an  instrument :  the  lower  one, 

Fig.  69. 


made  of  ivory,  ebony,  or  cocoa,  will  be  found  very  valuable.  Its  shape 
might  be  better  suited  to  some  operators  if  made  somewhat  larger  just 
above  the  ferule. 

The  flat  and  burr-headed  drills   represented  in  Fig.  70  are  very 


FILLING    TEETH. 


305 


Fig;7L 


useful  for  enlarging  the  orifice  of  a  cavity.   The  pressure  of  the  instru- 
ment against  the   hand, 

between  the  thumb  and  ^^^'  '"• 

forefinger,  is  often  pro- 
ductive of  much  irrita- 
tion. To  prevent  which, 
a  socket-ring  or  shield, 
like  the  one  represented 
in  Fig.  71,  invented  by 
Dr.  Westcott,  may  be  used 
with  advantage.  It  con- 
sists of  a  ring  adapted  for 
the  fore  or  middle  finger, 
with  a  small  socket  at- 
tached to  the  inside. 

The  author  uses  an  open 
ring,  like  the  one  repre- 
sented in  Fig.  72,  with  an 
arm  a  little  more  than  an 
inch  in  length  attached, 
having  a  socket  at  the 
extremity  resting  in  the 
hollow  of  the  hand,  be- 
tween the  thumb  and 
forefinger.  This  he  finds 
much  more  convenient,  as 
it  enables  him  to  apply 
more  pressure  upon  the 
instrument  without  irri- 
tating the  finger,  and,  as 
the  ring  is  open,  it  adapts 

itself  more  readily  to  it.  A  socket  handle  may  also  be  used  for  drills- 
as  for  excavators.  It  may  be  shaped  like  the  exca- 
vator socket  (Fig.  69),  with  the  end  of  the  handle 
pointed  so  as  to  fit  into  the  ring  (Figs.  71,  72);  or  it 
may  have  a  flattened  revolving  head.  The  bits  may 
be  fitted  either  by  firmly  pressing  them  into  a  simple 
round  socket,  or  a  trigger  socket  may  be  used. 

Fig.  73  represents  a  short  revolving  head  socket  for 
the  palm  of  the  hand,  by  means  of  which  the  ordinary 
drill  can  be  rotated  without  chafing  the  hand. 

Dr.  Forbes  has  adapted  to  enamel  burrs,  chisels, 
and  gouges  an  ingenious  handle,  which,  by  the  simple 
20 


Fjg.  72. 


506 


FILLING    TEETH. 


turning  of  a  small  wrench,  secures  the  square-cornered  bits  very  firmly 
(Fig.  74).  The  principle  may  be  applied  to  handles  of  different  shapes 
and  sizes,  provided  they  are  not  too  small. 


Fig.  73. 


Fig.  74. 


u 


The  old-fashioned  bow-and-string  drill  is  now  disused,  partly  because 
of  its  formidable  appearance,  but  chiefly  because  there  is  danger  of 
revolving  it  with  too  great  rapidity.  Many  very  ingenious  forms  of 
drill-stocks  have  been,  from  time  to  time,  invented ;  of  these  we  pre- 
sent several. 

The  instrument  represented  in  Fig.  75  is  a  modification  of  a  very 

Fig.  75. 


ingeniously  contrived  drill-stock,  invented  by  Dr.  Maynard,  for  open- 
ing a  cavity  in  the  grinding,  buccal,  or  posterior  approximal  surface  of 


a  molar  tooth.     It  is  so  constructed  as  to  move  a  drill,  pointing  in 
three  different  directions ;  t^ut,  as  in  the  case  of  the  drill-stock  used 


FILLING    TEETH. 


307 


with  a  bow,  the  original  instrument  required  both  hands  to  work  it. 
To  obviate  which  difficulty,  it  has  been  so  improved,  that  it  may  be 
used  with  one  hand,  as  shown  in  Fig.  75. 

Two  drill-stocks  were  presented  to  the  author  some  years  ago,  the 
first  (Fig.  76)  by  Dr.  James  Robinson,  of  London,  invented  by  Mr. 
McDowell,  of  Lincoln's  Inn  Fields.  It  is  upon  the  principle  of  the 
helix.  A  drill-stock,  inserted  at  the  end  of  the  screw,  is  moved  by 
means  of  a  female  screw  attached  to  the  handle  of  the  instrument. 
As  may  be  seen  from  the  engraving,  drills  pointing  in  three  directions 
may  be  worked  in  it.     The  other  was  presented  by  Mr.  John  Lewis, 


Fig 


formerly  of  Burlington,  Vt.  (Fig.  77.)  It  is  a  beautiful  and  ingeni- 
ously contrived  instrument.  The  drill  may  be  worked  in  any  direction 
within  its  circle  of  motion,  from  the  line  of  the  handle  round  to  the 
same  line  again. 

Fig.  78. 


Fig 


Fig.  78  represents  Chevalier's  drill-stock,  by  which  the  drill  can  be 
brought  to  bear  in  different  directions. 

Merry's  drill-stock  (Fig.  79),  more  recently  invented,  is  simpler 
than  the  preceding, 
and  will,  doubtless, 
prove  useful  in  cases 
where  such  instru- 
ments are  necessary. 

For  opening  a  ca- 
vity in  the  grinding 
surface  of  a  tooth,  partially  covered  by  projecting  portions  of  the  enamel, 
the  rose  or  burr-headed  drill  is  invaluable,  and  it  can  often  be  advan- 
tageously applied  to  the  side  of  a  tooth.  There  are  many  cases,  too, 
where  the  flat  triangular-pointed  drill  can  be  conveniently  employed, 
as,  for  example,  when  it  becomes  necessary  to  extend  the  cavity  further 


308 


FILLING    TEETH. 


into  the  tooth  than  the  disease  has  penetrated.  When  the  drill  is  used, 
it  should  be  frequently  dipped  in  water  to  prevent  its  becoming  heated 
by  the  friction  against  the  tooth  ;  this  precaution  ought  never  to  be 
neglected. 

A  three-sided  instrument  brought  to  a  point  (Fig.  80),  as  also   a 
chisel-edged  (Fig.  81  j,  and  a  four-sided  one  with  a  cutting  edge  (Fig.  82), 

Fig.  80. 


Fig.  8L 


Fig.  82. 


^7 


may  often  be  used  advantageously  in  cutting  away  portions  of  enamel 
to  enlarge  the  orifice.     Enamel  chisels  of  other  shapes  and  gouges  are 
Fig.  83.       '  also  very  valuable  instruments  for  the  prelimi- 

nary operation  of  opening  large  cavities,  or 
cutting  off  sound  enamel  or  dentine  whenever 
necessary.  Dr.  Forbes,  of  St.  Louis,  has  devised 
a  series  of  very  useful  forms  of  the  enamel 
gouge  which  are  adapted  to  the  handle  in 
Fig.  74. 

But  the  cavity  can  seldom  be  completed  with 
either  of  the  instruments  mentioned  above. 
After  it  has  been  opened,  and  the  orifice  made 
sufficiently  large,  it  should  be  finished  with  flat 
or  curve-pointed  excavators  (Figs.  68  and  83),  properly  adapted  to  the 
purpose;  in  fact,  in  the  majority  of  cases,  it  should  be  wholly  formed 
with  instruments  of  this  sort. 

Excavators,  shaped  like  those  represented  in  Figs.  68  and  83,  have 
been  found  by  the  author  to  be  as  well  adapted  to  the  removal  of  caries 
as  any  which  he  has  ever  employed.  There  should  be  several  sizes 
of  each  shape  ;  also  duplicates  of  each  instrument,  to  prevent  delay  in 
case  of  accident  while  operating.  As  the  proper  formation  of  the  cavity 
greatly  depends  on  having  suitable  instruments,  every  operator  should 
be  provided  with  a  large  supply  of  burr-drills  and  excavators,  so  that 
he  may  never  be  at  a  loss  for  such  as  the  peculiarity  of  any  case  may 
require.  He  should  also  have  the  material,  and  know  how,  in  an 
emergency,  to  point  his  own  excavators.  For  this  purpose  he  will  need 
a  lamp,  a  small  anvil  and  hammer,  a  set  of  fine-cut  files,  such  as  are 
used  by  watchmakers,  and  an  assortment  of  steel  rods  of  various  sizes 
and  of  the  best  quality.  It  is  not  our  purpose  to  give  specific  directions 
for  working  steel ;  but  we  would  offer  two  cautions  :  first,  small  points 


FILLING    TEETH.  309 

quickly  become  brittle  by  hammering  and  need  frequent  annealing ; 
second,  steel  is  greatly  injured  by  raising  it  to  a  full  red  or  white  heat. 
A  very  fine  temper  may  be  given,  after  shaping  the  point,  by  heating 
to  redness  and  suddenly  plunging  it  iu  wax  or  tallow. 

As  excavators  must  be  kept  very  sharp,  an  oil-stone  should  be  con- 
stantly at  hand.  The  Arkansas  stone  is  superior  for  thLs  purpose  to 
all  other  varieties,  on  account  of  its  hardness,  fineness,  and  sharpness 
of  grit. 

MANNER   OP   FORMING   THE   CAVITY. 

The  preparation  of  the  cavity  in  a  tooth  for  the  reception  of  a  filling, 
is  a  very  essential  part  of  the  operation,  and  though  usually  the  easiest, 
is  sometimes  attended  with  much  difficulty.  The  removal  of  the  diseased 
part  is  sometimes  all .  that  is  necessary,  preparatory  to  the  introduction 
of  the  gold ;  but  in  the  majority  of  cases  the  cavity  must  be  so  shaped, 
as,  when  properly  filled,  to  retain  the  filling  in  place.  The  part  of  the 
tooth  surrounding  the  orifice  should  present  no  rough  or  brittle  edges. 
The  size  of  the  bottom  of  the  cavity  should  be  as  near  that  of  the  orifice 
as  is  possible,  even  a  little  larger  rather  than  any  smaller.  But  the 
difference  between  the  size  of  the  one  and  the  other  should  never  be 
very  great ;  for  if  the  interior  of  the  cavity  is  much  larger  than  the 
orifice,  it  will  be  difficult  to  make  the  filling  sufficiently  firm  and  solid 
to  render  it  absolutely  impermeable  to  the  fluids  of  the  mouth.*  If, 
on  the  other  hand,  the  orifice  is  larger  than  the  bottom  of  the  cavity, 
it  will  be  difficult  to  obtain  sufficient  stability  for  the  filling,  so  as  to 
prevent  it  from  ultimately  loosening  and  coming  out.  It  often  happens, 
however,  that  the  situation  and  extent  of  the  decay  is  such  as  to  render 
it  impossible  to  make  the  cavity  so  large  at  the  bottom  as  at  the  orifice ; 
when  this  is  the  case,  several  pits  or  circular  grooves  should  be  cut  in 
the  inner  walls,  for  the  purpose  of  obtaining  as  much  security  for  the 
ailing  as  possible ;  being  careful  to  make  these  in  the  dentine  rather 
than  in  the  enamel,  which  is  so  much  more  brittle.  By  proper  atten- 
tion to  this  precaution,  a  filling  may  be  so  inserted,  in  this  difficult 
class  of  cases,  as  to  prevent  it  from  coming  out. 

As  ^  general  rule  it  is  easier  to  form  a  cavity  in  the  grinding  surface 

*  Place  a  lump  of  cotton  in  the  hollow  of  the  hand,  formed  by  bringing  the 
ends  of  the  fingers  against  the  palm.  Then  press  with  an  instrument  upon  the 
centre  of  the  cotton,  and  it  will  leave  the  sides  of  the  cavity.  This  simple  illus- 
tration, suggested  by  Dr.  Edward  Maynard.  will  explain  the  cause  of  failure,  in 
certain  cases  which  have  come  under  his  notice,  from  the  hands'" of  operators  of 
deservedly  high  reputation. 

The  cavity,  smallest  at  the  orifice,  had  been  well  filled;  but  the  final  compres- 
sion upon  the  centre  had  drawn  the  gold  from  the  sides,  thus  permitting  the 
access  of  fluids,  and  ultimately  decaying  the  tooth  around  the  filling. 


310  FILLING    TEETH. 

of  a  molar  or  bicuspid,  than  in  any  other  position  ;  though  it  some- 
times happens  that  even  here  it  is  attended  with  difficulty,  and  espe- 
cially when  the  decay,  commencing  in  the  centre,  follows  the  several 
depressions  which  run  out  from  it.  In  such  cases  the  edges  bordering 
on  and  covering  the  affected  parts,  Avhich  are  often  thick  and  very 
hard,  should  be  cut  away,  together  with  the  subjacent  decayed  dentine  ; 
the  radiating  depressions  should  open  fully  into  the  central  cavity,  and 
be  made  sufficiently  wide  and  deep  to  admit  of  being  filled  to  their 
extremities  in  the  most  perfect  and  substantial  manner.  The  surface 
of  a  filling  occupying  a  cavity  of  this  kind  presents  a  sort  of  stellated 
appearance.  When  two  or  more  decayed  places  are  separated  only  by 
very  thin  walls  of  tooth  substance,  these  should  be  cut  away,  and  a 
cavity  formed  large  enough  to  include  all  the  diseased  points ;  as  one 
large  filling  will  secure  the  preservation  of  the  tooth  more  efiectually 
than  by  filling  each  cavity  separately. 

Sharp  angles  should  be  avoided,  as  far  as  possible,  in  the  outline  of 
the  orifice  of  the  cavity,  because  of  the  extreme  difficulty  of  filling 
them  compactly.  The  orifice  must  also  have  a  firm,  decided  margin, 
with  no  thin  projecting  edges  of  enamel  on  the  one  hand ;  with  no 
countersunk  depressions  on  the  other.  In  the  first  case  the  thin  enamel 
is  apt  to  break  oflP  either  during  the  operation  or  subsequently-;  in  the 
second  case  the  thin  scale  on  the  edge  of  such  fillings  breaks  away  in 
the  course  of  time ;  in  both  cases  the  filling  fails  perfectly  to  answer  its 
purpose  in  the  preservation  of  the  tooth. 

It  is  preferable,  in  many  cases  of  front  approximal  fillings,  to 
cut  away  the  inner  angles  of  the  tooth,  thus  avoiding  the  injury  to  the 
external  appearance  of  the  tooth  caused  by  the  file.  Upon  completion 
of  the  operation,  the  surface  thus  cut  is  perfectly  polished,  as  every 
filed  or  cut  surface  upon  the  teeth  should  be,  and  so  shaped  as  to  be 
kept  readily  cleansed  with  the  brush  or  Avith  floss  silk.  It  is  also  very 
important  that  all  the  edges  of  cavities  should  be  smooth  and  polished 
before  and  after  the  introduction  of  the  filling. 

In  forming  a  cavity  for  the  reception  of  adhesive  gold  foil  and  crystal 
gold,  it  is  very  necessary  that  it  should  be  of  such  a  shape  as  to  retain 
securely  the  first  gold  introduced,  and  to  accomplish  this,  one  of  more 
small  cavities,  called  retaining  points,  are  made  within  the  larger  cavity. 
These  retaining  points  in  many  cases  afibrd  anchorage  for  the  entire 
mass  of  gold  composing  the  filling,  and  in  every  case  where  these  forms 
of  gold  are  used,  they  are  the  support  in  the  building  up  from  the 
bottom  to  the  orifice  of  the  cavity. 

These  retaining  points  are  formed  in  the  dentine  by  means  of  a 
small  square  or  chisel-edged  di-ill,  and  can  very  often  be  made  cf 
one-sixteenth  of  an  inch  in  depth ;  a  less  depth,  however,  will  answer  in 


FILLINa    TEETH.  311 

many  cases.  One  of  these  retaining  points  in  connection  witli  one  or 
two  under-cuttings  on  the  opposite  wall  will  be  sufficient  in  some  cavi- 
ties, while  in  others  two  or  three  are  required.  The  gold  should  be 
introduced  into  these  retaining  points  in  such  a  manner  as  to  form, 
when  they'are  filled,  solid  masses  of  metal,  which  would  require  con- 
siderable force  to  dislodge  them.  Upon  these  solid  masses  the  gold 
filling  the  cavity  is  built. 

Separating  Teeth. — Before  a  cavity  can  be  prepared  in  the  approxi- 
mal  surface  of  a  tooth,  it  is  usually  necessary  to  separate  it  from  the 
adjoining  one.  This  may  be  done  either  with  a  file  or  by  the  pressure 
of  some  interposed  elastic  substance.  Each  of  these  methods  has  its 
advantages.  When  caries  has  extended  over  nearly  the  whole  approxi- 
mal  surface,  so  that,  after  the  removal  of  the  diseased  part,  the  orifice 
of  the  cavity  will  be  surrounded  by  a  thin,  brittle,  and  irregular  wall, 
the  former  is  the  preferable  method  ;  especially  in  individuals  having 
a  decided  scorbutic  tendency,  or  who  have  suffered  from  the  use  of 
mercurial  medicines  or  syphilitic  disease,  and  in  aged  persons.  But 
when  the  caries  has  spread  over  only  a  small  portion  of  the  surface  of 
the  tooth,  and  is  surrounded  by  sound,  healthy  enamel,  the  latter 
method  should  be  adopted ;  especially  in  individuals  in  whom  there  is 
no  manifest  tendency  to  inflammation  or  sponginess  of  the  gums,  and 
in  young  subjects.  The  manner  of  separating  teeth  with  a  file  has 
been  already  described;  it  will  only  be  necessary,  therefore,  in  this 
place,  to  ofier  a  few  remarks  on  separating  by  pressure,  which  was  first 
adopted  by  Dr.  Eleazer  Parmly. 

The  following  are  its  advantages,  where  it  can  be  resorted  to  with 
safety :  after  the  removal  of  the  pressure,  the  teeth  almost  immediately 
come  together,  having  no  space  to  injure  their  beauty;  what  is  of  still 
greater  importance,  the  dentine  around  the  external  surface  of  the  fill- 
ing is  not  exposed  to  the  action  of  the  secretions  of  the  mouth,  or  other 
agents  capable  of  exerting  upon  it  a  deleterious  action.  On  the  other 
hand,  some  are  of  opinion  that  when  the  teeth  come  together,  again  a 
lodgment  is  afibrded  to  corrosive  agents,  upon  the  presence  of  which 
the  disease  was,  in  the  first  instance,  produced,  and  which  would  soon 
cause  a  recurrence  of  it.  In  replying  to  this  objection,  it  is  only  neces- 
sary to  observe,  that  the  parts  of  teeth  first  attacked  by  caries  were 
the  points  in  contact  with  each  other,  where  the  enamel  may  be  sup- 
posed to  have  sustained  some  injury  by  pressure,  thus  rendering  them 
more  vulnerable  at  these  points  to  the  action  of  the  causes  that  j)ro- 
duced  the  disease.  By  properly  replacing  the  diseased  parts  with  gold, 
the  external  surfaces  of  the  fillings  will  be  the  only  parts  that  come  in 
contact  with  each  other ;  and  if  of  gold  will  not  be  liable  to  injury 
from  the  above-mentioned  mechanical  causes.    The  enamel  around  the 


312  FILLING    TEETH. 

fillings,  if  proper  attention  to  cleanliness  be  observed,  is  not  so  liable 
to  be  acted  on  by  chemical  agents  as  the  dentine  which  the  file  would 
expose. 

But  teeth  cannot  always  with  impunity  be  separated  by  pressure;  it 
can  only  be  done  with  safety  in  certain  cases.  As  a  general  rule,  the 
writer  is  of  the  opinion  that  it  ought  not  to  be  attempted  after  the 
thirtieth  or  fortieth  year  of  age,  though  it  may  sometimes  be  done  with 
safety  at  even  a  later  period.  The  diseased  action,  excited  for  the  time, 
in  the  sockets  of  the  teeth,  does  not  so  readily  subside  at  a  later  age ; 
and  it  has  in  some  instances  been  known  to  result  in  the  loosening  and 
ultimate  loss  of  the  organs.  In  one  case  which  came  under  the  observa- 
tion of  the  author,  the  inflammation  extended  to  the  lining  membranes 
of  the  pulp,  causing  their  disorganization,  and  the  consequent  death  of 
the  tooth. 

The  pressure  ought  never  to  be  too  actively  exerted ;  it  should  be 
gradual  and  constant.  From  four  to  seven  days  are  usually  required 
for  the  separation  of  two  teeth  sufficiently  for  the  removal  of  the  de- 
cayed part  and  the  introduction  of  a  filling.  After  they  have  been 
separated  in  this  way,  they  should  be  kept  apart,  without  any  increase 
of  pressure,  until  the  soreness  in  the  sockets  shall  have  subsided,  before 
any  further  steps  are  taken  in  the  operation.  Only  two  teeth  should 
be  separated  in  the  front  part  of  the  mouth,  in  the  same  jaw,  at  the 
same  time. 

The  pressure  is  usually  made  by  introducing,  between  the  crowns  of 
two  teeth,,  a  thin  wedge  of  soft  wood,  a  piece  of  India-rubber,  tape,  a 
little  raw  cotton  or  ligatures,  replacing  the  first-named  substances  every 
day  or  two  with  thicker  pieces.  The  writer  prefers  India-rubber  to 
any  other  substance  he  has  employed  for  the  purpose  ;  but  the  object 
may  be  readily  attained  with  other  substances.  While  many  prefer 
gradual  pressure  in  separating  teeth,  there  are  others,  who,  on  account 
of  economy  of  time,  consider  it  better  for  the  separation  to  be  made  at 
once,  and  not  prolonged  through  several  days.  It  is  also  urged  that 
the  patient  suflTers  less,  and  that  there  is  also  less  danger  to  the  teeth, 
in  rapid  separation  than  where  this  process  is  gradual.  The  degree  of 
pressure,  and  the  method  hj  which  the  separation  is  to  be  accomplished, 
should,  however,  be  determined  by  the  susceptibility  of  the  parts  to 
inflammation.  The  operation  of  rapidly  separating  the  teeth  consists 
in  the  use  of  two  wedges  of  fine  grained  wood,  either  orange  or  box 
wood.  The  first  wedge  is  forced  between  the  necks  of  the  teeth,  care 
being  taken  not  to  lacerate  the  gum,  while  the  second  wedge,  which 
tapers  more  than  the  first,  is  inserted  between  the  points  of  the  teeth, 
the  wedges  being  driven  alternately  by  mallet  force,  until  suflScient 
space  is  obtained,  when  the  second  wedge  is  removed.   Very  great  care 


FILLING    TEETH. 


313 


should  be  exercised  in  driving  the  second  wedge  between  the  points  of 
the  teeth,  on  account  of  the  force  exerted  by  it.  This  description  ap- 
plies to  the  front  teeth,  as  it  is  not  advisable  to  attempt  the  separation 
of  the  molar  teeth  in  this  manner. 

But  whether  the  teeth  be  separated  with  a  file  or  by  pressure,  the 
space  should  be  sufficiently  wide  to  enable  the  dentist  to  operate  with 
ease,  otherwise,  it  will  be  impossible  to  remove  the  caries  and  fill  the 
teeth  in  a  proper  manner. 

Fig.  84. 


Protecting  Cavities  from  Moisture. —  The  first  step  in  this  operation 
is  to  wipe  the  mucous  membrane,  covering  the  parts  about  the  tooth  to 
be  filled,   perfectly  dry,  as 

well  as   the   mouth  of  the  ^^^'  ^^• 

duct  of  the  nearest  salivary 
gland,  from  which  saliva 
may  flow  in  such  a  manner 
as  to  interfere  with  the  oper- 
ation of  filling  the  cavity. 
Over  the  mouth  of  the  duct, 
a  roll  of  bibulous  paper  is 
placed,  upon  which  rests  one 
part  of  a  napkin,  which  is 
so  arranged  about  the  tooth 
as  to  prevent  the  mucus  se- 
cretions from  reaching  the 
cavity.  The  napkin  is  held 
in  place  by  the  thumb  and 
fingers  of  the  left  hand. 
The  remaining  portion  of 
the  napkin  can  be  used  to 
prevent  the  breath  from 
coming  in  contact  with  the 
material  used  for  filling,  as 
well  as  the  cavity.  When 
this  is  accomplished;  the 
cavity  is  dried,  as  hereafter 
described,  and  is  then  ready 
for  the  filling.     Much  more 


314 


FILLING    TEETH. 


difficulty  is  met  with  in  protecting  cavities  in  the  inferior  teeth  from 
moisture  than  in  the  case  of  the  superior,  and  various  appliances  have 
been  devised  to  overcome  it. 

p      gg  The  common  saliva  pump  (Fig. 

84)  is  used  to  remove  the  saliva  as 
it  accumulates  rn  the  lower  part  of 
the  mouth,  and  consists  of  a  glass 
tube  with  an  elastic  bulb. 

Fig.  85  represents  a  very  superior 
saliva  pump. 

A,  bottle  or  reservoir.  C,  clamp, 
furnished  at  its  upper  and  lower 
ends  with  eight  steel  pins,  E,  F,  to 
secure  it  to  the  upholstery  of  a  chair, 
so  that  it  cannot  be  detached  by  any 
accidental  force.  When  used,  the 
hard  rubber  mouth-tube,  /,  is  held 
in  the  mouth  by  one  hand  of  the 
patient,  and  the  bulb,  K,  in  the 
other.  Whenever  saliva  accumu- 
lates, the  patient  presses  the  bulb, 
and  the  saliva  flows  into  the  reser- 
voir. 

The  reservoir  is  emptied  by  un- 
screwing its  cap,  B. 

The  bulb  is  covered  with  soft 
leather.  Its  valves  are  of  hard 
rubber,  and  operate  well  in  any 
position.  As  they  operate  in  the 
air  only,  they  never  clog  or  become 
deranged  by  contact  with  the  saliva. 

The  mouth  tube  is  of  hard  rub- 
ber, and  the  apparatus  requires  no 
care  beyond  occasional  washing. 

Fig.  86  represents  Dibble's  saliva 
pump,  with  the  attachment  of  Dr. 
B.  F.  Arrington,  which  acts  also  as 
a  si)eculum,  or  tongue-holder. 

The  object  of  this  instrument  is 
to  facilitate  the  operation  of  filling 
teeth  of  the  lower  jaw  by  keeping 
the  mouth  free  from  saliva,  and  as  a 
means  of  holding  the  tongue  away 
from  the  teeth ;  also,  a   means   of 


FILLING    TEETH. 


315 


Fig.  87. 


supporting  tlie  upper  jaw,  and  so  assisting  tlte  muscles  which  keep  the 
mouth  open,  the  application  of  which  will  be  readily  understood  from 
the  illustration.  There  are  two  mouth-pieces,  one  for  the  right  side, 
and  one  for  the  left  side  of  the  mouth. 

Various  appliances  are  also   in  use  for  keeping   the  jaws  apart, 
pressing      away     the 
cheek,    and     holding 
down  the  tongue. 

Fig.  87  represents 
an  instrument  of  this 
kind,  invented  by  C. 
C.  Thomas,  of  Louisi- 
ana. It  consists  of 
two  grooved  plates  to 
admit  the  molar  teeth, 
which  may  be  sepa- 
rated or  brought  to- 
gether by  a  screw  working  in  a  cylinder.  Around  the  cylinder  are 
two  collars,  which  can  be  tightened  by  set  screws ;  to  the  lower  is 
soldered  a  rod  on  which  moves  a  ring  holding  a  hand-shaped  tongue- 
holder  ;  to  the  upper  is  attached  a  highly  polished  oval  concave  plate, 
connected  with  the  shaft  by  a 
ball  and  socket-joint ;  the  shaft 
itself  is  capable  of  extension  by 
a  rachet  movement.  The  instru- 
ment is  ingeniously  contrived,  so 
that  its  several  parts  can  be 
moved  in  any  required  direction 
and  extent.  Its  application  is 
obvious ;  it  opens  the  mouth, 
keeps  the  tongue  and  cheek  out 
of  the  way,  and  the  oval  mirror 
throws  light  on  the  cavity. 

Fig.  88  represents  an  excellent 
tongue  and  duct  compressor  — 
Hawes  instrument  modified  by 
Dr.  P.  T.  Smith.  By  its  use,  the 
tongue  may  be  clamped  down  in 
place  and  kept  in  position  as  long 

as  desired.  The  sublingual  and  submaxillary  ducts  may  be  very 
effectually  closed  by  placing  upon  them  rolls  or  pads  of  bibulous  or 
tissue  paper  before  applying  the  compress;  a  pad  of  paper  or  a 
napkin  should  be  placed  on  the  tongue  before  adjusting  the  instrument. 
The  use  of  it  is  a  relief  to  patients  rather  than  a  discomfort,  holding 


316  FILLING    TEETH. 

the  tongue  entirely  out  of  the  way  during  an  operation,  without  re- 
quiring a  constant  effort  on  their  part. 

For  one  of  the  most  simple,  yet  effective  appliances  for  controlling 
the  flow  of  saliva,  and  protecting  cavities  from  moisture,  we  are  in- 
debted to  Dr.  S.  C.  Barnum.  It  consists  of  nothing  more  than  a  thin 
sheet  of  India-rubber,  of  good  quality,  that  it  may  possess  sufficient 
strength  and  not  tear  easily,  and  of  a  thickness  double  that  of  letter 
paper. 

Some  distance  from  the  edge  of  the  sheet,  which  is  from  four  to 
eight  inches  square,  one,  two,  or  more  holes  are  made,  through  which 
the  crowns  of  the  teeth  are  passed,  when  it  is  applied  to  the  mouth. 

The  holes  made  in  the  rubber  should  be  about  one-tenth  smaller  in 
diameter  than  the  necks  of  the  teeth  they  are  to  embrace.  It  is 
better  in  all  cases  to  make  several  of  these  holes  in  the  sheet  in  order 
to  include  within  the  coffer-dam,  formed  when  the  sheet  is  in  position, 
the  crowns  of  the  teeth  adjoining  the  one  in  which  the  cavity  to  be  filled 
is  situated.  When  the  crowns  of  the  teeth  approximate  closely,  the 
holes  should  be  made  about  one-eighth  of  an  inch  apart ;  if  some 
space  exists  between  the  crowns,  the  holes  may  be  made  at  a  greater 
distance  from  each  other.  These  holes  may  be  formed  in  the  rubber 
by  means  of  a  small  chisel-edged  punch,  or  by  burning  with  a  heated 
instrument. 

The  rubber,  thus  prepared,  is  carried  between  the  teeth  by  either  a 
thin,  flat  burnisher,  or,  which  is  better,  by  waxed  floss  silk,  and  the 
margins  of  the  holes  pressed  gently  under  the  free  edges  of  the  gums 
in  the  direction  of  the  roots  of  the  teeth.  In  some  cases  it  may  be 
necessary  to  secure  these  margins  to  the  necks  of  the  teeth  by  means 
of  waxed  floss  silk  tied  around  them. 

Several  other  simple  appliances  are  in  use  to  protect  cavities  from 
moisture,  such  as  wooden  wedges  forced  between  the  necks  of  the 
teeth,  and  waxed  cord  surrounding  the  tooth  in  which  the  cavity  is 
situated,  and  passing  to  an  adjoining  tooth  ;  also  a  band  of  rubber 
cut  from  tubing,  which  is  placed  high  up  on  the  neck  of  the  tooth  and 
then  carried  around  an  adjoining  one.  Two  of  these  bands,  acting  in 
opposite  directions,  answer  better  than  a  single  one,  and  in  many  cases 
effectually  protect  the  cavity  from  moisture. 

Drying  Cavities. —  After  every  pai'ticle  of  decomposed  dentine  has 
been  removed,  the  cavity  should  be  thoroughly  cleansed  before  the 
filling  is  introduced.  This  may  be  done  by  first  injecting  tepid  water 
into  it  with  a  properly  constructed  syringe,  and  afterward  wiping  it 
dry  with  a  small  lock  of  raw  cotton  fixed  upon  the  point  of  a  probe 
or  excavator ;  or  the  cavity  may,  in  the  first  place,  be  wiped  with  a 
little  raw  cotton  moistened  with  water,  and  afterward  with  dry  cotton. 


FILLING    TEETH. 


317 


The  application  of  the  cotton  should  be  followed  by  that  of  bibulous 
paper,  made  expressly  for  the  purpose,  and  having  a  very  loose,  ab- 
sorbent texture,  and  folded  for  convenience  in  the  form  of  a  rope,  from 
which  the  moistened  end  can  be  torn  after  each  insertion.  Tissue  or 
bibulous  paper  absorbs  moisture  more  readily  than  cotton.  The  ab- 
sorbing qualities  of  cotton,  however,  may  be  increased  by  boiling  it 
fur  fifteen  or  twenty  minutes  in  a  tolerably  strong  alkaline  solution ; 
this  done,  it  should  be  thoroughly  washed  and  dried  before  using ;  or 
by  saturating  it  in  sulphuric  ether  to  remove  the  natural  oil.  Several 
materials  have  been  of  late  years  used  in  drying  cavities,  such  as  pre- 
pared flax,  fine  and  white,  with  a  long  absorbent  fibre,  and  prepared 
spunk.  It  is  desirable  that  the  cavity  should  be  perfectly  dry  before 
the  filling  is  introduced. 

INSTRUMENTS   FOR   INTRODUCING   GOLD. 

For  introducing  and  consolidating  non-adhesive  gold  foil,  a  number 
of  instruments  are  required,  which  should  be  sufiiciently  strong  to 
resist  any  amount  of  pressure  the  dentist  can  safely  exert  in  the  opera- 
tion. They  should  have  round  or  octagonal  handles,  large  enough  to 
prevent  the  liability  of  being  broken  and  to  enable  him  to  grasp  them 
firmly.  Their  points  should  vary  in  size,  though  none  should  be  very 
large.  Several  should  be  straight,  but  for  the  most  part  they  require 
to  be  curved  —  some  very  slightly,  others  forming  with  the  shaft  of 
the  instrument  an  angle  of  ninety  degrees.  Fig.  89  represents  a  set  of 
small  pointed  hand  pluggers.  For  other  forms,  the  reader  is  referred 
to  the  chapter  on  "  Filling  Individual  Cavities." 


Plugging  instruments  as  received  from  the  instrument  makers  have 
usually  a  temper  which  will  not  permit  them  to  be  bent.  It  will  add, 
we  think,  greatly  to  the  value  of  the  instrument,  if  the  practice  of  Dr. 


318 


FILLING    TEETH. 


Maynard  were  more  generally  adopted.  He  gives  to  the  extreme 
point  a  hard  temper  (straw  color)  to  prevent  it  from  wearing ;  for  a 
little  distance,  say  one  to  three-qnarters  of  an  inch,  a  spring  temper 
is  given  (purple  or  blue  color)  to  insure  strength  when  the  shape  is 
delicate  ;  the  rest  of  the  instrument  is  left  soft,  so  as  to  admit  of  being 
bent  (with  pliers)  in  the  direction  best  suited  for  that  particukir  point 
in  any  given  operation. 

Most  of  them  should  have  a  slim  wedge-shape ;  some,  however,  both 
of  the  straight  and  curved  instruments,  should  have  blunt  serrated 
points,  and  a  few  should  have  highly  polished  oval  points,  for  finishing 
the  surface  of  fillings.  Formerly,  most  dentists  employed  for  intro- 
ducing and  consolidating  the  gold  simple  blunt-pointed  pluggers;  but 
it  is  impossible  with  such  instruments  to  make  a  filling  as  firm  and 
solid  as  it  should  be  for  the  perfect  preservation  of  a  tooth,  especially 
if  the  cavity  is  large.  From  one-fourth  to  one-half  more  gold  can 
be  introduced  into  a  tolerably  large  cavity  with  a  wedge-pointed  than 
with  a  blunt-pointed  instrument. 


Fig.  90. 


FILLING    TEETH.  319 

The  sides  of  tlie  wedge-pointed  pluggers  should  be  left  a  little  rougli, 
for  the  purpose  of  preventing  them  from  cutting  the  gold ;  and  there 
should  be  two  or  three  small  notches  filed  across  their  edges.  When 
thus  prepared,  the  gold  can  be  more  perfectly  controlled  and  more 
readily  conveyed  to  the  bottom  of  the  cavity  than  with  smoother- 
edged  instruments.  The  blunt-pointed  instruments,  or  those  used  for 
condensing  the  extruding  extremities  of  the  folds  of  gold,  should,  as 
before  stated,  have  serrated  points,  that  the  surface  of  the  metal  may 
be  thoroughly  consolidated. 

This  general  description  will  serve  to  convey  a  tolerably  correct 
idea  of  the  kind  of  instruments  required  for  the  operation;  but  no 
two  dentists  have  their  filling  instruments  precisely  alike  ;  each  has 
them  constructed  in  such  a  way  as  he  thinks  will  enable  him  to 
apply  them,  most  easily  and  efficiently  to  the  various  parts  of  a 
tooth  which  may  require  filling. 

Instruments  having  serrated  points  are  required  for  filling  teeth 
with  crystal  or  sponge  gold,  and  with  adhesive  gold  foil. 

Fig.  90  represents  a  number  of  small  points  suitable  for  using  the 
adhesive  forms  of  gold.  For  other  forms  of  points,  the  reader  is  re- 
ferred to  the  illustrations  representing  the  points  of  mallet  pluggers. 

Fig.  91. 


Fig.  91  represents  a  pair  of  introducing  or  plugging  pliers  for  taking 
up  pieces  of  gold  and  placing  them  in  the  cavity.  This  instrument  is 
indispensable  in  using  adhesive  gold  foil,  and  also  the  non-adhesive  in 
the  form  of  cylinders  ;  for  carrying  cylinders  to  their  proper  position 
in  the  cavity,  the  points  are  not  serrated  as  in  the  cut. 

MANNER   OF   PREPARING,   INTRODUCING,    AND   CONSOLIDATING   GOLD 
AND   FINISHING   THE   SURFACE   OP   THE   FILLING. 

Non-Adhesive  Gold  Foil. — The  operator,  being  provided  with  the 
necessary  instruments,  should  cut  this  form  of  gold,  with  a  pair  of 
scissors,  into  strips  from  half  an  inch  to  an  inch  wide.  Each  of  these 
should  be  loosely  rolled  or  folded  together  lengthwise,  and  after  the 
cavity  has  been  properly  cleansed  and  dried,  the  end  of  one  should 
be  introduced  and  carried  to  the  bottom  of  the  cavity,  with  a  straight 
or  curved  wedge-pointed  instrument ;  the  roll  on  the  outside  should 
then  be  folded  on  the  part  first  inserted.     The  folding  should  be  com- 


320  FILLING    TEETH. 

menced  on  one  side  of  the  cavity,  and  the  inner  end  of  each  fold  taken 
to  the  bottom,  the  outer  extending  nearly  a  twelfth  or  an  eighth  of  an 
inch  on  the  outside  of  the  orifice  ;  thus,  fold  after  fold  is  introduced, 
until  no  more  can,  in  this  manner,  be  forced  into  the  cavity.  Having 
proceeded  thus  far  in  the  operation,  the  instrument  should  be  forced 
through  the  centre  of  the  filling,  and  the  gold  firmly  pressed  against 
the  'svalls  of  the  cavity.  The  opening  thus  made  should  be  filled  in 
the  manner  as  first  described,  and  this  time  it  should  be  packed  in 
as  tightly  as  j^ossible.  This  done,  the  operator  should  endeavor  to 
force  a  small  wedge-pointed  instrument  in  the  centre  of  the  filling, 
until  he  has  tried  every  part  of  the  plug ;  filling,  as  he  proceeds, 
every  opening  which  he  makes,  and  exerting,  in  the  packing  of  the 
gold,  all  the  pressure  which  he  can  apply,  without  endangering  the 
tooth.  If  one  roll  or  fold  of  gold  is  not  enough,  he  should  take 
another  and  another,  until  the  cavity  is  thoroughly  filled.  When  the 
Avails  of  a  cavity  are  frail,  it  is  the  practice  of  some  operators  to 
introduce  the  gold  rather  loosely,  and  to  depend  upon  surface  con- 
densing to  obtain  the  necessary  solidity.  But  it  is  better  to  well 
condense  every  fold  immediately  after  it  is  carried  to  its  proper  place 
in  the  cavity  ;  such  condensing  will  often  render  the  use  of  the  wedge- 
shaped  instrument  unnecessary. 

The  adv'autage  to  be  derived  from  introducing  the  gold  in  this  man- 
ner is  obvious.  By  extending  the  folds  from  the  orifice  to  the  bottom 
of  the  cavity,  the  liability  of  the  gold  to  crumble  and  come  out  is 
effectually  prevented ;  while  by  introducing  it  with  a  wedge-pointed 
instrument,  it  may  he  carried  into  all  the  depressions  of  the  walls  of 
the  cavity,  and  rendered  altogether  more  solid  than  it  could  otherwise 
be  made.  The  pliancy  and  adhesiveness  of  the  gold  may  be  increased 
by  slightly  warming  in  the  flame  of  a  spirit  lamp,  after  it  has  been 
made  into  rolls  or  folds. 

After  the  cavity  has  been  completely  filled,  every  portion  of  the  pro- 
jecting part  of  the  gold  must  be  thoroughly  consolidated,  before  it  is 
allowed  to  become  wet,  either  with  a  small  blunt-pointed  instrument, 
straight  or  curved  as  may  be  most  convenient ;  or,  if  the  filling  is  in  the 
approximal  side  of  a  tooth,  it  may  be  compressed  with  the  angle  of  the 
point  of  the  plugger,  making  the  adjoining  organ  to  a  slight  extent  a 
kind  of  fulcrum  for  the  instrument.  After  the  filling  has  been  thus 
consolidated,  as  long  as  it  can  be  made  to  yield  in  the  least  to  the 
pressure  of  the  instrument,  the  protruding  parts  may  be  scraped  or 
filed  off,  down  to  the  tooth,  so  as  to  form  a  smooth,  uniform,  gently 
swelling  or  perfectly  flat  surface.  Fig.  99  represents  a  number  of 
finishing  files.  If  in  this  part  of  the  operation  any  portion  of  the  gold 
should  crumble  or  be  dislodged,  which  it  will  not  do  if  it  has  been 


FILLING    TEETH.  321 

properly  introduced  and  consolidated,  the  injury  may  be  repaired  by 
making  in  the  part  of  the  plug,  where  it  has  occurred,  an  opening,  and 
filling  it,  or  by  the  removal  of  the  whole  of  the  filling  and  the  intro- 
duction of  another.  If  any  portions  of  the  gold  have  been  forced  over 
the  edge  of  the  orifice  of  the  cavity,  they  should  be  carefully  removed, 
either  with  a  file  or  sharp-pointed  cutting  instrument  suited  to  the  pur- 
pose. This  precaution  should  never  be  neglected,  especially  when  the 
filling  is  in  the  approximal  surface  of  a  tooth,  where  a  portion  of  the 
gold  is  very  liable  to  be  forced  up  or  down  upon  the  neck,  and  under 
the  gum. 

Cylinder  Filling. — The  method  of  filling  cavities  with  non-adhesive 
gold  foil  in  the  form  of  cylinders  is  a  favorite  one  with  many  opera 
tors,  and  is  in  some  cases  preferable  to  that  of  the  fold  or  rope,  inas 
much  as  the  gold  in  the  cylinder  form  can  be  more  rapidly  introduced 
and  condensed.  A  common  method  of  preparing  these  cylinders  is  to 
fold  lengthwise,  in  the  form  of  a  ribbon,  either  the  third,  half,  or  whole 
of  a  leaf  of  No.  4  or  6  gold  foil ;  the  width  of  the  ribbon  determines 
the  length  of  the  cylinders.  One  end  of  this  ribbon  is  then  held  between 
the  thumb  and  index  finger  of  the  left  hand  and  wound  upon  a  thref;- 
or  four-sided  broach  until  the  cylinder  thus  formed  is  of  the  size  desired, 
when  the  remaining  portion  of  ribbon  is  torn  off". 

The  cylinders  should  be  a  little  longer  than  the  cavity  is  deep,  in 
order  to  allow  for  surface  condensing.  The  density  of  the  cylinders 
depends  upon  the  firmness  with  which  the  ribbon  is  wound  upon  tho 
broach ;  by  winding  it  loosely  upon  the  broach  soft  cylinders  are 
formed,  to  be  placed  in  contact  with  the  walls  of  the  cavity,  while  the 
hard  cylinders  made  by  firmer  winding  are  introduced  inside  of  the 
soft,  and  form  the  centre  of  the  filling.  Different  forms  as  well  as  sizes 
of  cylinders  are  necessary  in  every  case,  cone-shaped  as  well  as  the 
true  cylindrical.  The  cone-shaped  cylinders  are  useful  where  there  is 
an  under-cutting,  and  also  for  completing  the  introduction  of  the 
gold. 

These  cone-shaped  cylinders  are  formed  by  winding  the  ribbon  back 
from  the  point  of  the  broach,  which  should  taper  slightly  in  order  that 
the  cylinder  when  completed  may  be  easily  detached. 

For  placing  the  cylinders  into  their  proper  places  in  the  cavity,  the' 
introducing  pliers  are  necessary,  which  have  smooth  points  bent  at 
such  an  angle  as  will  permit  of  their  being  used,  when  closed,  as  a 
condensing  point. 

The  cavity  being  prepared  for  the  gold  and  properly  protected  from 

moisture,  one  of  the  soft  cylinders  is  carried  into  it  with  the  pliers  and 

placed  in  such  a  position  that  one  end  rests  on  the  bottom  and  the 

other  protrudes  from  the  orifice.     Pressure  in  the  direction  oi  the  walL 

•21 


322  FILLING    TEETH. 

against  which  the  cylinder  rests  is  then  made  with  the  closed  points 
of  the  pliers,  and  afterward  with  a  condensing  instrument  having 
either  a  smooth  wedge-shaped  point  or,  witli  what  is  better,  a  serrated 
point,  such  as  are  represented  in  Fig.  93.  When  the  first  cylinder 
introduced  has  been  well  condensed  against  one  of  the  walls  of  the 
cavity,  others  are  introduced  and  condensed  in  succession  until  these 
walls  are  covered  by  the  soft  cylinders.  The  hard  cylinders  are  then 
disposed  round  the  cavity  in  the  same  manner  as  the  soft  ones,  until  it 
diminishes  so  much  as  to  render  it  necessary  to  form  a  cavity  in  the 
centre  of  the  gold  already  introduced,  by  means  of  a  smooth  wedge- 
shaped  instrument,  such  as   is  represented  in  Fig.  92.     The  cavity 

Fig.  92. 


formed  by  this  instrument  is  then  filled  with  a  small  dense  cylinder, 
and  successive  openings  are  thus  made  and  filled  until  no  more  gold 
can  be  introduced,  when  the  protruding  ends  of  the  cylinders  are  con- 
densed by  pressure  applied  in  the  direction  of  the  bottom  of  the  cavity. 
The  surface  of  the  filling  is  then  finished  in  the  manner  to  be  described 
hereafter. 

When  the  cavity  is  of  considerable  depth  and  small  in  diameter,  or 
the  bottom  is  uneven,  pellets  of  gold  may  be  introduced  and  condensed 
upon  the  bottom  until  the  cavity  is  about  one-third  filled.  By  this 
method  the  gold  is  better  adapted  to  the  bottom  of  the  cavity  than  by 
placing  the  ends  of  the  cylinders  upon  an  uneven  surface.  The  surface 
condensing  of  cylinder  fillings  should  be  made  with  small -pointed 
condensing  instruments,  and  any  opening  it  is  possible  to  make  with 
them  be  filled  with  small  dense  cylinders. 

Redman's  Method  of  Cylinder  Filling. — The  following  is  Dr.  W.  G. 
Redman's  description  of  his  method  of  preparing  and  introducing  non- 
adhesive  gold  foil  in  the  form  of  cylinders,  which  differs  from  the  one 
before  described : 

"  The  instruments  necessary  for  preparing  the  cylinders  by  this  method 
consist  of  half  a  dozen  of  steel  rods  six  inches  long,  and  of  the  follow- 
ing sizes :  Nos.  2,  4,  6,  8,  10,  12,  ^^^lite's  burr  gage  plate,  and  a  short, 
fine,  tapering  broach. 

"For  introducing  the  cylinders,  a  pair  of  introducing  pliers  having 
points  serrated  upon  the  inside,  are  necessary,  and  for  lateral  condens- 


FILLING    TEETH. 


323 


ing,  while  introducing  the  cylinders,  a  narrow  foot  instrument  lightly 
serrated  by  means  of  a  fine  file,  the  serrations  being  rubbed  down  with 
emery  paper,  together  with  several  sharp-pointed,  cone-shaped  instru- 
ments for  examining,  and,  if  necessary,  piercing  the  filling  for  the 
introduction  of  more  gold  before  commencing  the  surface  condensing. 
This  instrument  is  represented  in  Fig.  92. 

"  For  surface  condensing  in  crown  cavities,  after  all  the  cylinders  are 
introduced,  instruments  with  large  and  deeply  serrated  points  are 
necessary,  which  are  to  be  followed  by  smaller  ones  with  points  shaped 
and  serrated  like  an  ordinary  burr  drill. 

"  For  approximal  surface  cavities,  a  thin,  flat,  serrated  condensing 
instrument,  such  as  is  represented  in  Fig,  93,  is  necessary,  together 
with  a  small,  square,  wedge-shaped  instrument,  and  ordinary  right  and 
left  condensers." 

Fig.  98  represents  a  complete  set  of  Redman's  instruments. 

Fig.   93. 


"Preparation  of  the  Cylinders.  It  is  seldom  necessary  that  a  cylinder 
should  contain  more  than  one-third  of  a  sheet  of  No.  3  gold  foil.  Any 
number  of  small  cylinders  prepared  by  this  method  may  be  placed  side 
by  side,  and  condensed  by  lateral  pressure  more  readily  than  the  same 


324  FILLING    TEETH. 

quantity  of  gold  could  be,  if  formed  into  but  one  cylinder.  Small 
cylinders  can  also  be  adapted  to  the  walls  of  the  cavity  much  better 
than  long  ones.  The  gold  from  which  they  are  formed  should  be  as 
soft  and  tough  as  it  can  be  manufactured,  and  does  not  require  4;o  be 
reannealed  either  in  the  leaf  ribbon  or  cylinder.  In  preparing  the 
ribbon,  a  leaf  of  gold  is  cut  into  three  pieces,  each  of  which  is  rolled 
diagonally  on  a  steel  rod,  the  diameter  of  which  should  be  the  same  as 
the  depth  of  the  cavity  to  be  filled.  The  rod  is  withdrawn  from  the 
cylinder  by  passing  the  thumb  and  forefinger  gradually  to  tlie  free  end, 
and  rever.sing  the  movement  of  the  rod  in  winding  the  gold  about  it. 
The  long  cylinder  thus  formed,  and  held  between  the  thumb  and  fore- 
finger, is  now  rolled,  Avithout  being  flattened  previously,  on  a  rod  of  a 
size  necessary  to  give  a  proper  length  to  the  small  cylinder  it  is  desired 
to  make.  As  soon  as  the  cylinder  is  withdrawn  from  the  rod,  it  is 
pressed  slightly  between  the  thumb  and  forefinger  in  order  to  give  it 
an  oval  form,  and  also  to  prevent  its  unfolding.  To  form  smaller 
cylinders,  the  ribbon  is  cut  into  such  lengths  as  are  necessary  to  make 
the  size  desired.  Some  of  the  cylinders  should  be  dense  enough  to  per- 
mit of  their  being  forced  into  their  places  when  the  introduction  of  the 
gold  is  nearly  completed.  Dense  cylinders  may  be  made  from  the  oval 
form  by  bending  the  sides  together  with  the  introducing  pliers,  or  by 
the  common  method  of  folding  the  ribbon  and  winding  it  tightly  on  a 
broach. 

"Preparation  of  Cavity.  The  walls  should  be  as  nearly  per- 
pendicular as  possible,  and  without  much  under-cutting ;  retaining 
points  are  unnecessary.  Slight  grooves  in  opposite  walls  are  sufficient 
to  retain  the  filling. 

"  Introducing  the  Cylinders.  The  cylinders,  in  using  this  method, 
are  carried  with  the  pliers  to  a  point  in  the  cavity  fiirthest  from  the 
operator,  and  placed  in  such  a  manner  as  will  enable  him  to  apply  the 
pressure  against  the  free  ends ;  the  opposite  ends  of  the  cylinders  being 
in  contact  Avith  the  posterior  wall  of  the  cavity."  "  The  pressure 
applied  during  the  introduction  of  the  gold  should  always,  when  prac- 
ticable, be  in  fi  direction  from  the  operator."  "After  introducing  a 
sufficient  quantity  of  gold  to  fill  a  third  or  half  of  the  cavity,  before 
making  lateral  pressure  care  should  be  taken  to  adapt  the  gold  well  to 
the  bottom."  "Lateral  pressure  is  then  made  and  more  gold  intro- 
duced until  the  cavity  is  filled ;  the  last  cylinder  used  being  a  dense 
one."  "  The  gold  should  be  so  evenly  and  solidly  introduced  that 
there  will  be  no  necessity  for  using  the  wedge-shaped  instrument; 
should  the  use  of  this  instrument,  however,  be  necessary,  the  opening 
made  by  it  may  be  filled  with  one  of  the  dense  cylinders  or  with  the 
strip."     "  After  all  the  gold  necessary  is  introduced,  the  surface  of  the 


FILLING    TEETH.  325 

filling  should  be  condensed  with  a  large  and  deeply  serrated  instru- 
ment, and  followed  by  one  of  smaller  size  and  finer  serrations." 

Pellets. — Another  form  in  which  non-adhesive  gold  foil  is  used  is 
that  of  pellets,  w^hich  are  formed  by  lightly  rolling  a  portion  of  a  sheet 
between  the  thumb  and  fingers.  They  are  made  of  different  sizes,  and 
when  placed  in  a  cavity  are  welded  together  by  means  of  pointed  or 
serrated  instruments.  It  is  necessary  that  the  first  pellets  introduced 
should  be  securely  anchored,  in  order  that  the  successive  ones  may  be 
built  upon  them  ;  these  last  should  be  small  enough  to  allow  the  welding 
instrument  to  pass  through  them  to  the  gold  beneath. 

ADHESIVE   GOLD   FOIL. 

In  manipulating  with  adhesive  foil,  a  preliminary  step  in  the  opera- 
tion is  to  attend  to  the  quality  of  the  gold.  It  must  possess  sufficient 
adhesiveness  to  cohere  under  moderate  pressure ;  and  as  this  property 
deteriorates  on  the  exposure  of  foil  to  the  atmosphere,  it  is  often  neces- 
sary to  restore  it  by  the  application  of  heat,  as  the  welding  principle, 
and  not  mechanical  force,  is  relied  upon.  To  accomplish  this,  the  gold, 
either  in  the  sheet,  roll,  or  pellet  form,  is  subjected  to  the  flame  of  an 
alcohol  lamp  until  it  becomes  a  bright  red.  A  wire-gauze  frame  is 
very  convenient  for  reannealing  the  sheet,  and  a  mica  plate  or  plati- 
num pan  for  the  pellets.  Many  prefer  to  pass  the  roll  and  pellets 
directly  through  the  flame  at  the  moment  they  are  being  carried  to 
the  cavity  with  the  introducing  pliers.  Another  method  is  to  boil 
the  gold  for  a  few  minutes  in  a  solution  composed  of  forty  drops  of 
sulphuric  acid  and  two  gills  of  rain-water.  This  diluted  acid  removes 
all  extraneous  matter  from  the  surface  of  the  gold,  which  soon  dries, 
and  is  found  to  be  very  adhesive. 

There  are  a  number  of  methods  by  w^hich  this  form  of  gold  foil  is  pre- 
pared for  introduction  into  the  cavity.  One  consists  in  tearing  frag- 
ments from  a  sheet  which  has  previously  been  annealed  on  wire-gauze, 
and  condensing  a  single  thickness  at  a  time  with  a  fine  serrated  point. 
Another  method  consists  in  lightly  rolling  up  the  whole  or  part  of  a 
sheet  in  the  form  of  a  rope,  and  cutting  this  up  into  pellets  of  different 
sizes.  In  forming  the  pellets,  the  sheet  should  be  very  lightly  rolled 
up  between  the  thumb  and  fingers,  or,  what  is  better,  lightly  folded  by 
means  of  a  spatula  and  chamois  skin. 

Some,  instead  of  forming  pellets,  prefer  to  introduce  this  quality  of 
gold  in  a  long  rope,  which  is  annealed  by  holding  it  in  the  centre  with 
the  pliers  and  rapidly  passing  it  through  the  flame.  When  the  gold 
is  ready  to  introduce,  and  the  cavity  is  carefully  dried  and  protected 
against  moisture  —  absolute  dryness  being  very  essential  in  the  use  of 
all  the  adhesive  forms  of  gold  —  the  first  pellet,  or  the  end  of  the  rope, 


326  FILLING    TEETH. 

when  this  form  is  used,  is  carried  from  the  flame  to  a  retaining  point 
in  the  cavity,  Avhere  it  is  securely  anchored  by  being  thoroughly  con- 
solidated by  means  of  instruments  having  fine  serrated  points.  As 
soon  as  the  retaining  points  are  solidly  filled,  the  gold  is  built  up  from 
these  over  the  bottom  and  sides  of  the  cavity,  care  being  taken  to 
condense  it  well  against  the  walls  as  it  approaches  the  orifice. 
Every  pellet  must  be  consolidated  as  it  is  introduced,  and  the  gold 
built  up  higher  against  the  walls  of  the  cavity  than  in  the  centre,  until 
the  oi'ifice  is  reached,  when  the  depression  left  in  the  centre  can  be 
filled  up.  Very  lightly  rolled  pellets  should  be  applied  to  the  walls 
of  the  cavity ;  for  if  the  pellets  be  formed  from  a  tightly-rolled  rope, 
they  have  a  tendency  to  clog,  and  cannot  be  consolidated  to  such  a 
degree  as  is  necessary  to  give  solidity  to  the  filling.  Fig.  98  repre- 
sents the  forms  of  instruments  for  introducing  and  consolidating  adhe- 
sive gold  foil. 

Heavy  Foil. — A  number  of  years  ago,  attention  was  directed  by  Dr. 
Robert  Arthur  to  the  use  of  the  heavy  numbers  of  gold  foil  for  filling 
teeth;  and  of  late  the  interest  in  this  form  of  gold  has  revived  to  such 
a  degree  that  very  many  now  advocate  its  claims,  among  the  number 
Dr.  W.  H.  Atkinson,  to  whom  the  credit  is  due  of  again  bringing  it 
into  notice. 

Nos.  15,  20,  30,  60, 120,  and  even  higher  numbers,  are  in  use.  Nos. 
15  and  20  can  be  consolidated  by  hand  force,  if  such  is  desired,  while , 
the  heavier  numbers  require  mallet  force.  The  method  of  manipu- 
lating this  foil  is  to  cut  it — without  allowing  it  to  come  in  contact  with 
the  fingers  —  into  pieces  varying  from  one-fourth  to  three-fourths  of 
an  inch  square,  or  into  strips- of  a  proper  width  and  length  to  suit  the 
cavity  to  be  filled.  The  gold  is  then  annealed  by  heating  each  jDiece 
or  strip,  held  by  the  pliers  in  the  flame  of  an  alcohol  lamp,  to  a  red 
heat.  For  filling  the  front  teeth  the  strip  is  preferable,  condensing 
each  layer  across  the  entire  surface  of  the  cavity,  and  folding  the  strip 
upon  itself  Retaining  points  are  solidly  filled,  and  the  gold  built 
from  one  to  the  other,  presenting  as  plane  a  surface  as  possible,  and 
not  allowing  the  foil  to  become  crumpled  or  folded  irregularly  upon 
itself.  For  filling  the  posterior  teeth  the  small  pieces  are  preferable, 
introduced,  like  the  strip,  with  the  pliers,  and  each  one  thoroughly 
consolidated.  The  gold  should  be  carefully  condensed  at  and  over  the 
margins  of  the  cavity  layer  by  layer. 

The  manufacture  of  these  heavy  foils  by  rolling  instead  of  beating, 
is  said  to  render  them  softer  and  more  adhesive.  Fig.  98  represents 
the  instruments  necessary  in  manipulating  the  heavy  foils. 

Dr.  "W.  H.  Morgan,  after  considerable  experience  with  this  heavy 
foil,  believes  it  to  possess  the  following  advantages  over  light  foil :  It 


FILLING    TEETH. 


P.O.: 


is  softer,  and  does  not  harden  so  readily  under  the  instrument ;  there 
is  less  danger  of  breaking  thin  walls  in  using  it;  it  is  more  easily  han- 
dled and  controlled  with  the  instrument ;  it  is  much  more  adhesive ; 
it  finishes  up  when  welded  better  than  any  other  form  of  gold. 

CRYSTAL   OR   SPONGE   GOLD. 

In  the  use  of  crystal  or  sponge  gold,  a  different  method  of  procedure 
is  required  from  that  employed  with  foil. 

The  chief  difference  between  the  instruments  employed  for  introduc- 
ing and  consolidating  crystal  gold  in  the  cavity  of  a  tooth,  and  those 
used  for  gold  foil,  consists  mainly  in  having  the  working  extremity 
blunt,  varying  in  diameter  from  a  line  to  almost  a  mere  point,  with 
shallow  serrations  upon  the  surface. 

Fig.  94  represents  a  set  of  instruments  well  adapted  for  the  manipu- 
lation of  crystal  gold. 

Fig.  94, 


In  filling  teeth  with  crystal  gold,  the  cavity  is  prepared  in  the  same 
manner  as  when  leaf  gold  is  employed.  This  done,  the  gold  is  cut, 
or,  rather,  torn  from  the  block  with  the  point  of  an  instrument,  into 
small  pieces,  varying  in  size  according  to  the  dimensions  of  the  cavity 
and  the  particular  stage  of  the  operation  in  which  it  is  to  be  used.  It 
being  important  that  the  crystals  or  particles  composing  the  mass 
should  be  as  little  separated  or  displaced  as  possible,  before  the  piece 
is  carried  to  its  place  in  the  tooth,  it  should  be  used  in  pellets 
as  large  as  can  be  introduced  into  the  cavity  without  crumbling. 
The  gold  being  divided  into  pieces  of  the  proper  size,  the  cavity  is 
washed,  and  then  wiped  dry  with  prepared  cotton,  or  flax  and  bibu- 
lous paper ;  a  piece  of  gold,  as  large  as  the  orifice  of  the  cavity  will 
receive,  is  taken  up  with  suitable  pliers,  or  one  of  the  sharp-pointed 
instruments,  as  may  be  most  convenient. 

The  spongy  mass  readily  adheres  to  the  serrated  surface  of  the 
working  extremity,  when  pressed  gently  upon  it,  and  with  this  it  may. 


^rlS  FILLING    TEETH. 

in  most  cases,  be  carried  to  the  bottom  of  the  cavity.  Every  part 
must  uow  be  thoroughly  consolidated,  first  with  a  large,  and  next  with 
a  smaller,  and  lastly  with  a  very  delicately-pointed  instrument,  so  bent 
that  it  may  be  readily  applied  to  all  the  depressions  and  inequalities 
of  the  walls  and  floor  of  the  cavity ;  for  unless  the  gold  is  made  abso- 
lutely solid  in  these  places,  as  well  as  throughout  all  the  parts  of  the 
filling,  the  success  of  the  operation  will  be  more  or  less  uncertain. 
Thus,  piece  after  piece  is  applied,  consolidating  each  one  as  the  opera- 
tion progresses,  until  the  gold  protrudes  sufficiently  from  the  orifice 
of  the  cavity  to  admit  of  a  good  finish,  leaving  the  surface  flush  with 
that  of  the  tooth. 

If,  during  any  part  of  the  operation,  the  smaller  pointed  instruments 
can  be  forced  between  the  gold  and  the  walls  of  the  cavity,  such  open- 
ing or  openings  should  be  filled  with  smaller  masses  of  the  material 
before  another  large  piece  is  introduced.  This  precaution  ought  never 
to  be  neglected ;  for  should  any  soft  places  exist  after  the  completion 
of  the  operation,  the  filling  will  be  likely  to  absorb  moisture,  and  ulti- 
mately  to  crumble  and  come  out.  It  is  also  indispensably  necessary 
that  the  gold,  during  its  introduction  into  the  tooth,  be  kept  absolutely 
free  from  moisture,  as  this  destroys  the  adhesive  or  welding  property 
of  the  crystals. 

The  gold  having  been  introduced  and  consolidated  as  directed,  the 
exposed  surface  is  scraped  or  filed  down  to  a  level  with  the  orifice  of 
the  cavity,  then  made  smooth  by  rubbing  it  with  Arkansas  stone  or 
with  finely-powdered  pumice,  and  burnished  or  polished  with  crocus, 
in  the  manner  as  described  when  gold  foil  is  used. 

In  finishing  a  filling  made  with  these  preparations  of  gold,  the  ope- 
rator should  see  that  there  are  no  thin  overlapping  portions  upon  the 
teeth  outside  of  the  orifice  of  the  cavity.  They  are  liable,  in  biting 
hard  substances,  or  in  ordinary  mastication,  to  be  broken  off,  leaving 
a  depression  for  the  lodgment  of  extraneous  matter  and  clammy  secre- 
tions. Sooner  or  later  this  will  give  rise  to  a  softening  of  the  dentine 
thus  exposed,  which,  if  it  does  not  cause  the  filling  to  loosen,  will  ulti- 
mately render  its  removal  and  replacement  necessary.  In  short,  the 
precautions  necessary  to  be  observed  in  making  a  filling  with  gold  foil 
are  equally  necessary  when  the  operation  is  made  with  either  of  the 
preparations  now  under  consideration. 

Mallet  Force  in  Consolidating  Gold.  —  Some  ten  years  ago.  Dr.  "W. 
H.  Atkinson  introduced  a  method  of  consolidating  gold  by  means  of 
mallet  force,  which  has  now  become  a  favorite  one  wuth  many  of  the 
best  operators  in  the  profession.  He  claims  for  this  method  the  fol- 
lowing advantages  over  hand  pressure:  A  more  perfect  condensation 
of  the  goli  and  a  more  thorough  welding  than  can  be  made  by  hand 


FILLING    TEETH. 


329 


pressure;  that  the  gold  will  be  anchored  in  its  position  with  much 
more  facility ;  that  the  instrument  always  acts  under  the  mallet  upon 
the  designed  point,  does  not  slip  from  its  position,  and,  consequently, 
there  is  no  liability  of  abrading  or  wounding  the  soft  parts ;  that  mal- 
let force  is  not  more  unpleasant  to  the  patient  than  the  ordinary  method 
of  condensing ;  and  that  it  is  far  less  fatiguing  than  hand  pressure  in 
protracted  operations. 

That  mallet  force  is  an  effective  method  of  condensing  the  adhesive 
forms  of  gold,  there  can  be  no  question. 

Mallets  of  almost  every  description  are  used,  such  as  wood,  lead,  tin, 
copper,  brass,  steel,  ivory,  and  vulcanized  rubber. 

Heavy  lead  and  tin  mallets,  weighing  from  four  and  a  half  to  six 
and  a  half,  and  even  eight  ounces,  are  preferred  by  many  of  the  advo- 
cates of  this  method. 

In  using  the  hand  mallet,  which  is  represented 
in  Fig.  95,  the  aid  of  an  assistant  is  necessary, 
who  taps  the  end  of  the  plugger  squarely  with 
sharp,  springing  strokes,  while  the  principal  ope- 
rator directs  its  condensing  point  over  the  gold 
as  it  is  introduced  into  the  cavity. 

"With  instruments  called  automatic  mallet 
pluggers  —  Fig.  96  represents  Snow  and  Lewis's, 
and  Fig.  97,  Salmon's — the  aid  of  an  assistant  is 
unnecessary. 

Both  of  these  forms  operate  by  the  action  of  a 
spiral  spring. 

Fig.  98  represents  an  excellent  set  of  mallet 
pluggers  designed  by  Dr.  C.  R.  Butler. 

Finishing  the  Surface  of  the  Fillinrj.  —  After 
having  thoroughly  consolidated  the  surface  of 
the  filling,  finishing  files,  such  as  are  represented 
in  Fig.  99,  are  used  to  remove  the  protruding 
portions  of  gold,  and  to  form  a  smooth,  uniform 
surface,  free  from  the.  slightest  indentations  which 


Fig.  96. 


Fig.  97. 


330 


FILLING    TEETH. 


may  afford  lodgment  to  extraneous  matter.  This  is  a  point 
never  to  be  lost  sight  of;  for,  however  excellent  the  filling 
may  be  in  other  respects,  if  the  surface  is  not  smooth,  uni- 
form, and  flush  with  the  orifice  of  the  cavity,  the  object  in- 
tended to  be  accomplished  by  it  will  be  partially  if  not  wholly 
defeated. 

It  is  better,  however,  to  file  off  but  a  portion  of  the  pro- 
truding gold  at  first,  and  then  to  burnish,  condense,  and  to  file 


a  second  time,  with  a  fine  file,  all  it  is  necessary  to  remove. 
After  each  filing,  and  before  applying  the  burnisher,  the  sur- 
face should  be  cleansed  of  all  loose  pieces  of  gold.  After 
a  second  burnishing,  the  Arkansas,  Superior,  or  Scotch  stone, 
or  finely-powdered  pumice  may  be  applied  to  the  surface  to 
reniove  all  the  file  scratches  and  other  asi^erities.  For  a  filling 
in  the  approximal  surface  of  a  tooth,  the  stone  may  be  shaped 
like  a  pinion-file  ;  it  should  be  frequently  dipped  in  water,  and 
when  its  pores  become  filled  with  gold,  the  surface  may  be 
ground  off  by  rubbing  it  on  a  corundum  slab.  If  the  filling 
is  finished  with  pumice,  it  may  be  applied  with  floss  silk  or 
tape  moistened  with  water,  by  drawing  it  backward  and  for- 
w^ard  across  the  surface  of  the  filling. 

Fig.  100  represents  an  excellent  file-carrier,  contrived  by  Dr. 
Forbes,  for  files  for  finishing  fillings  on  the  approximal  sur- 
faces of  the  front  teeth,  and  Fig.  101,  a  tape-carrier. 

If  the  filling  is  in  the  grinding,  buccal,  or  palatine  surface 
of  a  molar  or  bicuspid,  a  long  piece  of  the  stone  having  a 
small,  triangular,  and   slightly  oval  point   may  be  used  ;   if 


FILLING    TEETH. 

Fig.  99. 


331 


Fig.  100. 


Fig.  101. 


332 


FILLING    TEETH. 


powdered  pumice-stone  be  employed,  it  may  be  used  on  the  point 
of  a  similarly  shaped  piece  of  soft  wood,  previously  softened  in  water. 
After  all  the  asperities  have  been  cut  down,  the  surface  should  be 
washed  until  every  particle  of  grit  is  removed.  This  done,  it  may 
be  polished  with  a  suitable  burnisher,  dipped  from  time  to  time  in  a 
solution  of  pure  Castile  soap,  until  the  filling  is  rendered  as  brilliant  as 
a  mirror.     Fig.  102  represents  various  forms  of  burnishers. 

Fig.  102. 


Having  proceeded  thus  far,  the  surface  may  be  again  washed,  and 
the  operation  completed  by  rubbing  it  from  three  to  six  minutes  with 
dry  floss  silk.  Rouge  or  rotten-stone  applied  to  the  surface  on  tape,  or 
finely-powdered  silex  or  pumice-stone  on  a  piece  of  orange-wood,  after 
it  is  prepared  by  the  method  just  described,  will  remove  the  bright 
metallic  lustre — when  this  is  objectionable  on  account  of  the  exposure 
of  the  filling  —  and  leave  a  fine  finish.  Holly  strips,  in  the  form  of 
thin  shavings,  answer  admirably  for  applying  levigated  pumice,  rouge, 
etc.,  in  the  polishing  process. 

Non- Conductors. —  When  the  caries  has  penetrated  nearly  to  the 
pulp-cavity,  the  presence  of  a  gold  or  any  other  metallic  filling  is 
sometimes  productive  of  considerable  pain  and  irritation,  especially 
when  hot  or  cold  fluids  are  taken  into  the  mouth,  or  during  the  inspi- 
ration of  cold  air.  In  some  cases,  inflammation  and  suppuration  of 
the  lining  membrane  and  pulp  supervenes.  To  prevent  these  dis- 
agreeable results,  a  variety  of  means  have  been  proposed.  Dr. 
Solyman  Brown  recommends  placing  asbestos,  this  being  a  non-con- 
ductor of  caloric,  on  the  bottom  of  the  cavity  previously  to  the  intro- 
duction of  the  gold.  The  author  prefers  a  thin  layer  of  gutta-percha, 
which  may  be  used  in  the  form  of  a  thick  solution  prepared  with 
chloroform,  or  a  layer  of  thin  gutta-percha  cloth  may  be  placed  at 
once  in  the  bottom  of  the  cavity.     When  the  solution  is  used,  a  drop 


FILLING    TEETH.  333 

may  be  placed  in  the  cavity,  and  a  sufficient  time  allowed  for  the 
chloroform  to  evaporate,  before  introducing  the  filling.  A  thin  layer 
of  "Hill's  stopping,"  of  which  gutta-percha  forms  the  principal  in- 
gredient, may  be  used  with  equal  advantage.  As  a  non-conductor, 
os-artificiel,  or  oxy chloride  of  zinc,  has  no  superior. 

The  time  required  by  an  expert  operator  to  fill  a  tooth  well  may  be 
said  to  vary  from  thirty  minutes  to  two  hours  and  a  half,  according  to 
the  size,  shape,  and  situation  of  the  cavity,  and  in  some  cases  a  much 
longer  time  will  be  required.  The  author  has  found  it  necessary  in 
filling  some  cavities,  especially  when  the  restoration  of  a  large  portion 
of  the  crown  was  called  for,  to  bestow  as  many  as  six  hours'  constant 
labor  upon  the  operation.  Less  time  and  skill  are  usually  required  to 
fill  a  cavity  in  the  grinding  than  in  the  approximal  surface  of  a 
tooth  ;  but  the  operation  in  either  place,  to  be  beneficial  to  the  patient, 
must  be  performed  in  the  most  thorough  manner.  The  dentist  who 
does  not  feel  the  importance  of  making  all  his  operations  as  perfect  as 
possible,  should  never  be  intrusted  with  the  management  of  these  im- 
portant organs.  Want  of  attention  to  two  points  in  the  consolidation 
of  a  filling  often  causes  the  ultimate  failure  of  operations  in  all  other 
respects  well  performed.  First,  by  not  making  sufficient  lateral  com- 
pression whilst  introducing  the  gold,  the  surface  is  apt  to  be  more 
solid  than  the  interior.  Consequently  the  filling  may  drop  out  for 
want  of  a  firm  contact  against  the  sides ;  or,  if  retained,  it  is  apt  on 
grinding  surfaces  to  be  pressed  inward,  leaving  a  space  around  the 
orifice  for  the  penetration  of  fluids.  Second,  want  of  care  in  condens- 
ing around  the  edges  of  the  filling  will,  by  the  crumbling  away  or 
scaling  ofl'  of  portions  of  the  gold,  expose  the  edges  of  the  cavity  to 
decay. 

In  every  part  of  the  operation,  the  dentist  should  so  guard  his  in- 
struments as  to  prevent  them  from  slipping,  which  he  will  usually  be 
better  able  to  do  by  standing  a  little  to  the  right  and  behind  his 
patient  than  in  any  other  position.  In  filling  the  lower  teeth  he  should 
stand  several  inches  higher  than  while  filling  the  upper,  and  for  this 
purpose  he  should  have  a  stool  or  movable  platform  on  which  to 
stand.  When  it  can  be  done,  he  should  grasp  the  tooth  with  the 
thumb  and  forefinger  of  his  left  hand,  not  only  to  prevent  it  from 
being  moved  by  the  pressure  he  applies,  but  also  to  catch  the  point  of 
the  instrument  in  case  it  should  slip ;  if  he  is  always  careful  to  press 
in  a  direction  toward  the  orifice  of  the  cavity,  this  need  not  happen  ; 
nevertheless,  he  -should  always  take  the  precaution  to  guard  against 
possible  accident.  When  he  cannot  shield  the  mouth  with  the  thumb 
and  finger  of  his  left  hand,  he  should  let  the  thumb  or  one  of  the 


334  FILLING    TEETH. 

fingers  of  his  right  rest  either  upon  the  tooth  he  is  operating  on  or 
upon  some  other. 

For  the  special  application  and  modification  of  these  general  direc- 
tions, the  reader  is  referred  to  the  filling  of  individual  cavities  in 
teeth. 

FILLING   INDIVIDUAL   CAVITIES   IN   TEETH. 

To  describe  the  method  of  filling  each  individual  cavity  in  every 
locality  in  Avhich  a  tooth  is  liable  to  be  attacked  by  caries  would  be 
XTnnecessarily  tedious.  But,  as  this  is  one  of  the  moet  important,  and, 
at  the  same  time,  one  of  the  most  difficult  operations  in  dental  surgery, 
it  may  be  well  to  enter  a  little  more  into  detail  upon  the  subject  than 
we  have  as  yet  done.  In  doing  this,  the  writer  will  confine  himself, 
for  the  most  part,  to  the  manner  of  filling  a  cavity  in  each  of  the  fol- 
lowing localities,  which  are  the  parts  of  teeth  most  liable  to  caries. 

First.  In  the  approximal  and  labial  surfaces  of  the  superior  in- 
cisors and  cuspids,  and  the  palatine  surfaces  of  the  incisors  ;  the  ante- 
rior surfaces  of  the  cuspids  and  the  posterior  surfaces  of  cuspids  and 
incisors  being  rarely  attacked  by  caries. 

Second.  In  the  grinding,  approximal,  buccal,  and  palatine  surfaces 
of  the  molars  and  bicuspids  of  the  upper  jaw. 

Third.  In  the  approximal  surfaces  of  the  inferior  incisors  and  cus- 
pids. 

Fourth.  In  the  grinding,  approximal,  and  buccal  surfaces  of  the 
molars  and  bicuspids  of  the  lower  jaw. 

Other  parts  of  the  teeth  sometimes  become  the  seat  of  caries,  but 
the  foregoing  are  the  localities  most  liable  to  be  attacked  by  the 
disease. 

FILLING  THE  SUPERIOR  INCISORS   AND   CUSPIDS. 

I.  With  Non-Adhesive  Gold  Foil. — In  describing  the  manner  of  intro- 
ducing a  filling  in  one  of  the  first-named  teeth,  we  shall  commence  with 
the  right  approximal  surface  of  the  left  central  incisor.  The  direc- 
tions we  propose  giving  for  the  performance  of  the  operation  here,  will 
be  applicable,  with  a  few  exceptions,  to  the  same  surface,  on  all  the 
upper  incisors.  As  a  general  rule,  the  gold  should  be  introduced  from 
behind  the  teeth  forward  and  upward,  and  for  the  following  reasons : 
1.  "When  the  aperture  between  the  teeth  has  been  formed  with  a  file, 
it  should,  when  the  circumstances  of  the  case  will  permit,  and  for 
reasons  stated  in  another  place,  be  made  wider  behind  than  before ; 
consequently,  the  diseased  part  can  be  most  easily  approached  from 
this  direction.  2.  The  gold,  in  the  majority  of  cases,  can  be  more 
conveniently  introduced  from  the  palatine  side,  and  the  force  required 
for  condensing  it  can  be  more  advantageously  applied. 


FILLING    TEETH.  •  335 

The  exceptions  to  the  above  rule  are,  when  the  approximal  side  of 
the  tooth  is  turned  slightly  forward  toward  the  lip,  and  when  the  caries 
is  situated  nearer  the  labial  than  the  palatine  angle  ;  also,  when  the 
teeth,  instead  of  occupying  a  vertical  position  in  the  alveolar  border, 
or  projecting  slightly,  as  they  usually  do,  incline  backward  toward  the 
roof  of  the  mouth.  It  sometimes  happens,  too,  when  they  are  sepa- 
rated by  pressure,  that  the  diseased  part  can  be  most  conveniently 
reached  from  before. 

The  instrument  which  the  writer  has  found  best  adapted  for  the 
introduction  of  the  gold  into  a  cavity  in  the  right  approximal  surface 
of  an  incisor  or  cuspid  tooth  is  represented  in  Fig.  103.  The  width 
and  length,  as  well  as  the  curvature  or  angle  of  the  point,  should  vary 
according  to  the  size  of  the  cavity  and  the  width  of  the  space  between 
the  teeth. 

Fig.  103. 


f--    — 


Fia.  104. 


The  stem  of  the  instrument  as  well  as  the  shank  should  be  strong 
enough  to  sustain  any  amount  of  pressure  which  it  may  be  necessary 
to  apply  in  forcing  the  folds  of  gold  tightly  against  each  other.  The 
point  should  be  wedge-shape,  and  the  extremity  serrated. 

The  ornamental  beading  and 
collar  are  objected  to  by  some 
operators  as  apt  to  wound  the 
mouth.  The  shaft,  ferule  and 
handle  may  be  made  continu- 
ously tapering,  as  in  Fig.  104. 

The  decay  having  been  removed,  the  cavity,  properly  shaped, 
cleansed,  dried,  and  protected,  is  ready  for  the  reception  of  the  gold. 
The  patient  should  be  seated  in  a  chair  sufficiently  high  to  bring  the 
head  on  a  level  with  the  breast  of  the  operator,  and  resting  on  the 
head-piece  of  the  chair,  with  the  face  upward.  The  operator,  standing 
upon  the  right  side,  should  support  the  patient's  head  firmly  with  his 
left  arm  during  the  operation,  while  with  the  thumb  and  forefinger  of 
the  same  hand  the  strip  or  roll  of  gold  is  held,  and  one  end  placed  in 
a  proper  position  to  be  introduced  into  the  cavity.  The  middle  finger 
of  the  same  hand  ought  to  rest  on  the  end  of  a  tooth  to  the  left  of  the 
one  on  which  the  operation  is  being  performed,  while  with  the  little 
finger  the  lower  lip  may  be  gently  depressed. 

During  the  introduction  of  the  gold,  the  instrument  should  be  held 
(Fig.  105)  in  the  right  hand  of  the  operator,  and  grasped  with  sufficient 
firmness  to  prevent  it  from  slipping  or  rotating. 


336 


FILLING    TEETH. 


Fig.  105. 


m  ,||4^„,., 


In  introducing  the  gold,  the  first  fold  should  be  applied  against 

the  upper  wall  of  the  cavity, 
that  the  pressure  may  always 
be  exerted  in  a  direction  to- 
ward the  extremity  of  the 
root,  apjilyingeach  additional 
fold  as  closely  to  the  preced- 
ing one  as  possible.  The  folds 
should  also,  in  their  introduc- 
tion, be  applied  as  closely  to 
the  labial  and  palatine  walls 
of  the  cavity  as  possible,  but 
always  directing  the  piressure,  when  these  are  thin  and  brittle,  in  the 
direction  of  the  axis  of  the  root. 

When  the  lower  part  of  the  cavity  is  very  narrow,  as  is  often  the 
case,  especially  where'  it  extends  nearly  to  the  labial  angle  of  the 
tooth,  it  is  often  necessary  to  change  the  instrument  for  one  having  a 
smaller  point. 

To  carry  a  fold  of  gold  to  the  bottom  of  a  cavity,  upon  the  point  of 
the  instrument,  without  breaking  or  cutting  it,  requires  some  tact.  The 
point  should  never  be  carried  directly  toward  the  bottom  :  on  entering 
the  orifice,  it  should  be  inclined  toward  the  wall  of  the  cavity  opposite 
the  one  against  which  the  folds  are  first  laid.  Equally  as  much  tact  is 
required  to  prevent  displacing  the  gold  before  a  sufficient  quantity  has 
been  introduced  to  procure  support  for  it  from  the  surrounding  walls: 
which  is  an  accident  particularly  apt  to  occur  with  young  practitioners, 
when  the  cavity  is  superficial  and  has  a  large  orifice.  To  prevent  this, 
the  folds  of  gold  should  be  long  enough  to  project  some  distance  from 
the  orifice,  that  they  may  receive  support  from  the  adjoining  tooth,  and 
from  the  thumb  and  forefinger  of  the  left  hand  of  the  operator,  until 
the  operation  has  reached  that  stage  when  sufficient  stability  shall  have 
been  obtained  from  the  walls  of  the  cavity. 

There  are  cases  in  which  an  instrument  like  the  one  represented  in 
Fig.  106  can  be  very  advantageously  em- 
ployed in  the  introduction  of  the  gold  ;  but 
in  the  majority  of  cases  the  instrument 
represented  in  Fig.  103  will  be  found  moi-e 
convenient. 

After  having  filled  the  cavity  so  thoroughly  that  a  small  wedge- 
pointed  instrument  cannot  be  made  to  penetrate  the  gold  at  any  point, 
the  extruding  portion  of  the  filling  should  be  consolidated  ;  beginning 
with  the  portions  overlapping  the  lower  part  of  the  tooth  and  the  edge 
of  the  posterior  wall.     These  should  be  carefully  and  firmly  pressed 


Fig.  106. 


FILLING    TEETH, 


337 


toward  the  cavity,  with  an  instrument  like  the  one  represented  in  Fi^, 
107.  This  done,  it  may  be  firmly  applied  to  every  part  of  the  surface 
of  the  filling,  continuing  the  pressure  as  long  as  the  jDoint  of  the  instru- 
ment can  be  made  to  indent  the  gold. 

.  When  the  space  between  the  teeth  is  very  narrow,  an  instrument 
shaped  as  in  Fig.  108  may  be  used.  The  operator  should  be  provided 
with  two  or  three  instruments  like  each  of  the  two  last,  varying  in  the 
size,  length,  and  curvature  of  their  points. 


Fig.  107. 


Fig.  K 


Fig.  109. 


During  the  process  of  consolidating  the  gold,  the  tooth  should  ba 
firmly  grasped  between  the  thumb  and  forefinger  of  the  left  hand  ; 
this  prevents  it  from  being  pressed  too  forcibly  against  the  opposite 
side  of  the  socket,  while,  at  the- same  time,  the  end  of  the  forefinger, 
by  being  placed  above  the  instrument,  assists  in  directing  its  point,  and 
serves  to  keep  it  from  slipping.  When  the  labial  and  palatine  walls  of 
the  cavity  are  very  thin,  great  care  is  necessary  tc  prevent  fracturing 
them,  in  introducing  and  consolidating  the  gold.  The  consolidation 
should  be  commenced  around  the  edges,  and  the  pressure  applied  to- 
ward the  centre  of  the  cavity. 

It  sometimes  happens  that  the  caries  extends  forward  to  the  labiaF 
angle  of  the  tooth,  and  upward,  at  the  same  time,  under  the  edge  of 
the  gum.  Great  difficulty  is  often  felt  in-  thoroughly  filling  this  por- 
tion of  the  cavity,  and  it  cannot  always  be  done  from  behind  the  tooth,. 
In  this  case,  after  having  filled  the  cavity 
in  the  manner  as  already  described,  the 
operator  may,  standing  on  the  left  side  of 
the  patient,  and  with  an  instrument  having 
a  wedge-shaped  point  (Fig.  109),  make  as  large  an  opening  as  pos- 
sible in  the  gold. 
This  done,  he  may 
grasp  the  left  late- 
ral incisor,  or  cus- 
pid tooth,  with  the 
thumb  and  middle 
finger  of  his  left 
hand,  elevating  the 
upper  lip  with  the- 
forefinger  of  the 
same ;  then, with  the 
instrument  held  as 
22 


Fig.  110. 


338 


FILLING    TEETH. 


in  Fig.  110,  he  may  proceed  to  iiitroduce  the  gold,  filling  the  upper 
part  of  the  opening  first.  After  introducing  fold  after  fold,  until  it  is 
completely  and  compactly  filled,  the  extruding  portion  should  be  con- 
solidated with  a  similarly  shaped  instrument,  having  a  round  serrated 
point,  or  the  one  represented  in  Fig.  108. 

The  size  of  the  roll  of  gold  must  be  varied  to  suit  the  size  of  the 
cavity,  though  it  should  seldom  have  in  it  more  than  a  fourth  of  a 
leaf  of  No.  4.  If  more  than  this  be  employed  at  one  time,  it  will  be 
difficult  to  apply  the  folds  sufficiently  near  each  other. 

When  the  teeth  have  been  separated  by  pressure,  or  when  the  aperture 
is  as  wide  anteriorly  as  posteriorly,  the  gold  may  be  introduced  from 
either  side  as  is  most  convenient ;  but,  when  introduced  from  before,  it 
may  be  done  in  the  manner  as  just  described,  the  operator  standing  on 
the  left  side  of  his  patient,  and  using  such  instruments  as  he  finds  best 
adapted  (Fig.  103  or  109).  The  gold  having  been  introduced  and  con- 
densed, the  surface  of  the  filling  is  to  be  finished  in  the  manner  already 
described. 

The  method  of  filling  the  right  central  incisor  in  the  left  approximal 
surface  is  so  very  similar  to  that  of  filling  the  left  in  the  right  side, 
that  it  will  not  be  necessary  to  enter  so  minutely  into  detail.  In  this 
as  in  the  other  case,  the  gold,  as  a  general  rule,  should  be  introduced 
from  behind  the  tooth,  forwai'd  and  upward ;  but  if  introduced  from 
the  front,  the  operator  should  still  stand  on  the.  right  side  of  the 
patient.  The  head  should  have  the  same  elevation,  and  inclination 
backward  ;  but  the  face  should  be  turned  more  toward  the  operator  to 
give  him  a  better  view  of  the  cavity  in  the  tooth,  and  to  enable  him  to 
reach  it  more  readily  with  the  instrument. 

The  cavity  being  formed,  cleansed  and  dried,  the  operator  may  pro- 
•ceed  to  introduce  the  gold  as  already  directed,  with  an  instrument  like 

the  one  represented  in 
Fig.    108.      In    many 
cases,  however,  he  will 
require  one   having  a 
'--    somewhat  longer  point, 
and  curved  at  nearly  a 
right   angle   with   the 
stem.     The  instrument 
should  be  held  some- 
what differently  in  the 
hand  (Fig.  Ill),  and 
grasped  firmly  with  the 
thumb  and  fore  and  middle  finger,  so  as  to  prevent  it  from  rotating. 
The  head  should  be  securely  confined  with  the  left  arm,  the  upper  lip 


Fig.  111. 


FILLING    TEETH.  339 

raised  with  the  left  thumb,  pressing  it  at  the  same  time  firmly  against 
the  anterior  surface  of  the  tooth.  The  middle  or  fore  finger  of  the  same 
hand  may  be  placed  against  the  gum  just  inside  the  tooth,  to  direct 
the  application  of  the  point  of  the  instrument,  prevent  the  liability  of 
its  slipping,  and  control  the  free  end  of  the  roll  of  foil.  The  lower 
lip  may  be  depressed  either  with  the  middle  joint  of  this,  or  with  one 
of  the  other  fingers. 

After  having  placed  one  end  of  the  gold  in  the  cavity,  fold  after 
fold  should  be  introduced  until  it  is  compactly  filled ;  except  in  those 
cases  where  the  lower  part  is  very  small,  when  a  smaller-pointed  in- 
strument should  be  employed  for  the  completion  of  the  operation ;  and 
indeed  for  the  introduction  of  all  the  gold,  if  the  cavity  is  not  large 
or  the  aperture  between  the  teeth  very  narrow. 

For  consolidating  the  extruding  gold,  the  instrument  represented  in 
Fig.  107  will,  in  many  cases,  be  all  that  is  required.  But  the  one  repre- 
sented in  Fig.  112  can  sometimes  be  used  very  advantageously;  and 

Fig.  112.  Fig.  113. 


the  one  in  Fig.  113  will  be  found  a  useful  condenser  for  the  right  as 
well  as  the  left  approximal  surface  of  an  incisor,  or  clispid  tooth ; 
and  both  the  last-mentioned  instruments  may  often  be  used  to  great 
advantage  on  the  approximal  surfaces  of  other  teeth.  Some  of  the 
instruments  employed  in  filling  teeth  with  adhesive  and  crystal  or 
sponge  gold  may  also  be  advantageously  employed  in  consolidating 
the  ordinary  gold  in  the  approximal  surfaces  of  the  incisors  and  other 
teeth. 

In  completing  the  operation,  it  is  important  that  every  particle  of 
gold  overlapping  the  orifice,  and  frequently  extending  under  the  free 
edge  of  the  gum,  should  be  removed  before  finishing  the  surface  of 
the  filling ;  but  the  operator  ought,  at  the  same  time,  to  avoid  as  much 
as  possible  wounding  the  gum  and  dental  periosteum.  As  the  cavity 
frequently  extends  a  little  above  the  gum,  great  care  is  necessary  to 
prevent  wounding  it ;  indeed,  there  are  many  cases  in  which  it  cannot 
be  avoided,  unless  the  point  of  the  gum  is  pressed  up  between  the  teeth, 
by  the  introduction  of  a  piece  of  raw  cotton,  band  of  rubber,  or  wedge 
of  wood,  a  day  or  two  before  the  operation  of  filling  is  performed. 

In  filling  an  incisor,  or  cuspid  tooth,  on  the  labial  surface,  the  ope- 
ration is  often  very  simple  and  easy;  but  there  are  many  cases  in  which 
it  is  both  difficult  and  tedious.  The  head  of  the  patient  should  rest 
with  the  face  upward,  as  already  described,  and  sustained  in  the  same 


340 


FILLING    TEETH. 


Fig.  114. 


way  with  the  left  arm.  of  the  operator;  while,  with  the  thumb  of  the 
left  hand  placed  ou  the  gum  above  the  tooth,  the  upper  lip  should  be 
elevated. 

The  forefinger  should  be  pressed  firmly  against  the  palatine  surface 
of  the  tooth,  and  the  left  side  of  the  chin  gently  grasped  with  the 
other  three  fingers.  Then,  with  an  instru- 
ment (Fig.  114)  having  a  wedge-shaped  point, 
grasped  with  the  right  hand,  as  in  Fig.  Ill 
or  115,  the  operator  should  proceed  to  intro- 
duce the  gold,  standing  at  the  right  side  of  the 
patient,  with  the  thumb  of  the  right  hand  resting  on  a  tooth  to  the 
left  of  the  one  he  is  about  to  fill,  or  against  the  cheek.  He  should  com- 
mence by  laying  the  fir.st  folds  against  the  walls  of  the  cavity  nearest  to 
him,  and  thusintroduce  fold  after  fold,  until  it  is  compactly  filled.     The 

Fig.  115.. 


'""*  <j4    <> 


'1»«^ 


..y-" 


Fig.  110. 


extruding  portion  may  be  consolidated  with  a  round  or  square-pointed 
instrument,  or  with  a  straight-poittted  one  as  represented  in  Fig.  116. 
Great  care  is  necessary  to  prevent  the  instrument  from  slipping  and 
wounding  the  gums.  After  having  partially  consolidated  the  gold, 
the  overlapping  portion  must  be  firmly  pressed  toward  the  centre  of 
the  cavity,  and  the  point  of  the  instrument 
repeatedly  applied  to  every  part  of  the  sur- 
face of  the  filling,  until  it  can  no  longer  be 
made  to  yield  to  pres.sure.  This  done,  the 
gold  may  be  filed  down  to  the  level  of  the  tooth,  smoothed  with  Ar- 
kansas stone,  and  burnished  or  polished. 

When  the  cavity  is  shallow  and  the  orifice  broad,  the  gold  as  it  is 
introduced  mast  be  held  in  its  place  with  the  thumb  of  the  left  hand, 
until  a  sufficient  quantity  has  been  placed  in  the  cavity  to  obtain  for 
it  the  necessary  support  from  the  surrounding  walls.  But  in  over- 
coming difficulties  of  this  sort,  the  peculiar  circumstances  of  the  case 
can  alone  suggest  the  proper  means  to  be  employed  by  the  operator. 


FILLING    TEETH,  341 

The  decay  sometimes  extends  entirely  across  the  labial  surface  of  the 
tooth,  leaving,  after  its  removal,  a  horizontal  groove  open  at  both  ends. 
In  this  case  the  walls  should  be  made  rough,  wider  at  the  bottom  than 
at  the  opening,  and  the  operation  of  filling  commenced  at  one  end,  by 
applying  the  folds  of  foil  alternately  against  the  upper  and  lower  wall, 
and  consolidating  them  so  thoroughly  as  to  prevent  the  liability  of 
their  being  displaced  during  any  subsequent  pai-t  of  the  ojDeration. 
Successive  folds  are  introduced  in  the  same  manner,  each  in  close  con- 
tact with  the  preceding  series,  until  the  groove  is  completely  filled, 
applying  the  pressure  during  the  whole  of  the  operation  against  the 
two  walls.  In  condensing  the  extruding  gold,  the  operator  should  com- 
mence first  at  one  end  of  the  groove,  then  at  the  other,  and  afterward 
consolidate  the  whole  surface  of  the  filling.  In  finishing  the  operation, 
the  same  precaution,  with  regard  to  wounding  the  gum  and  dental 
periosteum,  should  be  observed  here  as  recommended  for  the  approxi- 
mal  sur^ce  of  the  tooth. 

Although  it  rarely  happens  that  the  palatine  surfaces  of  the  upper 
incisors  are  attacked  by  caries,  yet  the  disease  does  sometimes  develop 
itself  there,  in  the  indentations  occasionally  found  a  little  below  the 
free  edge  of  the  gum.  The  removal  of  the  diseased  part,  the  forma- 
tion of  a  cavity,  and  the  introduction  of  a  filling,  can,  in  the  majority 
of  cases,  be  more  easily  accomplished  in  this  than  in  any  other  part 
of  an  incisor  tooth. 

Fig.  117.  Fig.  118. 


The  cavity  being  properly  prepared  for  filling,  the  head  should  be 
])laced  as  before  directed,  except  that  the  chin  may  be  a  little  more 
elevated,  to  enable  the  operator  to  obtain  a  more  convenient  view  of 
the  locality  of  his  operation  ;  the  thumb  of  the  left  hand  may  be  placed 
on  the  labial  surface  of  the  tooth ;  and  the  forefinger  on  the  gum 
immediately  above  the  palatine  surface.  He  should  now,  with  a 
wedge-pointed  instrument,  shaped  as  in  Fig.  117,  proceed  to  introduce 
the  gold,  applying  the  first  fold  against  the  palatine  wall  or  the  palato- 
approximai  angle  of  the  cavity,  as  may  be  most  convenient.  Having 
filled  the  cavity,  the  extruding  gold  may  be  condensed  with  an  instru- 
ment like  the  one  represented  in  Fig.  118. 

Sometimes  straight  instruments,  and  at  other  times  instruments 
curved  at  the  points  more  than  those  represented  in  Figs.  117  and  118, 
can  be  more  conveniently  employed ;  depending  altogether  upon  the 
size  of  the  mouth  and  the  forward  or  backward  deviation  of  the  teeth 


342  PILLING    TEETH. 

from  a  vertical  position.  This  is  a  matter,  therefore,  ^vhicll  tlic  judg- 
ment of  the  operator  must  determine. 

11.  With  Adhesive  Gold  Foil.  —  For  filling  cavities  in  the  approxi- 
mal  surfaces  of  the  superior  incisors  and  cuspidati,  the  most  efljectual 
means  should  be  adopted  to  retain  the  filling.  In  some  few  cases  it 
may  not  be  possible  to  do  more  than  form  small  under-cuttiugs  at  each 
approximal  angle  of  the  cavity,  and  another  similar  one  at  the  cutting 
edge,  which  would  be  sufficient  for  the  retention  of  a  non-adhesive  gold 
filling ;  but  in  the  majority  of  cases,  one  of  adhesive  gold  can  be  so 
securely  anchored  that  the  cervical  wall  is  perfectly  protected,  and  a 
fracture  at  any  point  along  the  edges  of  the  cavity  will  not  dislodge 
the  filling. 

To  effect  this,  retaining  points  made  by  a  small,  square-edged  drill, 
are  necessary,  which  can  be  formed  in  approximal  surface  cavities 
of  the  incisors  and  cuspidati,  in  that  portion  of  the  dentine  near  the 
labial  surface  where  it  unites  with  the  cementum,  and  in  the  S£vme  posi- 
tion in  the  palatine  surface.  These  retaining  points  can  be  made  from 
the  one-twentieth  to  the  one-sixteenth  of  an  inch  in  depth,  and  in  addi- 
tion a  small  under-tutting  on  the  wall  next  to  the  cutting  edge.  In 
drilling  the  retaining  points  in  the  cervical  wall  near  the  labial  and 
palatine  surfaces,  the  drill  should  be  directed  in  a  line  with  the  long 
axis  of  the  root  in  order  that  the  cavity  made  by  it  is  sufficiently  dis- 
tant from  the  pulp  of  the  tooth.  The  cavity  being  properly  formed, 
dried,  and  protected  from  all  moisture,  the  gold  foil,  prepared  in  the 
manner  before  described,  is  carried  into  the  cavity  with  the  introducing 
pliers,  or  on  the  point  of  an  instrument,  and  packed  into  the  retaining 
points  until  these  are  solidly  filled. 

The  gold  is  then  compactly  ])uilt  from  one  of  these  retaining  points 
to  the  other,  and  over  the  floor  of  the  cavity  until  a  base  is  formed 
extending  over  the  whole  of  the  floor. 

From  this  base  the  gold  is  then  built  to  the  orifice ;  and  during  the 
entire  process,  it  is  packed  a  little  higher  about  the  walls  than  in  the 
centre,  in  order  to  obtain  a  more  thorough  contact.  When  the  gold 
has  reached  the  orifice,  the  centre  is  then  built  up,  and  the  surface  con- 
densed and  finished  as  before  described. 

Crystal  gold  is  preferred  by  some  for  filling  the  retaining  points 
and  forming  the  base  covering  the  floor  of  the  cavity,  on  account  of  its 
retaining  its  position  better  than  foil.  This  description  of  the  method 
of  introducing  adhesive  foil  will  apply  to  all  cavities  wherever  situated, 
and  need  not  be  repeated  hereafter.  For  crystal  gold  the  cavity  may 
be  formed  in  the  same  manner  as  for  adhesive  gold  foil,  although  many 
depend  upon  under-cuttings  instead  of  retaining  points  for  its  retention. 


FILLING    TEETH.  343 

As  the  method  of  introducing  crystal  gold  into  cavities  has  already- 
been  described,  it  is  not  necessary  to  say  more  concerning  it. 

FILLING   THE   SUPERIOR   MOLARS   AKD   BICUSPIDS. 

I,  With  Non-Adhesive  Gold  Foil.  —  In  describing  the  manner  of 
filling  a  cavity  in  each  of  the  principal  localities  liable  to  be  attacked 
by  caries,  in  the  above-mentioned  teeth,  the  writer  will  begin  with  the 
grinding  surface  of  the  first  molar  on  the  right  side.  The  directions 
given  for  filling  a  cavity  here,  will,  with  a  few  exceptions,  be  applicable 
to  the  introduction  of  a  filling  in  the  grinding  surface  of  any  of  the 
upper  molars  or  bicuspids. 

When  the  cavity  is  very  deep,  and  its  circumference  not  large,  it  is 
difficult,  if  not  impossible,  to  make  a  filling  sufficiently  firm  and  solid 
in  every  part  by  the  introduction  of  folds  of  gold  long  enough  to 
extend  from  the  bottom  to  the  orifice.  The  operation,  therefore,  should 
be  divided  into  two  parts;  two-thirds  of  the  cavity  should  be  first 
thoroughly  filled  with  vertical  folds,  and  afterward  the  remaining  third 
in  the  same  manner. 

In  filling  a  molar  or  bicuspid  on  any  of  its  surfaces,  the  head  of  the 
patient  should,  for  the  most  part,  occupy  very  nearly  the  same  position, 
and  have  the  same 'elevation  as  required  for  an  operation  on  an  incisor 
or  cuspid.  The  cavity  being  prepared  for  the  filling,  and  one  end  of 
the  roll  of  foil  placed  in  it,  the  tooth  may  be  grasped  with  the  thumb 
and  forefinger  of  the  left  hand  of  the  operator  —  the  former  placed 
on  the  buccal  surface  in  such  a  manner  as  to  press  back  the  commissure 
of  the  lips,  and  the  latter  on  the  palatine  surface ;  then  fold  after  fold 
may  be  introduced  and  forcibly  pressed  against  the  posterior  wall  until 
the  cavity  is  filled.  For  this  purpose  an  instrument  may  be  used  like 
the  one  represented  in  Fig.  114  or  117.  If  the  former  is  used,  it  is  to 
be  held  as  shown  in  Fig.  111.  The  extruding  portion  should  then  be 
condensed  with  a  straight  instrument,  as  in  Fig.  116,  or  curved  plug- 
gers,  Fig.  118  or  119,  as  may  be  most  convenient. 

As  a  genera]  rule,  filling  a  cavity  in  the  grinding  surface  of  an  upper 
molar  or  bicuspid  is  an  exceedingly  simple  operation,  requiring  less  skill 
than  the  introduction  of  a  plug  in  any  other  locality  in  these  teeth; 
but  there  are  cases  in  which  it  is  rendered  very  difficult ;  as,  for  example, 
when  there  are  one  or  more  fissures  or  carious  depressions  radiating 
from  the  main  cavity.  After  the  caries  has  been  removed,  which  is 
often  a  very  tedious  operation,  it  requires  considerable  time  and  skill 
to  fill  these  thoroughly.  When  it  is  not  properly  done,  as  is  too  often 
the  case,  a  recurrence  of  the  disease  will  soon  take  place,  and  thus 
defeat  the  object  for  which  the  operation  was  performed. 

The  introduction  of  a  filling  in  the  grinding  surface  of  the  second 


344 


FILLING    TEETH. 


Fig,  119. 


or  third  molar  of  a  person  having  a  very  small  mouth,  is  sometimes 
attended  with  great  difficulty ;  in  some  cases  it  can  only  be  done  with 
an  instrument  having  a  point  bent  nearly  at 
right  angles  with  the  stem,  like  the  one  repre- 
sented in  Fig.  119 ;  consequently  the  power  re- 
quired for  introducing  and  consolidating  the 
gold  is  applied  to  great  disadvantage.  But  the 
instrument  represented  in  this  cut  is  only  in- 
tended for  the  first  part  of  the  operation  of  con- 
solidating the  metal ;  for  its  completion,  smaller  points  are  required. 

In  filling  a  cavity  in  the  grinding  surface  of  a  first  upper  molar  on 
the  left  side  of  the  mouth,  the  thumb  of  the  left  hand  may  be  placed 
against  the  left  cuspid  or  first  or  second  bicuspid,  as  may  be  most  con- 
venient to  the  operator;  while  the  forefinger  is  placed  behind  the 
point  of  the  instrument,  and  at  the  same  time  made  to  push  back  the 
commissure  of  the  lips.  To  obtain  a  good  view  of  the  cavity  in  a 
second  or  third  molar  during  the  operation,  the  cheek  should  be 
pressed  from  the  tooth  with  the  forefinger  of  the  left  hand  ;  but  this 
finger  can  seldom  be  carried  far  enough  back  on  this  side  of  the  mouth 
to  be  placed  behind  the  point  of  the  instrument.  During  the  intro- 
duction of  gold,  the  ring  finger  and  little  finger  of  the  right  hand 
should  be  made  to  rest  on  the  incisor  teeth,  while  the  instrument  is 
grasped  (Fig.  Ill)  with  the  thumb,  middle  and  fore  fingei". 

In  filling  a  cavity  in  the  anterior  approximal  surface  of  a  right 
superior   molar  or  bicuspid,  the  operation   may  be   commenced   by 

placing  the  gold  against  the  palatine 
wall,  and  ending  at  the  buccal.  But 
before  the  process  of  condensing  is 
commenced,  every  portion  of  the  sur- 
face ought  to  be  thoroughly  tested 
with  a  wedge-pointed  instrument,  and 
v.^ffe\  w^herever  the  point  can  be  forced  into 
V  the  gold,  the  cavity  thus  formed  should 
be  filled.  The  instrument  employed 
for  the  introduction  of  the  gold  may 
be  like  the  one  represented  in  Fig.  114, 
but  having  a  rather  longer  point,  and 
grasped  as  in  Fig.  111.  For  condens- 
ing the  extruding  portions,  either  or 
both  of  the  instruments  represented 
in  Figs.  108  and  112  may  be  used,  as 
also  the  one  employed  for  the  intro- 
duction of  the  gold ;  and  one  shaped  as 


Fig.  120. 


FILLING    TEETH.  345 

in  Fig.  120  may  be  sometimes  used  with  great  advantage.  During 
this  part  of  the  operation,  the  instrument  may  be  held  as  before,  or  as 
seen  in  Fig,  121,  which  permits  a  much  greater  amount  of  force  to  be 
applied  than  when  held  in  any  other  manner. 

Nearly  the  same  method  and  the  same  instruments  are  required  for 
filling  a  corresponding  cavity  on  the  opposite  side  of  the  jaw.  When 
practicable,  the  forefinger  of  the  left  hand  should  be  jolaced  on  the 
palatine  surface  of  the  tooth,  and  the  thumb  against  the  buccal  sur- 
face, and  in  addition  to  the  instruments  recommended  for  the  right 
side  of  the  mouth,  the  one  shown  in  Fig.  106  may  be  very  conveniently 
employed  to  introduce  the  gold ;  also  Fig.  108  or  Fig.  122,  in  con- 
densing the  surface  of  the  filling.  The  writer 
finds  this  last  particularly  valuable  in  very  ^^^-  ^'^^• 

many  cases. 

A  cavity  in  the  posterior  appi'oximal  sur- 
face of.a  superior  bicuspid  on  either  side  of  the 
mouth,  can,  in  the  majority  of  cases,  be  as  easily  filled  as  one  in  the 
anterior  approximal  surface.  The  position  of  the  left  hand  is  very 
nearly  the  same,  and  in  the  introduction  of  the  gold,  the  first  folds 
are  placed  against  the  palatine  wall  of  the  cavity.  By  commencing 
on  this  side,  the  operator  is  enabled  to  lay  the  folds  more  compactly 
than  he  could  were  he  to  commence  at  any  other  point.  He  also  has 
a  more  perfect  control  over  the  instrument  in  this  part  of  the  opera- 
tion, and  has  a  better  view  of  the  cavity  during  the  introduction  of 
the  gold.  For  consolidating  the  filling,  the  instruments  represented 
in  Figs.  107,  108,  and  113  are  as  well  adapted  to  the  purpose  as  any 
that  can  be  employed. 

When  the  mouth  of  a  patient  is  large,  a  filling  can  often  be  intro- 
duced with  nearly  as  much  ease  in  the  posterior  apj)roximal  surface 
of  a  first  or  even  a  second  upper  molar  as  in  that  of  a  bicuspid ;  but 
when  the  mouth  is  small  and  the  cheeks  fleshy,  it  often  becomes  a 
difficult  and  perplexing  operation,  although  the  same  method  is  used; 
yet,  as  it  is  absolutely  necessary  to  the  introduction  of  a  good  filling 
that  the  operator  should  see  the  cavity  and  witness  every  part  of  the 
operation,  his  ingenuity  is  often  taxed  to  the  utmost  in  contriving  the 
most  suitable  means  to  enable  him  to  do  it.  A  number  of  instruments 
for  drawing  back  the  corner  of  the  mouth  have  been  invented ;  but 
the  writer  believes  there  are  none  so  well  suited  to  the  purpose  as  the 
thumb  or  forefinger  of  the  left  hand  of  the  operator.  If  the  operator 
will  accustom  himself  to  the  use  of  a  small  mouth-glass  held  in  the 
left  hand  whilst  operating,  he  will  be  spared  many  back-breaking 
efforts  to  keep  in  view  fillings  on  posterior  surfaces.  It  is  necessary  to 
become  familiar  with  the  apparently  reverse  motion  of  the  instrument 


346  FILLING    TEETH. 

as  seen  in  the  glass;  also  to  accustom  the  three  fingers  of  the  left 
hand  to  act  independently  of  the  thumb  and  forefinger.  But  one  of 
the  most  careful  and  skilful  operators  of  this  or  any  other  country, 
Dr.  Maynard,  assures  us  that  he  works  from  a  reflected  view  in  the 
glass  with  the  same  ease  as  where  he  has  a  direct  view  of  the  cavity, 
and  obtains,  in  very  many  cases  where  he  uses  the  glass,  an  accuracy 
of  view  which  direct  vision  could  not  give  him. 

Before  dismissing  this  part  of  the  subject,  there  is  one  point  to 
which  the  attention  of  the  young  practitioner  should  be  particularly 
directed.  Many,  in  other  respects  tolerably  good  operators,  are  most 
likely  to  foil  in  not  introducing  a  sufficient  quantity  of  gold  in  the 
upper  palatine  portion  of  the  cavity.  The  author  frequently  meets 
with  cases  in  which  the  walls  of  the  cavity  are  perfectly  sound,  and 
every  other  part  of  the  filling  well  consolidated ;  but  here,  upon  the 
application  of  a  wedge-pointed  instrument,  the  gold  is  easily  perfo- 
rated. He  would,  therefore,  advise  the  inexperienced  operator  to  test 
this  by  severe  pressure  with  a  sharp  wedge-pointed  instrument,  as  well, 
indeed,  as  every  part  of  the  filling,  before  leaving  the  operation. 
There  is  also  one  other  precaution  applicable  to  fillings  in  the  approx- 
imal  surfaces  of  the  incisors  and  cuspids,  as  well  as  of  the  molars  and 
bicuspids ;  it  relates  to  overlapping  portions  of  gold  under  the  free 
edge  of  the  gum,  which  must  be  carefully  and  completely  removed 
before  the  operation  can  be  regarded  as  complete. 

In  filling  a  cavity  in  the  buccal  surface  of  an  upper  bicuspid  or 
molar,  on  either  side  of  the  mouth,  the  gold  may  be  introduced  with 
the  instruments  represented  in  Figs.  104,  114.  The  latter  is  better 
adapted  for  the  left  side,  but  may  also  be  used  on  the  right.  The 
straight  wedge-pointed  instrument  may  also  be  advantageously  em- 
ployed on  this  side.  The  first  folds  of  gold  should  be  placed  against 
the  posterior  wall,  proceeding  from  behind  forward,  and  pressing  the 
folds  against  each  other  as  compactly  as  possible.  When  the  cavity 
has  a  large  orifice,  and  is  rather  shallow,  or  in  other  respects  badly 
shaped  for  the  retention  of  the  gold,  the  operation  is  often  tedious,  dif- 
ficult, and  perplexing.  But  under  favorable  circumstances  a  filling 
may  be  almost  as  readily  introduced  here  as  in  any  other  part. 

The  palatine  surface  of  a  bicuspid  or  of  a  molar  is  rarely  attacked 
by  caries ;  on  the  latter,  it  is  usually  seated  in  a  depression  at  the  termi- 
nation of  a  fissure  leading  from  the  posterior  depression  in  the  grinding 
surface.  It  is  usually  situated  near  the  posterior  palato-approximal 
angle  of  the  crown,  about  half-way  between  the  gum  and  the  coronal 
extremity  of  the  tooth.  It  sometimes  happens  that  the  walls  of  these 
fissures  are  affected  with  caries  throughout  their  whole  extent,  requiring 
to  be  filled  from  the  depression  in  the  grinding  to  its  termination  on 


FILLING    TEETH. 


347 


the  palatine  surface.  In  this  case,  the  portion  of  the  cavity  on  the 
grinding  surface  may  be  first  filled ;  then  the  operator  may  proceed  to 
fill  the  palatine  portion  in  the  same  manner  as  if  it  were  a  simple  cavity, 
placing  the  first  folds  of  foil,  in  the  case  of  a  right  molar,  against 
the  upper  and  posterior  side  of  the  opening,  with  an  instrument  like 
the  one  represented  in  Fig.  114.  Great  care  is  necessary  to  prevent 
the  instrument  from  slipping.  It  often  happens,  too,  that  the  orifice 
becomes  choked  with  foil  before  the  cavity  is  half  filled.  This,  indeed, 
is  liable  to  occur  in  filling  any  cavity  in  any  tooth ;  and  when  it  does 
happen,  unless  a  sufficient  amount  of  pressure  is  applied  to  make  a  free 
opening  into  it,  the  filling  will  be  imperfect,  and  the  object  of  the  opera- 
tion wholly  defeated.  When  the  cavity  is  situated  in  a  left  molar,  the 
gold  may  be  introduced  with  the  instruments  represented  in  Figs.  104, 
117,  placing  the  first  folds  against  the  upper  wall  of  the  cavity,  and 
proceeding  downward. 

The  curvatures  of  the  points  of  condensing  instruments  may  be  simi- 
lar to  those  employed  for  the  introduction  of  the  gold.  The  process 
of  condensing  the  extruding  portion  of  a  filling  in  the  buccal  or  pala- 
tine surface  of  a  molar,  as  well  as  in  the  approximal  surface  of  almost 
any  isolated  tooth,  may  be  greatly  aided  by  properly  constructed  for- 
ceps. The  following  cuts  of  Prof.  Flagg's  patterns  will  convey  a  more 
correct  idea  of  their  construction  than  any  description  that  can  be 
given.     They  are  provided  with  both  straight  and  curved  points. 


Fig. 123. 


Fig.  123  is  a  straight  forceps  used  for  condensing  plugs  between  teeth, 
upon  the  mesial  or  lateral  faces  above  or  below,  the  plugs  being  located 
near  the  cutting  edges  of  the  incisors,  the  cusps  of  the  cuspids  or  bi- 
cuspids, and  the  buccal  edges  of  the  approximating  faces  of  the  molars. 


Fig.  124  is  used  for  condensing  such  plugs  or  parts  of  plugs  as  are 
located  between  incisors,  cuspids,  and  bicuspids  of  the  upper  jaw  near 


348  FILLING    TEETH. 

their  necks,  and  the  lingual  or  palatine  edges  of  the  approximal  plugs 
as  they  may  pertain  to  superior  or  inferior  teethi 

Fig.  125. 


Fig.  125  is  intended  for  condensing  plugs  upon  the  labial,  palatine, 
and  lingual  faces  of  incisors  and  cuspids  above  and  below,  also  upon 
the  buccal,  palatine,  and  lingual  faces  of  bicuspids  and  molars  above 
and  below,  right  and  left  sides. 

It  is  only,  however,  in  a  small  number  of  cases  that  these  instru- 
ments can  be  advantageously  employed.  The  credit  of  the  invention 
of  plugging  forceps  belongs,  we  believe,  to  the  late  Dr.  H.  H.  Hayden. 

A  tubercle,  of  greater  or  less  size,  is  sometimes  found  on  the  anterior 
palatine  surface  of  a  molar,  near  the  crown.  Between  this  and  the 
body  of  the  crown,  a  deejD  depression  is  often  seen,  which  becomes  the 
seat  of  caries  ;  but  the  removal  of  the  diseased  part,  and  the  introduc- 
tion of  a  filling  is  so  simple,  that  a  special  description  of  the  oj^eration 
is  not  deemed  necessary. 

II.  With  Adhesive  Gold  Foil.  —  In  forming  cavities  in  the  approxi- 
mal surfaces  of  bicuspids  and  molars,  it  is  essential,  in  the  majority  of 
cases,  to  separate  the  teeth  either  by  means  of  pressure  or  by  cutting 
away  a  portion  of  the  crowns. 

When  they  are  very  close  together,  it  is  often  impossible  to  gain  suffi- 
cient space  by  pressure,  and  it  then  becomes  necessary  to  resort  to  the 
enamel  chisel  and  file,  cutting  away  a  portion  from  each  tooth,  when 
both  are  decayed,  and  from  one  only,  if  the  other  is  in  a  sound  condi- 
tion. The  former  practice  in  separating  these  teeth  was  to'  cut  away, 
so  much  of  the  entire  approximal  surface  as  to  form  a  V-shaped  sjoace 
of  sufficient  extent  to  enable  the  operator  to  reach  the  cavity  easily. 
But  by  this  method  the  crown  of  the  tooth  was  disfigured,  and  a  space 
formed  in  which  food  readily  collected,  and  became  a  source  of  con- 
siderable annoyance.  To  avoid  this,  the  practice  now  is  to  cut  through 
the  grinding  surface  to  the  approximal  cavity,  mortising  this  opening,- 
and  thus  preserve  the  palato-  and  bucco-approximal  angles,  while  at  the 
same  time  the  shape  of  the  opening  through  the  grinding  surface  ma- 
terially assists  in  the  retention  ol  the  filling.  In  preparing  these  cavi- 
ties for  adhesive  gold  foil,  at  least  two  good  retaining  points  should 
be  made  at  the  cervical  wall  and  two  under-cuttings  at  the  cusps,  which 
have  been  preserved  by  the  method  uf  gaining  space  just  described. 


FILLIXa    TEETH.  349 

But  one  of  these  retaining  points,  in  connection  with  the  two  under- 
cuttings  at  the  cusps,  will  often  secure  the  filling,  when  the  nature  of 
the  case  will  not  allow  of  more  being  made. 

In  preparing  a  cavity  on  the  posterior  approximal  surface  of  a 
molar  tooth,  access  is  obtained  by  cutting  through  the  grinding  sur- 
face in  the  manner  before  referred  to ;  then,  by  means  of  instruments 
more  or  less  curved,  the  buccal  and  palatine  walls  are  made  parallel 
with  each  other,  under-cuttings  formed  at  the  cusps,  and  retaining  points 
drilled  in  the  cervical  wall  at  different  angles.  Advantage  is  also 
gained  from  having  the  cervical  wall  slightly  undercut.  In  introduc- 
ing the  gold  into  a  cavity  of  this  nature,  many  prefer  placing  a  pol- 
ished plate  of  metal  back  of  the  cavity  in  the  space  between  the  teeth, 
and  condensing  the  gold  firmly  against  it  in  building  up  this  portion 
of  the  crown.  By  this  method  a  good  support  is  obtained,  and,  after 
all  the  gold  necessary  is  introduced  and  consolidated,  the  metal  plate 
is  removed.  In  filling  grinding  surface  cavities  in  the  molar  teeth, 
where  the  decay  has  extended  along  one  or  more  of  the  crown  fissures, 
with  adhesive  gold  foil  or  crystal  gold,  the  gold  is  first  introduced  into 
the  bottoms  of  the  crown  fissures,  and  built  up  to  their  orifices,  thus 
completing  the  filling  of  these  fissures  before  the  central  cavity  is  filled. 
In  preparing  cavities  extending  in  the  form  of  grooves  over  the  buccal 
and  palatine  surfaces  of  the  bicuspids  and  molars,  all  projecting  por- 
tions of  enamel  should  be  cut  away,  so  as  to  allow  these  cavities  to  be 
but  little  larger  within  than  at  their  orifices ;  and  the  ends  of  the 
groove,  which  are  usually  shallow,  should  be  made  as  deep  as  the  cen- 
tre. One  retaining  point  may  then  be  made  in  each  of  the  two  walls 
forming  the  ends  of  the  groove-like  cavity,  or  one  retaining  point  in 
the  posterior  wall,  in  connection  with  an  under-cutting  in  the  anterior 
one,  will  answer  for  the  retention  of  the  filling.  In  introducing  the 
gold  into  a  cavity  of  this  form,  the  retaining  points  are  first  filled  and 
the  gold  built  across  the  floor  of  the  cavity  from  one  to  the  other,  and 
from  the  base  thus  formed  to  the  orifice.  When  a  cavity  upon  the 
buccal  or  palatine  surface  extends  under  the  free  margin  of  the  gum, 
it  is  necessary  to  either  force  the  gum  away  by  pressure  with  pledgets 
of  cotton,  or  to  remove  the  portion  overlapping  the  cavity.  The  hem- 
orrhage which  follows  this  latter  method  may  be  checked  by  any  of  the 
hemostatic  agents  in  use,  such  as  tannin,  phenol  sodique,  creosote, 
powdered  subsulphate  of  iron,  etc.,  and  a  few  layers  of  bibulous  paper 
applied  to  the  gum  during  the  operation  of  filling  the  cavity. 

FILLING   THE   INFERIOR   INCISORS   AND   CUSPIDS. 

The  operation  of  filling  a  lower  incisor  or  cuspid  is  far  more  difficult 
than  filling  an  upper.     It  is  fortunate,  therefore,  both  for  the  dentist 


350  FILLING    TEETH. 

and  the  patient,  that  the  hiwer  incisors  and  cuspids  are  less  liable  to 
caries  than  the  upper. 

The  constant  tendency  of  the  lower  jaw  to  change  its  position  is  em- 
barrassing to  the  dentist  in  operating  on  any  of  tlie  teeth  in  it,  and  in 
case  of  the  incisors  and  cuspids  it  is  sometimes  2>eculiarly  perplexing. 
To  prevent  this,  all  the  effort  the  operator  can  make  with  his  left  hand 
is  frequently  required.  From  the  backward  inclination,  too,  of  these 
teeth,  it  rarely  happens  that  the  gold  can  be  introduced  from  the  lingual 
side  of  the  arch  ;  consequently,  it  is  necessary  to  make  the  space  as 
wide  anteriorly  as  posteriorly.  But  as  the  teeth  are  comparatively 
small,  the  separation,  when  made  with  a  file,  should  be  no  wider  than 
is  absolutely  necessary  for  the  removal  of  the  diseased  part  and  the 
introduction  of  the  gold.  When,  however,  it  can  be  done  with  safety, 
the  separation  should  be  made  with  a  piece  of  rubber  or  other  sub- 
stance between  the  teeth,  iu  the  manner  before  described. 

While  operating  on  the  lower  teeth,  the  head  of  the  patient  should 
occupy  a  more  perpendicular  position  than  while  operating  on  the 
upper ;  this  may  be  done  either  by  lowering  the  seat  or  raising  the 
head-piece  of  the  chair.  When  by  the  latter,  it  will  be  occasionally 
necessary  for  the  operator  to  stand  upon  a  stool  five  or  six  inches  in 
height. 

In  filling  a  cavity  in  the  right  approximal  surface  of  a  lower  incisor 
or  cuspid  with  non-adhesive  gold  foil,  the  following  method  is  recom- 
mended. The  cavity  being  prepared,  and  a  sufficient  quantity  of  gold 
foil  made  into  a  small  roll,  or  folded  lengthwise,  as  the  operator  may 
prefer,  with  the  left  arm  over  the  patient's  head,  the  chin  is  gently 
grasped  with  the  left  hand,  while  the  thumb  is  placed  against  the 
lingual  surface  of  the  tooth,  the  forefinger  serving  to  direct  the  gold 
and  point  of  the  instrument,  and  also  to  de})ress  the  lower  lip.  The 
folds  of  gold  in  their  introduction  are  pressed  firmly  against  the  lower 
wall  of  the  cavity.  The  instrument  employed  for  this  purpose  may 
be  shaped  like  the  one  represented  in  Fig.  126,  with  a  very  small 

Fig.  126.  Fig.  127. 


wedge-shaped  point,  and  held  as  in  Fig.  111.  The  consolidation  of  the 
gold  may  be  eflfected  partly  with  the  same  instrument,  partly  with  a 
round-pointed  one,  shaped  as  shown  in  Fig.  127,  and  partly  with  an 
instrument  shaped  as  in  Fig.  113.  The  tooth  should  be  firmly  held 
between  the  thumb  and  forefinger  of  the  left  hand  to  prevent  it  from 
being  moved  in  its  socket  by  the  pressure  of  the  instrument. 

When  the  incisors  are  very  small,  and  the  caries  has  spread  over  a 


TILLING    TEETH.  351 

large  portion  of  the  side  of  the  tooth,  it  is  often  difficult  to  form  a 
suitable  cavity  for  the  retention  of  a  filling  without  penetrating  to  the 
pulp-cavity.  In  such  cases,  the  patience  and  skill  of  the  operator  are 
frequently  taxed  severely  in  obtaining  a  sufficiently  secure  support  for 
the  gold.  But  this  he  can  usually  do,  if  he  can  make  the  bottom  of 
the  cavity  as  large  as  the  orifice,  even  though  it  have  but  little  depth. 

The  manner  of  introducing  a  filling  in  the  left  approxiraal  surface 
is  very  similar.  The  left  arm  and  hand,  as  well  as  the  thumb  and 
forefinger,  are  all  disposed  of  in  the  manner  just  described.  The  same 
instruments,  too,  may  be  employed  for  introducing  and  consolidating 
the  gold,  though  in  the  first  part  of  the  operation  the  instrument 
(Fig.  109)  may  often  be  advantageously  substituted  for  the  one  in 
Fig.  126. 

Nothing  has  been  said  with  regard  to  fillings  in  the  labial  or  lingual 
surface  of  lower  incisors  and  cuspids.  Although  caries  rarely  attacks 
either  of  these  surfaces  of  a  lower  incisor,  it  does  sometimes  develop 
itself  in  the  labial  surface  of  a  cuspid ;  but  the  operation  of  intro- 
ducing a  filling  here  is  so  simple,  that  a  separate  description  of  the 
manner  of  it  is  not  deemed  necessary. 

■  The  operation  of  forming  cavities  in  the  inferior  teeth  and  intro- 
ducing adhesive  gold  /oi7  and  crystal  gold  is  the  same  as  that  de- 
scribed for  the  superior  teeth,  and  a  second  description  is  therefore 
not  considered  necessary.  As  absolute  dryness  is  essential  in  manipu- 
lating with  the  adhesive  forms  of  gold,  the  reader  is  referred  to  the 
various  methods  and  appliances  before  described  for  drying  cavities, 
and  protecting  them  from  moisture.  In  filling  the  inferior  teeth,  the 
rubber  cofier-dam  will  be  found  to  be  a  valuable  appliance  for  ex- 
cluding all  moisture  from  both  the  gold  and  cavity,  and  the  saliva- 
pump  an  efficient  adjunct  to  this  dam  for  relieving  the  mouth  of  the 
saliva  as  it  accumulates  in  prolonged  operations.  For  controlling  the 
movements  of  the  tongue,  the  tongue  and  duct  compressor  can  be  used 
in  connection  with  pads  of  bibulous  paper  placed  upon  the  mouths  of 
the  duets  beneath  the  tongue.  Prepared  spunk  is  also  used  success- 
fully on  the  mouths  of  the  sublingual  and  submaxillary  ducts,  for  con- 
trolling the  flow  of  saliva. 

FILLING   THE   INFERIOR   MOLARS   AND   BICUSPIDS. 

In  filling  a  cavity  in  the  grinding  surface  of  a  right  lower  molar  or 
bicuspid,  the  operator  may  stand  on  the  same  side  of  his  patient,  and 
a  few  inches  higher  than  while  operating  on  an  incisor  or  cuspid. 
With  his  left  arm  placed  over  his  patient's  head,  the  tooth  may  be 
grasped  with  the  thumb  and  forefinger  of  the  left  hand,  while  the 
middle  finger  is  placed  by  the  side  of  the  chin ;  the  other  two  should 


352  FILLING    TEETH. 

be  placed  beneath  it.  After  preparing  the  cavity,  non-adhesive  gold 
foil  may  be  introduced  with  an  instrument  like  the  one  represented  in 
Fig.  117,  and  lield  as  shown  in  Fig.  Ill,  pressing  the  folds  against  the 
posterior  wall  of  the  cavity. 

In  condensing  the  gold  after  the  cavity  is  filled,  use  the  instrument 
represented  in  Fig.  118.  Sometimes,  however,  the  one  shown  in  Fig. 
120,  which  may  be  held  as  seen  in  Fig.  105,  answers  a  better  purpose; 
but  a  greater  amount  of  force  can  be  exerted  when  held  in  the  man- 
ner shown  in  Fig.  121,  previously  wrapping  it  with  the  corner  of  a 
napkin,  to  prevent  the  small  part  of  the  instrument  from  hurting  the 
little  finger.  The  kind  of  instrument,  and  the  manner  of  holding  it, 
will,  after  all,  have  to  be  determined  by  the  operator.  During  the 
introduction  and  consolidation  of  the  gold,  the  lower  jaw  should  be 
firmly  held  with  the  left  hand,  to  prevent  it  from  moving,  and  from 
being  too  much  depressed.  This  precaution  is  the  more  necessary,  as 
the  muscles  of  the  lower  jaw  and  the  articular  ligaments  are  seldom 
stroncx  enough  to  resist  the  amount  of  force  required  in  the  operation. 
-  In  filling  a  cavity  in  the  griudhig  surface  of  a  tooth  on  the  left 
side,  the  dentist  may  sometimes  operate  to  greater  advantage  by 
standing  on  the  same  side.  In  this  case,  the  commissure  of  the  lips 
should  be  pressed  back  with  the  thumb  of  the  left  hand,  placing  it  on 
or  against  the  tooth  to  be  filled,  while  the  forefinger  passes  in  front  of 
the  chin,  and  the  other  three  beneath  it.  As  a  general  rule,. however, 
he  will  be  able  to  operate  more  conveniently  by  standing  on  the  right 
side  of  his  patient,  and  hold  the  tooth  and  the  chin  in  tlie  manner  be- 
fore directed.  In  either  case,  the  gold,  in  its  introduction,  should  be 
pressed  against  the  posterior  wall  of  the  cavity. 

The  foregoing  general  directions  will  be  found,  for  the  most  part, 
applicable  to  the  introduction  of  a  filling  in  the  approximal  surfaces. 
When  the  crowns  of  the  teeth  are  long,  and  the  cavity  situated  near 
the  gum,  the  operation  is  sometimes  very  difficult  and  tedious,  requir- 
ing all  the  patience  and  skill  the  dentist  can  exercise  to  accomplish  it 
securely.  This  difficulty  is  increased  when  the  shape  of  the  cavity  is 
unfavorable  for.  the  retention  of  the  gold ;  or,  in  other  w^ords,  when 
the  cavity  is  shallow,  and  has  a  large  orifice.  There  is  also  another 
very  serious  difficulty  which  the  operator  encounters  in  the  introduc- 
tion of  a  filling  in  the  approximal,  and  also  in  the  buccal,  surface  of 
a  lower  molar  or  bicuspid.  The  flow  of  saliva  is  often  so  profuse  that 
the  whole  of  the  lower  part  of  the  mouth  is  completely  filled,  and  the 
tooth  inundated  before  it  is  possible  to  introduce  a  sufficient  quantity 
of  gold  to  fill  the  cavity.  This  not  only  retards  the  operation,  but  it 
also  renders  it  more  difficult  and  perplexing;  for  it  is  necessary  to 
force  out  every  particle  of  moisture  from  the  cavity  and  from  between 


FILLING    TEETH.  353 

the  different  layers  of  gold,  before  the  necessary  cohesive  attraction 
between  them  can  be  secured.  If  this  is  not  done,  or,  at  any  rate,  if 
all  the  moisture  is  not  forced  from  the  cavity,  and  the  gold  sufficiently 
consolidated  to  render  it  impermeable  to  the  fluids  of  the  mouth,  the 
operation  will  be  unsuccessful. 

Ordinary  foil,  sometimes  called  non-adhesive,  when  introduced  in 
folds  lying  parallel  with  the  sides  of  the  cavity,  keeps  its  place  by  the 
close  lateral  contact  of  the  folds  against  each  other  and  the  walls  of 
the  cavity.  Hence  such  fillings  may  prove  successful,  although  done 
"  under  w^ater,"  provided  the  lateral  pressure  is  sufficient  to  force  out 
the  saliva  from  between  the  layers  of  foil.  But  if  the  folds  are  laid 
in  parallel  with  the  bottom  of  the  cavity,  the  operation  will  fail,  in 
consequence  of  the  scaling  off  of  the  successive  layers  which  have  no 
adhesion.  Crystal  gold  and  adhesive  foil  fillings  depend  for  their 
success  upon  the  perfect  adhesion  of  their  component  pieces;  there- 
fore, the  slightest  moisture,  or  even  dampness,  while  being  introduced^, 
is  fatal  to  their  durability. 

For  the  purjDose  of  obviating  this  difficulty,  a  variety  of  means  havs 
been  proposed,  the  most  important  of  which  have  already  been  de- 
scribed, and  need  not  be  again  referred  to. 

In  the  introduction  of  non-adhesive  gold  on  the  right  side,  it  may  be 
pressed  against  the  buccal  wall  of  the  cavity  on  the  left  side,  or  against 
the  lingual  wall.  Either  of  the  instruments  represented  in  Figs.  103 
and  114  may  be  employed  for  the  introduction  of  the  gold,  whether 
the  cavity  be  situated  in  the  anterior  or  posterior  approximal  surface 
of  the  tooth,  and  may  be  held  in  the  hand  in  the  manner  shown  in 
Fig.  111. 

In  filling  a  cavity  in  the  lingual  and  posterior  approximal  angle 
of  a  first  or  second  bicuspid,  and  especially  from  the  loss  of  the  tooth 
behind  it,  when  there  is  a  backward  inclination  of  the  organ,  great 
care  is  necessary  to  prevent  the  instrument  from  slipping  and  wound- 
ing the  lower  lip.  The  most  convenient  position  for  the  operator  in 
this  case  is  on  the  left  side,  and  partly  in  front  of  the  patient.  The 
tooth  may  then  be  firmly  grasped  between  the  thumb  and  forefinger' 
of  the  left  hand,  or  the  thumb  alone  pressed  against  the  outside  of 
the  tooth ;  in  either  case  it  is  to  be  .used  as  a  rest  for  the  ring-finger  of 
the  right  hand,  during  the  introduction  and  consolidation  of  the  gold.. 
But  the  locality  of  the  cavity  is  such,  especially  when  the  mouth  of 
the  patient  is  small,  that  it  can  only  be  seen  with  great  difficulty. 
Hence  the  operator  is  constantly  liable  to  place  the  point  of  the  in-- 
strument  on  one  side  of  the  orifice  against  an  overlapping  portion  of 
gold,  which,  when  pressure  is  applied,  is  cut  through  or  detached. 
The  instrument  thus  comes  in  contact  with  the  hard,  smooth  enamel,. 
23 


354  FILLING    TEETH. 

and  unless  tire  hand  is  so  guarded  as  to  control  its  motions,  it  is  liable 
to  slip  and  wound  some  part  of  the  mouth,  especially  the  lower  lip : 
which  accident,  unless  proper  precaution  is  observed,  may  occur  in 
filling  any  tooth. 

Among  the  principal  difficulties  which  the  dentist  encounters  in 
filling  a  cavity  in  the  buccal  surface  of  a  lower  molar,  apart  from  that 
of  keejiing  the  cavity  dry  until  the  gold  is  introduced,  is  the  contact 
of  the  lower  and  inner  part  of  the  clieek  with  the  tooth.  This  may, 
to  a  considerable  extent,  be  prevented,  and  the  commissure  of  the  lips 
at  the  same  time  pushed  back  with  the  forefinger  of  the  left  hand  of 
the  operator;  which  also  Avill  serve,  when  the  cavity  is  shallow  and  the 
orifice  large,  to  hold  the  gold  in  place,  until  a  sufficient  quantity  is 
introduced  to  obtain  support  from  the  surrounding  Avails :  it  is  some- 
times, howevei*,  attended  with  much  difficulty,  and  the  aid  of  such  an 
instrument  as  is  'represented  in  Fig.  87  is  necessary.  In  operating 
upon  the  bicuspids,  it  is  only  necessary  to  depress  the  corner  of  the 
mouth  to  obtain  free  access  to  the  cavity. 

For  the  introduction  of  the  gold  on  the  right  side,  either  of  the 
instruments  represented  in  Figs.  104  and  114  may  be  employed,  but  on 
the  left  side  the  latter  will  generally  be  found  most  convenient.     A 
straight  wedge-pointed  instrument  (Fig.  128)  can  often  be  advanta- 
geously used  in  introducina;  the  foil  in  either  of 
Fig.  128.  ...  . 

the  right  bicuspids,  and  sometimes  even  in  the 

first  molar.     This  instrument  can  also  often  be 


used  in  filling  a  cavity  in  the  grinding  surface 
of  a  molar  of  either  jaw,  but  oftener  in  the  upper  than  the  lower.  It 
is  scarcely  necessary  to  say,  that  the  introduction  of  the  gold  should 
commence  behind  and  proceed  forward.  The  instruments  represented 
in  Figs.  107,  120,  and  116  may  be  used  in  consolidating  the  foil. 

It  may  be  well  to  mention  here,  that  in  filling  a  molar  or  bicuspid 
on  the  left  side  in  the  lower  jaw,  whether  in  the  grinding,  approxinial, 
or  buccal  surface,  the  back  of  the  chair,  if  so  constructed  as  to  admit 
of  being  moved,  should  be  thrown  five  or  six  inches  further  back,  to 
lower  the  head  of  the  patient  and  give  the  face  a  more  horizontal 
inclination.  By  this  means  the  operator  is  enabled  to  approach  the 
locality  of  his  manipulations  with  greater  ease,  thus  enabling  him  to 
exercise  a  more  perfect  control  over  his  instrument,  as  well  as  over  the 
mruth.  But  if  the  back  of  his  operating  chair  is  stationary,  he  should 
stand  upon  a  stool  of  five  or  six  inches  in  height. 

When  the  cavity  is  situated  near  the  gum,  or  when  the  lower  part 
of  it  runs  a  little  under  its  margin,  the  precaution  of  removing  all  the 
overlapping  portions  of  gold  ought  never  to  be  omitted,  and  this  some- 
..times  constitutes  a  difficult  part  of  the  o|)eration.     For  this  purpose, 


FILLING    TEETH.  355 

some  of  the  files  represented  in  Fig.  99  may  be  very  advantageously 
used.  Some  are  made  straight  at  each  end,  others  are  curved.  These 
valuable  instruments  were  first  invented  by  Dr.  Elisha  Townsend ;  they 
are  very  useful,  not  only  for  the  purpose  just  stated,  but  also  for  filing 
down  the  surplus  gold  of  a  filling  in  the  approximal  and  other  surfaces 
of  all  the  teeth.     , 

The  profession  is  now  well  supplied  with  these  files,  having  an  almost 
endless  variety  of  shape,  size,  and  fineness  of  cut.  It  is  difficult  to 
overestimate  the  utility  of  these  indispensable  instruments.  Different 
makers  seem  to  vie  with  each  other  in  devising  new  forms.  A  valuable 
modification  has  lately  been  suggested  by  Dr.  Edward  Maynard.  It 
is  to  make  the  two  ends  different  —  not  in  shape,  as  is  usually  done, 
but  in  the  direction  of  the  file-cut ;  or  rather,  to  have  the  file  on  each 
end  set  in  the  same  direction,  marked  by  an  arrow  on  the  shaft. 
Thus  one  end  will  cut  toward,  the  other  from  the  operator  ;  which,  as 
the  two  movements  are  constantly  required  upon  the  same  filling,  adds 
greatly  to  the  value  of  the  instrument.  Whereas  a  difference  in  the 
shape  of  the  two  ends  is  rather  an  annoyance,  and  precise  similarity 
of  no  use,  except  on  the  score  of  economy. 

The  foregoing  details  with  regard  to  the  manner  of  filling  teeth  will 
serve  as  a  general  guide  for  the  performance  of  the  operation,  and  at 
the  same  time  give  to  the  student  and  inexperienced  practitioner  some 
idea  of  the  amount  of  labor,  accuracy  of  manipulation,  and  perfection 
of  execution  it  requires. 

The  manner  of  building  up  the  whole  or  part  of  the  crown  of  a 
tooth  will  now  be  described. 

BUILDING  ON  THE  WHOLE  OR  PART  OP  THE  CROWN  OF  A  TOOTH. 

Few  persons  have  the  patience  to  undergo  an  operation  requiring  so 
much  time  for  its  performance,  as  the  building  on  the  whole  or  a  large 
part  of  the  crown  of  a  tooth,  and  fewer  still  are  willing  to  incur  the 
expense  of  the  labor  and  gold  necessary  to  make  one.  Prof.  Austen, 
speaking  of  these  operations,  says :  "  The  majority  of  them  are  a  use- 
less waste  of  the  skill  of  the  dentist,  the  money  of  the  patient,  and  the 
time  of  both.  A  molar  fang  that  has  its  periosteum  injured  by  the 
protracted  and  heavy  pressure  required  in  building  up  a  golden  crown 
is  in  far  worse  condition  than  if  nothing  had  been  done.  If  simply 
the  canals  and  remaining  part  of  the  pulp-cavity  had  been  filled,  the 
root  would  present  a  condition  analogous  to  those  ca^es  in  which  the 
crown  is  worn  off  (or,  it  may  be,  decayed  off,)  and  the  pulp-cavity 
filled  by  ossific  deposit :  such  roots  render  valuable  service  for  many 
years.  An  incisor  tooth  which  carries  upon  half  or  one-third  of  its 
surface  a  golden  sign  of  dental  craft,  disfigures  the  patient;  shows 


356  FILLING    TEETH. 

none  of  tlie  ars  celare  artem  wliich  should  as  far  as  possible  charac- 
terize all  dental  work,  and  has  a  very  questionable  permanence  or 
utility."  Nevertheless,  as  these  operations  are  frequently  performed, 
now  that  the  adhesive  forms  of  gold  are  so  universally  used,  it  would 
not  be  pi'oper  to  otait  a  description  of  the  manner  of  doing  them. 

It  is  scarcely  to  be  expected,  however,  that  any  one  who  has  not  had 
considerable  experience  in  filling  teeth,  and  acquired  a  high  degree  of 
dexterity  in  the  use  of  instruments  and  the  working  of  some  one  or 
more  of  the  preparations-  of  gold  employed  for  the  purpose,  will, 
simply  from  any  directions  that  can  be  laid  down  upon  the  subject,  be 
able  at  once  ta  perform  the  operation.  But  it  is  hoped  that  the  fol- 
lowing description  may  serve  as  a  guide  to  those  who  have  never 
attempted  it,  and  may  wish  to  exercise  their  mechanical  and  artistic 
abilities  on  this  the  most  difficult  of  all  operations  in  dentistry.  Those 
only  who  are  aiming  at  high  excellence  in  this  department  of  practice 
will  be  likely  to  undertake  it ;  and  should  their  first  efforts  prove 
unsuccessful,  the  increase  of  skill  they  will  have  thus  acquired  in  the 
use  of  instruments  will-  inspire  new  confidence,  and  ultimately,  by 
perseverance,  enable  them  to  achieve  the  object  of  their  wishes. 

The  operation,,  to  be  successful,  must  not  only  be  performed  in  the 
most  perfect  manner,  but  the  tooth  itself  must  be  situated  in  a  healthy 
socket  and  firmly  articulated.  Under  other-  circumstances  it  would  be 
useless  to  attempt  the  restoration  of  the  organ.  The  general  system, 
too,  should  be  free  from  any  preternatural  susceptibility  to  morbid 
impressions. 

A  tooth  on  which  this  operation  is  called  for  has,  in  nearly 
every  case,,  suffered  so  much  loss  of  substance  as  to  involve  exposure 
of  the  pulp;  consequently  the  destruction  and  removal  of  this  is  the 
first  thing  to  be  attended  to ;  unless,  as  is  sometimes  the  case,  it  has 
previously  perished  from  inflammation  and  suppuration.  Where  this 
has  happened,  the  permanent  preservation  of  the  organ  cannot  be 
counted  on  with  as  much  certainty  as  when  it  is  destroyed  by  extirpa- 
tion, or  by  the  application  of  an  escharotic  two  or  three  days  before 
the  performance  of  the  operation.  Its  destruction  by  the  suppurative 
process  is  more  apt  to  be  followed  by  alveolar  abscess  ;  and  this  having 
once  established  itself,  is  seldom  so  completely  cured  as  to  prevent  the 
liability  to  its  recurrence.  Still,  if  the  operation  is  determined  on, 
the  parts  of  the  extremity  of  the  root  must  first  be  restored  to  health ; 
for  without  this  it  should  never  be  attempted.  The  preparatory  treat- 
ment in  cases  of  this  sort,  as  well  as  in  cases  of  simple  morbid  secre- 
tion escaping  from  the  root,  is  given  in  another  chapter. 

In  describing  the  oj^eration,  we  will  commence  with  the  first  molar 
of  the  left  side  of  the  superior  maxilla.     We  will  suppose  that  about 


FILLING    TEETH.  357 

three-fourtlis  of  the  crown  has  been  destroyed  by  caries,  and  that  the 
buccal  wall  is  the  only  portion  remaining,  the  pulp  being  more  or  less 
exposed.  This  is  to  be  destroyed  and  extirpated  to  the  extremity  of 
each  root ;  the  decayed  portions  of  the  tooth  are  then  to  be  removed, 
and  the  central  chamber  enlarged  until  the  wall  of  dentine  on  the 
palatine,  anterior  and  posterior  approximal  sides  are  only  about  one 
line  in  thickness.  On  the  inside  of  this  wall,  a  shallow  groove  or  un- 
dercut is  made,  and  also  retaining  points,  to  give  additional  security 
to  the  gold. 

The  tooth  as  now  prepared  is  represented  in  Fig.  129,  and  is  ready 
for  the  introduction  and  building  on  of  the  gold.  But 
before  describing  the  manner  of  doing  this,  it  may  be 
well  to  say  a  few  words  with  regard  to  the  preparation 
of  gold  most  proper  to  be  employed.  For  filling  the 
roots,  non-adhesive  gold  foil  is  the  best.  If  the  leaves 
are  thick,  weighing  from  fifteen  to  twenty  grains,  it 
should  be  introduced  in  very  narrow  strips,  without 
folding,  in  the  manner  described  in  another  chapter ; 
if  leaves  of  four  or  six  grains  are  preferred,  it  may  be 
cut  in  strips  varying  from  an  eighth  to  a  quarter  of  an 
inch  in  width,  according  to  the  size  of  the  canal  in  the  root,  and  then 
rolled  or  made  into  very  narrow  folds.  For  the  central  chamber  and 
crown,  gold  possessing  adhesive  properties  should  be  employed ;  this 
property  may  be  imparted  to  common  gold  foil  by  slightly  annealing 
immediately  before  using ;  but  adhesive  gold  foil  possesses  it  in  a  higher 
degree,  but  this  also  requires  to  be  annealed.  Either  kind  of  foil, 
therefore,  or  crystal  gold  may  be  employed.  The  operation,  however, 
can  be  better  performed  with  the  adhesive  foil  or  crystal  gold  than 
with  the  non-adhesive  foil.  Crystal  gold  is  often  used  to  fill  the  cen- 
tral chamber,  and  act  as  a  base  upon  w'hich  to  build  the  adhesive  gold 
foil. 

As  the  manner  of  filling  roots  is  described  in  another  place,  we  shall 
commence  with  the  pulp-cavity.  The  gold,  supposing  it  to  be  adhesive 
foil,  is  loosely  rolled  into  a  fold  or  rope  from  which  pellets  are  cut. 
A  sufficient  number  of  these  having  been  prepared,  the  surfaces 
against  which  the  gold  is  to  be  placed  are  made  perfectly  dry  by 
wiping  with  bibulous  paper,  flax,  or  cotton.  This  done,  one  of  the 
pellets  is  placed  in  the  central  chamber  with  pliers,  pressed  into  a 
retaining  point  where  the  formation  of  such  points  is  necessary,  and 
consolidated  with  a  small  pointed  condensing  instrument ;  another 
and  another  is  added,  each  being  consolidated  as  the  first,  until  a 
sufficient  number  have  been  introduced  to  fill  this  chamber.  The 
process  of  consolidation  is  now  to  be  repeated  and  continued,  until  no 


358  FILLING    TEETH. 

part  of  the  gold  can  be  made  to  yield  to  the  pressure  of  the  instru- 
ment ;  then  additional  pellets  are  applied  and  condensed  as  in  the 
first  instance,  forcing  those  placed  against  the  surrounding  wall  firmly 
and  compactly  into  the  groove  or  undercut  made  in  it,  thus  securing 
for  the  entire  mass  the  greatest  possible  stability.  Again,  pellet  after 
pellet  is  applied,  pressing  those  placed  along  the  outer  edge  firmly 
against  the  exposed  margin  of  dentine  and  against  the  buccal  wall  of 
the  tooth,  until  a  solid  mass,  considerably  larger  than  the  portion  of 
the  crown  to  be  supplied,  shall  have  been  thus  formed. 

For  the  complete  solidification  of  every  part  of  the  gold,  and  the 
welding  of  every  piece  to  the  adjoining  ones,  a  number  of  instruments 
are  required,  with  serrated  points,  which  are  represented  in  the  Figs. 
illustrating  the  instruments  employed  in  the  use  of  the  adhesive  forms 
of  gold.  For  some  parts  of  the  operation  a  straight  instrument  can 
be  employed  most  advantageously ;  for  other  parts,  one  slightly  bent 
near  the  point ;  and  for  others,  one  bent  at  right  angles  wnth  the  stem. 
The  kind  most  suitable  for  each  case  must  be  determined  by  the  judg- 
ment of  the  operator.  One,  perhaps,  may  use  very  efficiently  an  in- 
strument in  a  particular  locality  and  for  a  certain  purpose  that  another, 
for  the  same  purpose,  would  handle  very  awkwardly.  But  for  com- 
pleting the  work  of  consolidation,  all  agree  that  very  small  pointed 
instruments  are  indispensable. 

As  the  adhesiveness  of  the  gold  is  destroyed  by  the  contact  of  liquids, 
it  must  be  kept  absolutely  free  from  moisture  during  the  entire  process 
of  introducing  and  consolidating  the  metal.  But  if,  notwithstanding 
every  precaution,  the  saliva  should  come  in  contact  Avith  the  gold 
before  its  complete  introduction,  the  unfinished  surface  must  be  thor- 
oughly consolidated,  then  dried  with  some  good  absorbing  substance, 
scraped,  burnished,  dried  again,  and  made  rough  with  a  sharp-pointed 
instrument.  To  this  surface  fresh  portions  of  gold  can  now  be  united, 
and  made  to  adhere  as  firmly  as  if  no  interruption  had  taken  place. 
The  use  of  the  rubber  coffer-dam  and  other  appliances  now  enables  the 
operator  to  perform  prolonged  operations  without  the  danger  from 
moisture  which  formerly  existed. 

The  next  step  is  to  consolidate  thoroughly  every  part  of  the  surface. 
This  may  be  commenced  with  the  larger  pointed  instruments.  After 
going  over  it  ten  or  a  dozen  times  with  these,  smaller  points  may  be 
used,  and  these  again  changed  for  still  smaller,  until  no  more  impres- 
sion can  be  made  upon  it  than  upon  a  solid  ingot  of  pure  gold. 

It  now  remains  to  file  and  scrape  the  surface  until  the  gold  is  made 
to  assume  very  nearly  the  shape  of  that  portion  of  the  original  tooth, 
the  loss  of  which  it  supplies.  In  doing  this  an  opportunity  is  afforded 
to  the  operator  for  the  display  of  much  artistic  skill  and  ingenuity. 


FILLING    TEETH.  359 

While  shaping  the  grinding  surface,  the  patient  should  be  requested, 
from  time  to  time,  to  close  the  mouth,  that  the  depressions  in  it  may 
be  made  to  correspond  to  the  cusps  of  the  tooth  with  which  it  antago- 
nizes, so  that  these  two  may  touch  simultaneously  with  the  other  teeth 
of  the  upper  and  lower  jaws.  This  part  of  the  operation  is  always 
tedious,  usually  requiring  more  time  than  for  the  consolidation  of  the 
gold. 

The  surface  of  the  gold  may  now  be  rubbed  with  properly  shaped 
pieces  of  Arkansas  or  Lake  Superior  stone,  or  with  pulverized  pumice, 
until  all  the  scratches  left  by  the  file  are  removed ;  then 
polished  with  crocus  and  a  burnisher.     The  appearance       ^^^'-  ■'^^• 
of  the  tooth  as  thus  restored  is  shown  in  Fig.  130. 

As  it  is  impossible  to  perform  the  entire  operation  at 
one  time,  it  may  readily  be  divided  into  three  parts. 
The  first  consisting  in  the  extirpation  of  the  pulp  and 
the  preparation  of  the  tooth ;  the  second,  in  the  intro- 
duction and  solidification  of  the  gold  ;  the  third,  in  giv- 
ing to  the  metal  the  proper  conformation,  and  in  finishing 
the  surface.  The  time  required  for  the  first,  supposing 
the  operation  to  be  like  the  one  just  described,  may  vary  from  one  and 
a  half  to  two  and  a  half  hours ;  for  the  second,  from  two  to  three  and 
a  half  hours  ;  and  for  the  third,  from  two  to  six  hours  —  according  to 
the  difficulties  to  be  encountered,  the  ability  of  the  dentist,  and  the 
completeness  of  his  preparation  for  the  operation.  Some,  perhaps, 
may  prefer  crystalline  or  sponge  gold,  supposing  it  to  be  more  easily 
welded  than  adhesive  foil ;  but  as  the  manner  of  working  this  variety 
of  gold  has  already  been  described,  it  will  not  be  necessary  to  give 
additional  directions  for  its  use. 

.  The  operation  of  building  on  the  entire  crown  of  a  tooth  should  be 
proceeded  with  much  in  the  same  way  as  just  described  for  part  of  the 
crown.  If  too  large  pieces  of  either  crystal  gold  or  foil  are  used  at 
one  time,  the  surface  will  become  crusted  over  by  the  pressure  of  the 
point  of  the  instrument,  and  this  will  prevent,  by  any  subsequent  force 
that  can  be  safely  applied,  its  thorough  consolidation.  In  this  case, 
the  general  mass  will  be  more  or  less  spongy  and  the  operation  imper- 
fect. The  dentist  should  be  well  assured,  therefore,  as  he  progresses 
with  his  work,  that  every  successive  layer  is  firmly  adherent  to  the 
preceding  one.  To  build  up  an  entire  crown  requires  more  time ; 
perhaps,  also,  more  skill,  as  there  is  no  wall  of  tooth  substance  to  give 
partial  support.     In  other  respects  it  resembles  the  previous  operation. 

It  has  been  suggested  by  Prof.  Austen,  as  a  plan  to  avoid  much  of 
the  tediousness  of  the  second  stage  of  this  operation,  to  fill  the  pulp- 
cavity,  inclosing  in  the  centre  a  screw-cut,  notched,  or  double-headed 


360  FILLING    TEETH. 

pin,  and  carrying  the  gold  over  the  edges  of  the  cavity ;  make  this 
surface  somewhat  irregular  in  shape,  but  finish  it  smoothly,  and  trim 
the  circumference  to  the  exact  size  of  the  tooth ;  take  a  Avax  or  plastei 
impression  of  the  surface,  and  fit  to  the  plaster  model  a  lump  of  gold, 
having  in  the  centre  a  hole  larger  than  the  pin  projecting  from  the 
root;  shape  and  polish  it  out  of  the  mouth,  then  set  it  in  place  and 
secure  it  by  filling  with  gold  around  the  pin.  If  the  color  is  not  ob- 
jected to,  a  vulcanite  crown  could  be  very  perfectly  adapted  in  this 
manner;  or  a  porcelain  tooth  could  be  made,  hollow  in  the  centre,  with 
pins  or  a  dovetail  to  hold  a  thin  layer  of  vulcanite,  by  means  of  which 
it  could  be  fitted  with  perfect  accuracy  to  the  prepared  root.  Prof. 
Austen  tliinks  that  in  this  way  the  root  will  be  less  injured,  and  the 
union  between  the  gold  and  the  root  less  disturbed,  than  by  the  long- 
continued  and  severe  pressure  of  the  ordinary  operation.  While  the 
artificial  crown  is  being  made,  he  suggests  a  temporary  gutta-percha 
crown  to  prevent  any  irritation  from  the  projecting  pin. 

A  large  portion  of  the  crown  of  a  tooth  may  be  built  up  Avith  ordi- 
nary gold  foil,  if  it  be  of  the  best  quality ;  but  the  adhesive  prepara- 
tions, either  foil  or  crystal  gold,  are  preferable.  It  is  more  difficult  to 
build  up  the  crown  of  a  tooth  in  the  lower  than  in  the  upper  jaw, 
owing  to  the  great  difficulty  of  controlling  the  flow  of  saliva  during  so 
long  an  operation.  But  by  the  use  of  the  appliances  before  referred 
to,  this  difficulty  is  now  almost  entirely  obviated. 

We  have  endeavored,  in  the  foregoing  descrij^tion,  to  point  out  the 
general  method  of  procedure  in  the  operation  of  which  we  have  been 
treating.  We  have  also  noticed  some  of  the  precautions  necessary  to 
be  observed ;  but  unexpected  difficulties  are  sometimes  encountered, 
the  peculiar  nature  of  which  it  is  impossible  to  anticipate.  Few,  how- 
ever, are  of  so  formidable  a  character  that  they  cannot  be  overcome. 
"Only,"  says  Prof.  Austen,  "let  the  operator  assure  himself  that  he  is 
laboring  for  the  real  benefit  of  his  patient,  and  not  degrading  his  ai't: 
on  the  one  hand,  by  humoring  an  idle  w4iim  of  his  patient;  or,  on  the 
other,  by  making  him  the  reluctant  advertising  medium  of  dental 
ingenuity." 


FILLING    TEETH    OVEK    LIXINQ    MEMBRANE.       361 


CHAPTER  III. 

FILLINa  TEETH  WHEN   THE   LINING   MEMBRANE  IS   EXPOSED. 

THE  propriety  of  filling  a  tooth,  after  the  invasion  of  the  pulp- 
cavity  by  caries,  without  first  destroying  the  pulp,  was  for  a  long 
time  doubted  by  many  practitioners.  It  was  thought  that  inflamma- 
tion and  suppuration  of  the  lining  membrane  and  pulp  must  necessa- 
rily result  from  the  operation.  But  Dr.  Koecker,  who  was  the  first  to 
recommend  filling  a  tooth  under  such  circumstances,  cited  a  number 
of  cases  in  which  he  performed  the  operation  successfully.  He  also 
expressed  the  belief  that  "on  an  average,  five  out  of  six  teeth  may  be 
preserved  alive,  and  rendered  useful  for  a  long  while."  The  author 
has  been,  since  1846,  in  the  constant  habit  of  filling  teeth  under  such 
circumstances,  whenever  a  favorable  case  presented  itself,  and  occa- 
sionally for  nearly  twelve  years  previously  to  this  period ;  and  his 
experience  warrants  the  belief  that  the  vitality  of  even  a  larger  pro- 
portion may  be  saved  under  skilful  treatment.  He  believes  he  has 
been  successful  in  at  least  fourteen  cases  out  of  every  fifteen,  since 
1853 ;  and  it  may  be,  as  he  has  stated  in  another  place,  that  when  the 
treatment  of  teeth  in  which  caries  has  penetrated  to  the  pulp-cavity 
shall  be  better  understood,  the  vitality  of  a  still  larger  relative  propor- 
tion may  be  preserved.  But  so  long  as  it  can  be  done  in  even  nine 
cases  out  of  ten,  the  operation  must  be  regarded  as  valuable ;  for  a 
healthy  living  tooth  is  less  liable  to  become  obnoxious  to  the  surround- 
ing parts  than  one  deprived  of  a  large  portion  of  its  vitality. 

Admitting  the  fact  that  teeth  can  be  preserved  alive  after  the  lining 
membrane  has  become  exposed,  the  question  arises.  Does  the  pulp 
remain  in  the  condition  in  which  it  is  at  the  time  the  operation  is 
performed  ?  It  is  difficult  to  conceive  either  how  a  vacant  space  can 
exist  between  it  and  the  filling,  or  how  a  foreign  body  can  remain  in 
contact  with  it,  with  impunity.  Drs.  Harwood,  of  Boston,  and  J.  H. 
Foster  and  W.  H.  Dwmelle,  of  New  York,  hold  the  opinion,  from  ex- 
periments they  have  made,  that  it  ossifies.  That  some  change  of  this 
sort  does  take  place  is  well  known,  and  the  transition  is  evidently  the 
result  of  increased  vascular  action  caused  by  irritation.  Examples  of 
such  ossification  are  met  with  in  teeth  in  which  the  crowns  have  lost  a 
considerable  portion  of  their  substance  from  mechanical  or  spontaneous 
abrasion  ;  and  it  is  a  beautiful  provision  of  nature  to  prevent  the  expo- 
sure of  these  delicate  and  highly  sensitive  parts.   The  same  thing  some- 


362      FILLING    TEETH    OVER    LINING    MEMBRANE. 

times  occurs  in  teeth  which  have  suffered  no  loss  of  substance,  and  is 
doubtless  the  result  of  some  constitutional  or  local  cause  of  irritation. 

These  facts  would  seem  to  justify  the  conclusion,  elsewhere  stated, 
that  the  pulp  of  a  tooth,  when  subjected,  for  a  sufficient  length  of  time, 
to  the  influence  of  an  irritating  agent,  capable  of  exciting  only  a  very 
slight  inflammatory  action,  undergoes  ossification ;  or  rather  is  con- 
verted into  a  substance  resembling,  erusta  petrosa,  or  what  Prof 
Owen  terms  osteo-dentine.  A  tooth  which  has  been  filled  after  the 
lining  membrane  has  become  exposed,  is  liable,  when  it  fails  to  undergo 
this  change,  either  to  perish  from  derangement  of  its  nutritive  func- 
tions, or  to  become  the  seat  of  active  inflammation  and  suppuration. 
But  something  more  than  ossification,  or  conversion  into  osteo-dentine, 
takes  place  when  a  space  is  left  between  it  and  the  filling.  If  this 
vacant  space  were  not  filled  up,  we  have  reason  to  believe  that  the 
slightest  increase  of  vascular  action  would,  as  has  been  justly  remarked 
by  Dr.  Elliot,  force  a  portion  of  the  pulj:)  into  it ;  and  thus  active 
inflammation  would  be  excited  by  contact  with  the  sharp  angles  of  the 
walls  of  the  cavity,  and  this,  as  a  natural  consequence,  would  be  apt 
to  terminate  in  suppuration.  We  believe,  from  experiments  which  we 
have  made,  that  nature,  ever  fruitful  in  her  resources,  uses  means  for 
the  prevention  of  such  an  occurrence :  consisting,  first,  in  filling  the 
vacant  space  with  coagulable  lymjih,  effused  from  the  lining  membrane 
or  exposed  surface  of  the  pulp ;  then,  in  its  organization,  and,  lastly, 
its  conversion  into  hone,  or,  more  properly,  osteo-dentine.  Nature  seems 
to  employ  here  the  same  means,  as  in  other  parts  of  the  body,  for  the 
reparation  of  injuries. 

When  this  reparative  process  does  not  take  place  after  the  operation, 
it  may  be  owing  either  to  want  or  the  excess  of  vascular  action  in  the 
lining  membrane  or  pulp.  A  certain  amount  of  increased  vascular 
action  seems  necessary  to  the  effusion  of  coagulable  lymph,  an  indis- 
pensable requisite ;  but  when  this  is  too  great,  it  must  of  necessity  ter- 
minate in  suppuration.  It  is  obvious,  therefore,  that  the  success  of  the 
operation  must  very  greatly  depend  upon  the  circumstances  under 
wdiich  it  is  performed.  If  these  be  unfavorable,  all  efforts  to  preserve 
the  vitality  of  the  organ  will,  in  a  majority  of  cases,  prove  unavailing; 
however  skilful  the  opei'ator  may  be  in  the  preparation  of  the  cavity 
and  the  introduction  of  the  gold.  The  health  of  the  patient  should  be 
unimpaired  ;  the  tooth  of  a  tolerably  good  quality,  free  from  pain  at 
the  time  the  operation  is  performed  ;  it  should  never  have  ached  ;  and 
the  pulp,  peridental  membrane  and  surrounding  parts  should  be  in  a 
perfectly  healthy  condition.  The  cavity  should  be  of  a  proper  shape 
for  the  easy  introduction  and  permanent  retention  of  the  filling ;  and 
the  smaller  the  point  of  exposure  of  the  lining  membrane,  the  greater 


FILLING    TEETH    OVER    LINING    MEMBRANE.      363 

the  prospect  of  success.  It  is  also  important  that  every  particle  of 
completely  decomposed  dentine  be  removed,  and  if  there  be  any  oozing 
of  blood  from  the  ruptured  vessels,  this  must  cease  before  the  filling  is 
introduced. 

The  direct  application  of  any  metallic  substance  to  the  lining  mem- 
brane or  pulp,  is,  according  to  the  observation  of  the  author,  very 
apt  to  be  followed  by  inflammation  and  suppuration  of  these  tissues. 
Some  of  the  vessels  of  the  lining  membrane  are  always  necessarily 
wounded  in  removing  the  last  layer  of  decomposed  dentine,  but  the 
hemorrhage,  when  no  other  injury  is  inflicted,  is  very  slight,  and 
sometimes  scarcely  perceptible ;  so  that  the  operation  of  filling  need 
never  be  delayed  more  than  from  three  to  ten  minutes.  The  applica- 
tion of  a  small  particle  of  raw  cotton  moistened  with  spirits  of  cam- 
phor will  immediately  arrest  it. 

Dr.  S.  S.  Fitch  proposed  to  cover  the  nerve  when  exposed,  with  a 
plate  of  gold,  previously  to  filling  the  cavity;  and  this,  in  the  opinion 
of  the  author,  is  preferable  to  the  direct  application  of  a  piece  of  leaf 
lead,  as  was  recommended  by  Dr.  Koecker.  It  is  certainly  a  better 
protection  to  the  nerve,  and  if  it  be  fitted  to  the  cavity  so  that  its 
edges  shall  rest  upon  the  surrounding  dentine,  a  filling  may  afterward 
be  introduced  without  injury  to  the  pulp.  Still,  in  many  cases  the 
application  of  a  covering  of  this  sort  is  objectionable.  It  is  diffi- 
cult to  fit  it  with  sufficient  accuracy  to  prevent  the  liability  to  dis- 
placement in  the  introduction  of  the  filling ;  and  when  the  cavity  is 
very  shallow  it  will  occupy  so  much  room  as  to  render  it  impossible  to 
fill  the  remainder  of  it  in  a  substantial  manner;  yet  it  may  sometimes 
be  very  advantageously  applied. 

The  plan  pursued  by  Dr.  J.  H.  Foster,  in  filling  teeth  after  the 
pulp  has  become  exposed  or  is  covered  only  by  a  very  thin  layer  of 
dentine,  is  as  follows :  "  If,"  says  he,  "  after  a  careful  removal  of  all 
the  defective  portion,  within  and  about  the  parietes  of  the  cavity,  the 
thin  layer  of  bone  which  lies  adjacent  to  the  lining  membrane  has  a 
moderate  degree  of  consistency,  yet  not  sufficient  to  protect  the  dental 
pulp  from  irritation  caused  by  the  pressure  of  external  agents,  it  has 
been  my  practice  to  leave  it  there,  and  after  fitting  a  gold  cap  over  it 
(with  great  caution  as  to  its  proper  adjustment  as  a  protection),  pro- 
ceed to  fill  the  tooth."  But  this  method,  he  says,  was  not  as  success- 
fid  as  he  could  have  desired,  owing,  as  he  supposed,  to  the  extent  to 
which  the  thin  subjacent  layer  of  dentine  had  been  involved  in  disease, 
and  to  the  liability.of  the  pulp  to  be  affected  by  heat  and  cold. 

To  guard  against  the  irritation  and  inflammation  proceeding  from 
this  cause,  he  filled  the  concave  surface  of  the  gold  cap  with  Hill's 
stopping ;  using  the  precaution  to  preserve  the  concavity,  so  that  it 


364      FILLIXG    TEETH    OVER    LINING    MEMBRANE. 

may  not  press  upon  the  part  it  is  designed  to  protect.  This  treatment, 
he  says,  proved  successful  in  a  majority  of  cases.  Believing  that  many 
failures  occurred  in  consequence  of  the  comparatively  small  portion  of 
newly  exposed  bone  which  was  covered  and  protected  by  the  non-con- 
ducting medium,  he  resolved  to  try  still  another  experiment.  Instead 
of  lining  the  gold  cap,  after  having  fitted  it  accurately  upon  the  floor 
of  the  cavity,  he  filled  the  whole  of  the  cavity  external  to  it  with 
Hill's  stopping,  allowing  this  to  remain  for  five  or  six  mouths  as  a 
temporary  filling. 

By  this  plan.  Dr.  Foster  says  he  has,  with  one  or  tw^o  exceptions, 
been  successful  in  preserving  the  vitality  of  the  tooth  in  every  case 
treated  during  the  past  year  (1850).  He  also  states  that  he  has  occasion- 
ally removed  these  fillings  after  the  lapse  of  two  or  three  months,  and 
finding  the  irritability  of  the  tooth  still  existing,  he  refilled  them  in 
the  same  manner,  and  permitted  the  filling  to  remain  two  or  three 
months  longer;  on  again  removing  the  stoppings,  he  found  the  inflam- 
mation diminished,  and  the  subjacent  layer  of  bone  almost  firm 
enough  to  bear  the  pressure  of  a  gold  filling;  but  he  still  uses  the 
cap  underneath  the  gold,  as  before.  He  believes,  however,  that,  if 
Hill's  stopping  could  be  relied  upon  for  preserving  the  walls  of  the 
cavity  for  one  or  two  years,  as  perfectly  as  it  does  for  a  few  months, 
the  caps  might  be  removed  and  a  solid  gold  filling  introduced,  without 
danger  of  causing  irritation  by  pressure  upon  the  bottom  of  the  cavity. 
He  further  adds,  that  he  "has  frequently  taken  out  gold  fillings  of 
his  own  insertion,  by  way  of  experiment,  which  had  been  introduced 
under  like  circumstances,  after  they  had  been  in  for  two  or  more 
years,  and  on  removing  the  cap,  had  found  the  bone  beneath  so  un- 
yielding and  void  of  sensibility,  that  he  w^as  able  to  introduce  a  solid 
gold  filling  without  the  cap."  The  author  had,  in  1848,  a  case  (first 
left  upper  molar)  in  which  he  removed  a  suppurating  pulp,  and  after 
treating  for  ten  days  with  injections  of  chlorinated  soda,  filled  the  cav- 
ity with  Hill's  stopping.  The  patient  was  requested  to  call  in  three 
weeks,  or  sooner  ;  but  put  it  ofl"  for  tw^o  years.  On  removing  the  tem- 
porary filling  for  the  purpose  of  introducing  gold,  the  Avails  of  the 
cavity  were  found  to  be  as  perfect  as  when  it  was  inserted. 

That  Dr.  Foster's  method  of  treatment  by  means  of  gutta-percha 
has  justified  the  expectations  which  he  many  years  ago  formed  of  it, 
may  be  inferred  from  the  following  extract  taken  from  a  letter,  written 
in  1863,  to  a  professional  friend.  The  importance  of  the  subject  will, 
it  is  hoped,  excuse  this  use  of  a  letter  not  written  with  any  thought  of 
publication : 

"  I  would  I  could  speak  trumpet-tongued  to  the  members  of  my  pro- 
fession upon  the  importance  of  an  expectant  course  of  treatment  in 


FILLING    TEETH    OVEE    LUSTING    MEMBRANE.      365 

preventing  exposure  of  the  nerve.  I  now  rarely  expose  a  nerve  in  pre- 
paring a  cavity.  If  there  has  been  neither  inflammation  in  the  dental 
pulp,  nor  pain  previously  to  the  operation,  I  avoid  cutting  too  deep, 
and  prepare  the  cavity  as  for  a  gold  filling.  But  if  I  consider  there  is 
the  least  danger  of  inflammation  from  the  pressure  of  the  gold  or  from 
the  action  of  heat  and  cold  through  the  metallic  medium,  I  invai'iably 
pursue  the  expectant  course  of  treatment. 

"  I  use  for  this  purpose.  Hill's  stopping,  renewing  it,  if  necessary, 
until  all  local  irritation  has  ceased,  and  the  intei'ior  of  the  cavity  has 
attained  a  degree  of  hardness,  such  as  will  safely  permit  the  insertion 
of  a  solid  gold  filling.     This  usually  occupies  a  year. 

"Root  filling,  treatment  of  the  pulp,  of  abscess,  etc.,  all  demand  our 
most  serious  consideration.  But  still  more  important  is  it  for  us  to 
inquire  if  there  is  not  some  mode  of  treatment  which  will  prevent  these 
evils.  Hence  I  think  this  method  of  prevention,  here  so  briefly  stated, 
demands  the  most  careful  attention  of  every  practitioner." 

The  method  pursued  by  the  author,  in  filling  a  tooth  after  caries  has 
penetrated  to  the  pulp-cavity,  is  a  very  simple  one.  The  caries  is 
removed  and  the  cavity  prepared  in  the  usual  manner,  using  the  pre- 
caution not  to  wound  the  lining  membrane  if  it  can  be  avoided;  though 
some  of  its  vessels  are  always  ruptured  in  the  removal  of  the  last  lay- 
ers of  decomposed  dentine ;  then  the  cavity  is  wiped  out  very  carefully 
with  a  dossil  of  cotton  saturated  with  spirit  of  camphor,  which  imme- 
diately arrests  the  eff"usion  of  blood.  The  gold  is  next  introduced, 
commencing  by  placing  the  folds  on  one  side  of  the  cavity,  and  insert- 
ing fold  after  fold,  without  carrying  to  the  bottom  of  the  cavity  those 
immediately  over  the  exposed  part  of  the  lining  membrane  or  pulp ; 
thus  every  part,  except  a  very  small  space  immediately  over  the  nerve, 
is  thoroughly  filled.  The  folds  are  forced  so  tightly  one  against  the 
other,  as  to  prevent,  in  the  consolidation  of  the  outer  extremities  of  the 
folds,  the  liability  of  pressing  their  inner  extremities  against  the 
exposed  pulp  at  the  bottom  of  the  cavity.  After  tlie  gold  has  been 
thoroughly  condensed,  the  surface  of  the  filling  is  finished  in  the  usual 
manner. 

The  author  has  occasionally  placed  a  drop  of  the  solution  of  gutta- 
percha or  collodion  in  the  bottom  of  the  cavity,  waiting  until  the  chlo- 
roform had  completely  evaj)orated,  before  introducing  the  gold.  Dr. 
Elliot,  of  Montreal,  states  in  an  article  on  filling  teeth  over  exposed 
nerves,  that  he  places  the  gold  "  directly  upon  the  living  nerve,  and  in 
perfect  contact  with  it,  over  the  whole  of  its  exposed  surface,"  using, 
when  the  cavity  is  sufficiently  deep  to  admit  of  it,  asbestos,  a  non-con- 
ductor, "enveloped  in  a  few  thicknesses  of  gold  foil."  He  also  says  that 
within  the  last  year  he  had  but  two  cases  in  which  irritation  advanced 


366       FILLING    TEETH    OVER    LINING    MEMBRANE. 

po  far  as  to  become  troublesome  to  the  patient ;  anil  that,  in  both 
instances,  perfect  and  permanent  relief  was  obtained  by  the  use  of 
leeches  and  a  mild  cathartic.  The  result  of  the  operation,  however, 
])erformed  in  either  way,  cannot  always  bs  immediately  ascertained. 
Tliaiigh  it  may  at  first  be  apparently  successful,  sujipuration  of  the 
lining  membrane  and  pulp  may  take  place  three,  six,  or  even  twelve 
months  after  the  introduction  of  the  filling ;  hence  we  should  not 
decide  too  quickly  upon  the  results  of  any  given  treatment. 

Dr.  S.  P.  Hullihen  described  to  the  author,  in  the  fall  of  1851,  a 
method  which  he  had  recently  introduced  of  treating  teeth  after  the 
lining  membrane  had  become  exposed.  It  consists,  after  filling  the 
tooth  in  the  usual  way,  of  drilling  a  hole  with  a  small,  spear-pointed 
drill,  about  a  line  above  the  edge  of  the  alveolus,  through  the  gum, 
alveolar  wall  and  root,  into  the  pulp-cavity,  using  the  precaution  not 
to  separate  the  nerve,  and  wounding  it  as  slightly  as  possible.  The  ef- 
fused lymph  resulting  from  the  inflammation  occasioned  by  the  j^ressure 
of  the  filling,  escapes  through  this  opening ;  Avhich,  he  believes,  when 
the  increased  vascular  action  subsides,  is  filled  with  callus,  and  ulti- 
mately with  dentine.  Dr.  Hullihen  informed  the  author  that  he  had 
succeeded  in  almost  every  instance  in  preserving  the  vitality  of  the  tooth. 

Of  late  years  a  mode  of  treatment  has  been  practised  to  preserve 
the  vitality  of  the  pulp  after  exposure,  which  has  proved  more  success- 
ful than  either  arching  with  gold  foil,  capping  with  gold  plate,  tin, 
lead,  asbestos,  oiled  silk,  gutta-percha,  or  excision  of  a  portion  of  the 
pulp  at  the  orifice  of  exposure.  It  consists  in  the  application  of  oxy- 
chluride  of  zinc,  in  the  form  of  os-artificiel,  directly  to  the  point  of 
exposure.  After  removing  all  the  decomposed  dentine  with  delicate 
instruments,  and  perfectly  drying  the  cavity  with  prepared  cotton  and 
spunk,  a  small  quantity  of  the  os-artificiel,  mixed  quite  thin,  is  apjolied 
to  the  exposed  pulp,  the  surface  of  which  has  been  previously  touched 
with  carbolic  acid. 

The  excess  of  chloride  of  zinc  is  then  removed  by  pressing  bibulous 
paper  upon  the  soft  mass  of  os-artificiel  in  the  cavity,  and  time  is 
allowed  it  to  harden.  When  this  has  occurred,  the  cavity  is  filled  with 
the  os-artificiel,  mixed  as  stiff  as  it  can  be  used,  and  the  surface  pro- 
tected by  sandarach  varnish,  or  melted  wax,  for  at  least  thirty  minutes. 

It  is  then  the  practice  of  some  to  cut  away  a  portion  of  this  filling 
of  os-artificiel,  and  immediately  fill  the  cavity  with  gold  :  others  allow 
the  os-artificiel  filling  to  remain  in  the  cavity  for  some  days  before  cut- 
ting a  part  of  it  out  and  filling  over  the  remaining  portion  with  gold. 
When  the  cavity  is  very  shallow,  after  removing  all  the  decayed  mat- 
ter, small  retaining  points  should  be  made  as  near  the  pulp  as  it  is  safe 
to  approach,  Avhich  will  give  support  to  the  os-artificiel  covering  the 


FILLING   PULP-CAVITIES   AND    EOOTS   OF   TEETH.      367 

bottom  of  the  cavity,  and  prevent  its  being  detached  in  the  operation 
of  introducing  the  gold  over  it.  In  such  cavities  it  is  well  to  allow  the 
os-artificiel  to  become  as  hard  as  possible  before  removing  a  portion  of 
it,  in  order  that  the  first  introduced,  and  which  is  in  contact  with  the 
pulp,  is  not  disturbed. 


CHAPTER  IV. 

FILLING  PULP-CAVITIES   AND   EOOTS   OF  TEETH. 

THIS  operation  has  now  become  very  common,  and  is  practised 
by  the  most  skilful  dentists  in  America  and  in  Europe,  although 
its  propriety  was  for  a  long  time  doubted  by  many.  The  objection  to 
the  practice  was  founded  upon  the  supposition  that,  in  proportion  as 
the  vitality  of  the  tooth  is  lessened,  it  becomes  obnoxious  to  the  sur- 
rounding living  parts. 

It  was  contended  that,  though  the  presence  of  the  tooth  may  not 
give  rise  to  alveolar  abscess,  it  is  to  some  extent  a  local  irritant ;  that 
as  such  it  must  necessarily  exert  a  morbid  influence  not  only  upon 
the  living  parts  with  which  it  is  in  immediate  contact,  but  also  upon 
the  whole  economy.  Hence  it  was  argued  that  the  proper  remedial 
indication,  after  the  death  of  the  lining  membrane,  is  the  extraction 
of  the  tooth.  This  reasoning,  it  must  be  admitted  by  all  who  have 
any  knowledge  of  the  laws  of  health  and  disease,  is  not  without  much, 
seeming  plausibility.  Until  within  a  comparatively  recent  period,  the 
result  of  most  of  the  efforts  made  for  the  preservation  and  retenticm 
of  teeth  in  this  condition  fully  justified  its  supposed  correctness  ;  for, 
in  nine  cases  out  of  ten,  the  operation  of  filling,  unless  an  opening 
was  left  for  the  escape  of  matter  secreted  at  the  extremities  of  the 
root,  was  followed,  sooner  or  later,  by  alveolar  abscess.  The  conclu- 
sion, therefore,  that  such  teeth  could  not  remain  in  the  mouth  with 
impunity,  was  a  very  natural  one.  But  more  recent  experiments  have 
shown  that  it  is  not  a  necessary  consequence. 

Drs.  Maynard  and  Baker  were  the  first  to  show  that  most  of  the 
morbid  phenomena  resulting  from  the  presence  of  a  tooth  in  the 
mouth  after  the  destruction  of  the  lining  membrane,  arose  from  the 
irritation  produced  by  the  matter  contained  in  the  pulp-cavity  and 
canal  of  the  root.  To  prevent  their  occurrence,  therefore,  they  pro- 
posed filling  both  cavity  and  canal  in  such  a  manner  as  completely  to 
exclude  everything  else.  The  accumulation  of  purulent  matter  being 
prevented  here,  its  secretion  at  the  extremity  of  the  root  will,  in  a  ma- 


368     FILLING   PULP-CAVITIES   AND   EOOTS   OF  TEETH. 

jorily  of  cases,  either  cease  altogether,  or  go  on  no  faster  tlijin  it  is 
reabsorbed,  as  has  been  shown  by  repeated  experiments.  Thus  it 
would  seem  that  the  amount  of  vitality  which  a  tooth  derives  from 
the  investing  membrane  is  sufficient,  ordinarily,  to  prevent  it  from  ex- 
erting any  apparent  morbid  action  upon  the  surrounding  parts. 

Although  it  is  desirable  that  the  operation  should  be  performed 
before  any  diseased  action  has  been  set  up  at  the  extremity  of  the 
root,  much  advantage  may  sometimes  be  derived  from  it  even  after 
alveolar  abscess  has  actually  occurred.  Dr.  Maynard  informed  the 
author  that  he  had  succeeded  in  curing  the  disease  by  it.  Other 
dentists  have  also  done  it,  and  the  author  has  certainly  known,  in 
several  instances,  great  benefit  result  from  cleansing  and  filling  the 
roots  of  teeth  which  had  given  rise  to  abscess.  The  discharge  of  mat- 
ter has,  in  most  cases  on  which  he  has  operated,  been  greatly  dimin- 
ished ;  often  subsiding  altogether  for  several  months  at  a  time,  the 
recurrence  rarely  occasioning  much  inconvenience,  or  continuing  for 
more  than  a  week  or  ten  days. 

The  application  of  creosote  to  the  inner  .walls  of  the  sac,  introduced 
through  the  canal  in  the  root,  previously  to  filling,  has  been  recom- 
mended as  one  of  the  most  certain  means  of  cure.  It  was  first 
recommended  by  Dr.  C.  W.  Ballard,  and  has  been  tried  by  the 
author  Avith  very  gratifying  results.  It  is  introduced  on  the  end  of  a 
thread  of  Avaxed  floss  silk  to  the  sac  at  the  extremity  of  the  root, 
through  the  pulp-cavity  and  canal  of  the  root,  previously  freed  of  all 
extraneous  matter.  Another  mode  of  applying  this  agent  to  the 
ulcerated  inner  surface  of  the  sac,  recommended  by  Dr.  F.  H.  Badger, 
is  to  throw  it  into  the  tooth  with  a  syringe,  the  opening  in  the  crown 
being  first  closed  with  a  filling  of  Hill's  stopping,  with  a  perforation  large 
enough  to  admit  the  tvibe  of  the  instrument.  The  creosote  is  used  in 
the  form  of  a  strong  alcoholic  solution,  say  one  drachm  of  creosote  to 
an  ounce  of  alcohol.  This  being  forcibly  injected  into  the  tooth, 
passes  through  the  sac  at  the  end  of  the  root  and  escapes  through  the 
fistulous  opening  in  the  gum,  where  it  is  caught  on  a  piece  of  soft 
sponge  or  a  few  folds  of  bibulous  paper.  There  are  many  cases  in 
Avhich  there  is  simply  a  slight  morbid  secretion  that  escapes  through 
the  tooth  without  any  discharge  from  the  gums.  The  means  most 
efficacious  in  arresting  this  are  the  same  as  those  recommended  for  the 
treatment  of  abscess  of  the  socket ;  the  creosote,  in  this  case,  should 
be  introduced  in  the  manner  as  first  described. 

Dr.  E.  J.  Dunning  stated  in  a  letter  to  the  author,  in  1850,  that  he 
had  been  for  several  years,  and  was  then,  constantly  in  the  habit  of 
filling  the  roots  of  teeth  after  destroying  their  nerves,  and  also  of 
cleansing  and  filling  the  roots  of  teeth  which  had  previously  lost  the 


FILLING  PULP-CAVITIES  AND    ROOTS   OF   TEETH.      369 

entire  pulp  and  become  more  or  less  diseased.  He  also  stated  that 
very  few  cases  had  occurred  in  his  practice  where  suppuration  had  su- 
pervened, rendering  the  removal  of  the  tooth  necessary.  He  further- 
more remarks,  that  whenever  the  investing  membrane  and  gums  of 
teeth,  treated  in  this  manner,  become  thickened  and  swollen,  the  symp- 
toms are  less  severe.  In  proof  of  the  correctness  of  this  opinion,  he 
has  furnished  the  author  with  the  following  details  of  a  case  which 
came  under  his  observation. 

"A  gentleman  from  the  Soutb  called  immediately  after  his  arrival 
in  this  city,  and  stated  that  during  his  passage  in  the  steamer  he  had 
been  suffering  intensely  from  pain  in  a  first  superior  molar.  On  exam- 
ination I  found  the  tooth  thoroughly  injected  with  red  blood  and  th> 
periosteum  highly  inflamed  and  considerably  thickened,  though  then* 
was  no  swelling  of  the  gum.  A  small  cavity  in  the  posterior  approxi 
mal  surface  had  been  filled  with  gold  a  day  or  two  before  sailing.  In 
preparing  the  cavity  for  filling,  arsenic  had  been  used  to  allay  sens!  • 
bility.  In  most  cases  I  should  have  advised  the  removal  of  the  tooth, 
for  the  symptoms  were  very  unfavorable  to  any  operation  for  its  pre>- 
servation.  But  as  the  mouth  was  otherwise  perfectly  healthy,  the  arcli 
unbroken,  the  cavity  in  the  tooth  very  small,  and  the  patient  extremely 
anxious  to  preserve  it,  I  determined  to  make  the  trial. 

"On  examining  the  cavity  carefully,  I  found  that  the  nerve  had 
never  been  exposed :  the  arsenic  had  acted  upon  it  through  the  circu- 
lation, and  had  thus  produced  this  severe  inflammation.  Having 
removed  the  layer  of  sound  bone  that  covered  the  nerve,  and  finding 
it  quite  sensitive,  I  made  an  application  of  an  exceedingly  small 
quantity  of  a  mixture  of  arsenic,  morphine,  and  creosote,  and  covered 
it  with  a  metallic  cap  or  arch,  to  prevent  pressure,  followed  by  a  loose 
filling  of  tin  foil.  The  pain  and  much  of  the  soreness  were  immedi- 
ately relieved. 

"  Saw  the  patient  again  on  the  fourth  day ;  found  the  soreness  en- 
tirely gone;  had  suffered  pain  since  the  apjjlication  was  made;  injec- 
tion remained  the  same.  Found  the  part  of  the  pulp  contained  in  the 
central  cavity  entirely  insensible ;  removed  it ;  finding  the  portion  in 
the  roots  still  sensitive,  made  the  same  application  at  the  entrance  of 
each  canal  and  filled  the  cavity  again  with  tin.  At  this  sitting  ven- 
tured to  file  the  tooth  so  as  to  increase  the  separation  between  it  and 
the  second  molar.  The  filed  surface  showed  the  injection  beautifully, 
the  bone  appearing  a  bright  red,  and  the  line  at  the  junction  with  the 
enamel  very  distmct.  In  three  or  four  days  saw  the  patient  again,  and 
to  my  surprise  and  delight  found  that  the  injection  had  entirely  disap- 
peared, and  the  tooth  almost  as  perfect  in  color  as  any  of  its  neighbors.. 
The  nerve  was  then  removed  from  the  roots,  and  its  place  filled  withi 
24 


370      FILLING   PULP-CAVITIES   AND   ROOTS  OF  TEETH. 

gold,  and  at  a  subsequent  sitting  the  external  cavity  was  filled.  As 
three  months  have  elapsed  since  the  operation  was  performed,  without 
hearing  from  it,  I  conclude  that  it  is  thus  far  successful." 

Other  cases  of  a  similar  character  and  with  similar  results  might  be 
given.  The  injection  of  the  tooth  from  the  vessels  of  the  lining  mem- 
brane and  pulp  is  of  frequent  occurrence  in  teeth  to  which  arsenic  is 
applied  for  the  purpose  of  merely  destroying  the  sensibility  of  the  den- 
tine. At  the  first  meeting  of  the  American  Society  of  Dental  Surgeons, 
Dr.  Hayden  mentioned  a  case  that  had  a  short  time  before  fallen  under 
his  observation,  and  several  others  were  cited  by  the  author  at  the 
same  time.  Since  then  he  has  met  with  numerous  cases  in  which  this 
had  occurred.  It  is  doubtless  the  result  of  increased  vascular  action, 
•excited  in  the  lining  membrane  and  pulp  by  the  action  of  the  arsenic, 
and  it  proves  that  the  vessels  of  teeth,  under  certain  circumstances, 
are  capable  of  conveying  red  blood.  It  occurs,  however,  much  more 
frequently  in  the  teeth  of  young  than  in  those  of  old  persons. 

Destruction  of  the  Pulp.  —  With  regard  to  the  best  means  of  destroy- 
ing the  nerve,  or  rather  the  pulp  of  the  tooth,  there  exists  much 
diversity  of  opinion.  There  are  two  methods  by  which  this  may  be 
^accomplished — one  by  immediate  extirpation  with  an  instrument,  and  by 
actual  cauterij ;  the  other  by  the  application  of  some  devitalizing  agent, 
&S  arsenic.     Each  method  has  its  advocates. 

For  the  removal  of  the  pulp  by  extirpation,  there  are  different 
forms  of  instruments  employed,  such  as  a  three-  or  four-sided  broach, 
barbed  for  some  distance  from  the  point,  which  is  thrust  as  far  up  the 
pulp  canal  as  is  possible,  then  rotated  and  Avithdrawn,  bringing  the 
pulp  with  it.  Fig.  131  represents  a  broach  of  this  kind,  which  may 
be  used  with  or  without  a  holder.  Another  form  of  broach  is  used  for 
this  operation  which  is  not  barbed,  but  thrust  into  the  pulp  for  the 
purpose  of  so  lacerating  it  that  it  may  afterward  be  removed  with 
nerve  instruments  without  much  pain.  A  fine  round  steel  wire,  from 
which  the  temper  has  been  drawn,  and  having  a  flat  point  bent  on  au 
angle  of  about  forty  degrees,  is  also  used  for  extirpating  the  pulp. 

The  edge  of  the  point,  in  introducing  this  instrument,  is  pressed 
agciinst  one  wall  of  the  canal  and  gradually  forced  up  as  far  as  it  will 
enter,  when  it  is  suddenly  turned  so  as  to  excise  the  pulp,  and  on  with- 
■drawicg  the  instrument  bring  the  severed  organ  with  it. 

For  extirpating  the  pulps  of  the  molar  teeth,  a  larger  instrument  is  re- 
quired, which  is  thrust  into  the  pulp  chamber  and  rotated  so  as  to  sever 
the  body  of  the  pulp  from  the  branches  filling  the  root  canals.  The 
small  nerve  instruments  are  then  employed  for  removing  these  branches. 

The  actual  cautery  consists  in  thrusting  a  wire,  heated  to  a  white 
heat,  up  the  canal ;   but  as  this   is  considered  a  barbarous  method. 


t'lLLING  PULP-CAVITIES  AND   ROOTS   OF  TEETH.      371 

it  is  not  resorted  to  by  practitioners  in  this  country.  Besides,  periosteal 
inflammation  is  often  a  result  of  its  use,  and  the  pain  following  its 
application  is  sometimes  very  severe. 

Arsenious  acid  has  long  been  used,  in  connection  with  ^^' 
sulphate  of  morphia  and  creosote,  to  devitalize  the  pulp ; 
the  arsenic  and  morphia  being  mixed  in  equal  parts,  and 
taken  up  on  a  small  pellet  of  cotton  saturated  with  creosote, 
which  is  introduced  directly  upon  the  exposed  portion  of 
the  pulp,  and  the  cavity  filled  with  wax  or  cotton  saturated 
with  a  solution  of  gumsandarach  and  alcohol.  The  morphia 
was  formerly  supposed  to  modify  the  irritating  action  of  the 
arsenious  acid  ;  but  since  this  has  been  discovered  not  to  be 
the  case,  its  use  has  been  dispensed  with  by  many.  Water, 
alcohol,  and  ether  are  employed  as  substitutes  for  the  creo- 
sote, and  in  some  cases  are  pr-eferable.  The  arsenious  acid 
is  at  times  combined  with  an  equal  part  by  weight  of  pul- 
verized charcoal,  on  account  of  the  antiseptic  properties 
of  this  latter  agent,  and  also  on  account  of  its  mechanical 
action  in  preventing  the  dentine  from  absorbing  what  is 
intended  for  the  pulp  alone.  A  favorite  mixture  is  known 
as  "nerve  paste;"  but  when  a  definite  quantity  of  the  arse-  '^^ 

nious  acid  is  desired  for  application  to  a  pulp,  it  is  better  to 
employ  the  dry  form.  Various  formulas  are  in  use  for  the 
preparation  of  devitalizing  mixtures,  such  as  equal  parts  by 
weight  of  arsenious  acid,  and  either  the  sulphate  or  acetate 
of  morphia ;  three  parts  by  weight  of  arsenious  acid  to  two 
parts  of  morphia ;  two  parts  of  arsenious  acid  and  one  part 
of  morphia.  Creosote  is  generally  employed  to  combine  the 
ingredients,  and  by  some  is  regarded  as  a  solvent  of  the 
arsenic.  The  thirtieth  part  of  a  grain  of  arsenious  acid. is 
the  average  quantity  employed  to  devitalize  the  pulp.  The 
length  of  time  the  j)reparation  should  be  allowed  to  remain 
varies  from  six  to  twenty-four  hours.  Kot  unfrequently 
cases  are  met  with  where  repeated  applications  of  the  prepa- 
ration fail  to  destroy  the  vitality  of  the  pulp,  which  is  doubt- 
less owing,  in  cases  where  the  organ  is  fairly  exposed,  to  a 
peculiar  condition  at  the  time  the  application  is  made,  which 
enables  it  to  resist  the  absorbent  action  of  the  arsenic.  In 
such  cases  a  preparation  composed  of  tannin  and  creosote 
has  proved  serviceable. 

To  the  use  of  arsenic  and  all  similar  agents.  Dr.  Harwood, 
of  Boston,  is  strongly  opposed.  He  states  in  a  letter  to  the 
author,  written  in  1850, that  "they  cause  death  and  slough- 


372     FILLIXG   PULP-CAVITIES   AND   ROOTS   OF  TEETH. 

ing  in  the  parts  to  whicli  thoy  are  more  immediately  applied,  and  irri- 
tation and  unmanageable  trouble  in  the  parts  next  beyond  those  they 
absolutely  kill.  In  other  Avords,  they  irritate  the  parts  beyond  the 
dental  cavity,  and  from  tliis  cause  (and  perhaps  from  chemical  injury 
to  the  teeth  itself)  the  periosteum  of  the  root  and  socket  becomes  the 
seat  of  great  and  frequently  of  uncontrollable  difficulty."  Entertain- 
ing these  views,  he  regards  the  use  of  such  means  as  opposed  both  to 
experience  and  sound  philosophy,  and  adopts,  witliout  knowing  that 
the  same  thing  had  been  done  by  others,  what  he  believes  to  be  a 
more  correct  practice — immediate  extirpation.  He  thus  desci'ibes 
his  method  of  accomplishing  this  object: 

"I  first  efl'ect  such  an  opening  as  will  enable  me  to  approach  the 
exposed  pulp  in  the  line  of  its  axis,  or  as  nearly  so  as  circumstances 
■will  permit.  Then,  having  carefully  but  sufficiently  exposed  the  sur- 
face of  the  pulp,  I  pass  down  to  the  apex  of  the  root,  through  the  pulp, 
a  small  untempered  steel  instrument,  with  a  trocar-shaped  point,  and 
revolving  it  once  or  twice  sever  the  vessels  and  nerve.  Tliis,  as  any  one 
knows,  w'ho  is  accustomed  to  inserting  artificial  teeth,  produces  but  a 
slight  and  momentary  pain.  I  then,  by  means  of  minute  instruments, 
adapted  to  the  purpose,  endeavor  to  remove  every  portion  of  the 
severed  pulp  and  lining  membrane,  and,  as  soon  as  the  hemorrhage 
ceases,  dry  and  fill  the  cavity. 

"I  have  sometimes  only  filled  the  canal  at  the  first  sitting — leaving 
the  body  of  the  tooth  to  be  treated  after  a  few  days.  This  course  has  been 
adopted  from  a  fear  that  the  pressure  necessary  to  complete  the  whole 
operation  might  enhance  the  danger  of  inflammation  and  suppuration." 
This  is  prudent,  but  expferience  does  not  convince  me  that  it  is  necessary. 

"  It  should  be  borne  in  mind,  that  at  the  point  where  the  vessels 
and  nerve  in  question  enter  the  root,  the  passage  is  much  smaller  than 
it  is  immediately  within.  This  strait  will  be  easily  recognized  when 
reached,  by  the  touch,  the  instrument  ap2:)earing  to  be  arrested  by  an 
obstacle,  and  not  by  being  wedged  in  a  narrow  passage.  Care  should 
be  taken,  I  think,  that  the  instrument  is  not  allowed  to  pass  through 
the  strait,  either  by  being  too  small,  or  by  being  revolved  there  till  it 
cuts  its  way  through.  For,  by  wounding  the  parts  without  the  tooth, 
and  forcing  particles  of  bone  out  upon  the  parts  external  to  the  root, 
the  danger  of  an  unfavorable  result  would  be  greatly  increased." 

Dr.  Harwood  adds,  in  conclusion,  that  he  believes  it  is  better  to 
make  the  division  of  the  parts  a  little  within  the  strait,  though  he  does 
not  regard  the  matter  as  being  yet  fully  settled  by  observation  and 
experience.  As  to  the  success  of  the  practice,  he  speaks  very  confi- 
dently ;  not  having  had  a  case  treated  in  this  manner  where  the  patient 


FILLING  PULP-CAVITIES  AND   EOOTS   OF  TEETH.     373 

and  pulp  were  healthy,  in  which  there  has  been  a  single  symptom  of 
alveolar  abscess. 

In  a  paper  read  before  the  American  Society  of  Dental  Surgeons, 
at  the  meeting  held  in  the  city  of  New  York,  August,  1845,  and 
published  in  the  sixth  volume  of  the  American  Journal  of  Dental 
Science,  p.  15,  Dr.  E.  J.  Dunning  maintains  very  similar  views  with 
regard  to  the  means  most  proper  to  be  employed  for  the  destruction 
of  the  pulp  of  a  tooth.     He  says : 

"  The  destruction  of  the  nerve  by  mechanical  means  has  been  prac- 
tised to  a  small  extent  by  dental  surgeons  for  many  years:  but  on 
account  of  the  severe  pain  which  in  many  cases  attends  it,  as  well  as 
from  the  fact  that,  in  the  manner  in  which  it  has  generally  been  prac- 
tised, it  has  proved  no  more  successful  than  other  and  less  severe 
methods,  it  has  been  considered  rather  in  the  light  of  a  dernier  res- 
sort."  This  he  believes  to  be  owing  to  the  fact  that  the  nerve  is  often 
only  punctured  and  lacerated,  and  afterward  shut  up  in  the  tooth  and 
left  to  decompose.  To  prevent  which,  he  says,  the  whole  nerve  should 
be  removed,  and  its  place  filled  with  gold. 

Again,  Dr.  Dunning  remai-ks :  "  The  instrument  which  I  have  used 
to  excavate  the  roots  is  a  delicate  probe  of  steel,  perfectly  annealed. 
The  point  should  be  converted  into  a  very  slight  hook,  and  made 
sharp,  so  as  to  bring  away  the  nerve  or  other  matter  with  which  the 
cavity  may  be  filled.  For  the  removal  of  the  nerve  in  the  chamber 
of  the  crown,  in  molar  teeth,  as  well  as  for  enlarging  the  cavity,  so  as 
to  give  free  access  to  each  of  the  roots,  a  burr-drill  is  very  useful. 
As  these  teeth  are  generally  very  much  decayed,  it  will  be  found  ad- 
visable, when  the  cavity  is  on  the  side  of  the  crown,  to  remove  its 
edges  in  such  a  manner  as  to  admit  the  light  directly  upon  the  open- 
ings of  the  roots.  This  will  facilitate  the  operation  very  much,  and 
at  the  same  time  give  strength  to  the  walls  that  are  to  contain  the 
stopping."  When  the  nerve  has  been  destroyed  in  the  manner  above 
described,  Dr.  Dunning  says  that  the  operation,  so  far  as  he  has  been 
able  to  observe,  has  been  successful  in  every  case. 

On  the  different  methods  of  destroying  the  nerve,  Dr.  J.  H.  Foster 
says:  "It  is  a  diflScult  matter,  and  I  have  generally  found  it  utterly 
futile,  to  attempt  to  induce  patients  to  submit  to  the  removal  of  the 
pulp  hy  extraction  or  excision  with  instruments,  in  those  cases  in  which 
it  becomes  necessary  to  destroy  vitality  before  the  teeth  can  be  filled. 
To  obtain  the  consent  of  the  patient  by  a  representation  of  the  advan- 
tages, in  its  immediate  effects,  of  this  mode  of  treatment  by  extirpation 
as  contrasted  with  the  more  slow  and  uncertain  practice,  by  the  aid 
of  chemical  agents,  has  been  my  earnest  endeavor.  I  do  not  remember 
a  single  case  of  the  removal  of  the  dental  pulp  by  an  instrument  — 


374      FILLING  PULP-CAVITIES   AND   ROOTS   OF  TEETH. 

the  gold  being  inserted  iuto  the  dental  cavity  immediately  after  the 
hemorrhage  has  been  cheeked  —  which  has  resulted  in  alveolar  abscess." 

Dr.  Foster,  however,  generally  employs  arsenious  acid,  with  sul- 
phate of  morphia,  one  part  of  the  former  to  four  of  the  latter,  applied 
on  a  small  pellet  moistened  with  creosote.  After  applying  this  di- 
rectly over  the  nerve,  he  covers  it  with  a  cap,  to  avoid  pressure ;  then 
fills  the  external  cavity  with  some  soft  material  which  will  exclude 
moisture.  At  the  end  of  forty-eight  hours  he  enlarges  the  dental  cav- 
ity, removing  its  contents  to  the  ai>ex  of  the  root :  then,  after  waiting 
another  forty-eight  hours,  he  proceeds  to  fill  the  canal,  leaving  the 
cavity  in  the  crown  to  be  filled  at  a  subsequent  sitting. 

In  performing  this  operation  on  molar  teeth,  where  there  is  a  proba- 
ble chance  of  a  favorable  issue,  and  the  preservation  of  these  teeth  is 
particularly  called  for,  he  thinks  it  important  that  the  excavation 
should  be  done  at  intervals,  so  as  to  cause  as  little  irritation  at  each 
sitting  as  possible,  and  that  the  filling  of  the  different  cavities  in  the 
tooth  be  also  proceeded  with  in  like  manner. 

Dr.  Maynard — who  has  been  as  successful  in  filling  the  pulp-cavity 
and  roots  of  teeth  as  any  other  practitioner,  and  has  probably  had 
more  experience,  having  been  in  the  habit  of  performing  the  operation 
since  1838  —  having  thoroughly  tested  the  method  of  destroying  the 
nerve  by  immediate  extirpation  vnth  an  instrument,  as  well  as  that  by 
the  application  of  arsenious  acid,  gives  the  preference  to  the  latter. 
His  method,  as  described  by  Dr.  Westcott,  in  vol  vii.,  p.  286,  of  the 
American  Journal  of  Dental  Science,  is  as  follows  : 

He  takes  white  wax,  and  works  it  into  cotton  or  lint  until  it  is  tho- 
roughly mixed  together.  With  this  he  fills  the  cavities  in  the  tooth. 
But,  before  doing  this,  he  exposes  the  nerve  as  much  as  possible,  ap- 
plies the  arsenic,  and  caps  the  orifice  with  a  cup-shaped  plate  of  lead, 
the  convex  side  outward.  While  this  is  carefully  kept  in  place,  he 
fills  the  cavity  with  the  cotton  and  wax,  very  carefully  and  perfectly, 
in  such  a  way  as  not  to  shut  in  and  compress  any  air  which  might 
press  upon  the  nerve.  This  packing,  as  introduced  by  Dr.  Maynard, 
will  keep  the  "medicine,"  as  he  terms  it,  perfectly  dry  for  twenty-four 
hours,  or  longer. 

After  removing  this  packing  and  the  preparation,  he  proceeds  to 
remove  the  nerve.  Instead  of  attempting  to  do  this  at  once,  he  begins 
by  cutting  on  every  side  of  the  orifice,  so  much  enlarging  it  as  to  be 
enabled  to  remove  the  nerve  without  pressing  the  contents  of  the  cavity 
upward. 

His  probes  are  objects  of  peculiar  interest,  especially  those  for  extir- 
pating the  nerve.  Some  of  them  are  made  from  the  main-spring  of  a 
watch,  by  filing  or  grinding  them  sufficiently  narrow  to  enter  the 


FILLING  PULP-CAVITIES   AND   ROOTS   OF   TEETH.      375 

smallest  space  which  he  wished  to  probe.  In  this  way  he  secures  the 
most  perfect  spring  temper,  a  point  not  easily  attained  in  so  frail  an 
instrument  as  a  probe  adapted  to  this  purpose.  These  probes  are 
bearded  by  cutting  them  with  a  sharp  knife  —  the  beard  pointing  back- 
ward. AVith  different  sizes  of  these  and  other  probes,  and  by  enlarg- 
ing the  cavity  from  time  to  time,  he  removes  the  nervd  to  the  extremity 
of  the  root. 

Dr.  Arthur,  in  a  series  of  ably  written  articles,  published  in  the 
American  Journal  of  Dental  Science,  on  the  treatment  of  caries  of 
the  teeth,  complicated  with  disorc},ers  of  the  pulp  and  peridental  mem- 
brane, recommends  the  use  of  cobalt  for  destroying  the  nerve  as  pre- 
ferable to  any  other  agent  or  means  that  have  been  employed  for  the 
purpose.  But  as  arsenic  is  the  active  principle  of  cobalt,  it  is  to  this 
agent  it  owes  its  efficacy.  It  has  not,  however,  been  found  to  be  as 
effective  as  the  arsenious  acid. 

In  the  destruction  of  the  pulp  of  a  tooth,  the  author  (Prof.  Harris) 
has  employed  both  mechanical  and  chemical  agents.  He  has  been  in 
the  habit,  for  more  than  twenty  years,  of  occasionally  extirpating  the 
pulp  to  the  extremity  of  the  root  by  introducing  a  veiy  small  untem- 
pered  instrument,  with  a  spear-shaped  point;  though  not  at  first  with 
the  view  of  afterward  filling  the  pulp-cavity.  He  has  also  used  the 
actual  cautery  and  arsenious  acid.  To  the  last-named  agent,  as  used 
by  most  dentists  for  destroying  the  vitality  of  teeth,  he  was  at  one 
time  strongly  opposed,  and  still  believes  a  vast  amount  of  injury  is 
produced  by  it;  but  with  proper  care  and  judicious  after-treatment,  it 
may  be  used  with  safety,  and,  in  most  cases,  with  advantage.  He 
now  employs  it  for  destroying  the  vitality  of  the  lining  membrane  and 
pulps  of  the  molar  and  bicuspid  teeth,  and  occasionally  applies  it  to 
the  incisors  and  cuspids.  As  a  general  rule,  however,  when  he  wishes- 
to  destroy  the  nerve  of  one  of  the  last-named  teeth,  he  extirpates  it 
by  thrusting  a  small  instrument  up  the  pulp-cavity  to  the  extremity 
of  the  root.  When  he  uses  arsenic,  he  applies  about  the  thirtieth  or 
fortieth  part  of  a  grain,  with  an  equal  quantity  of  sulphate  of  morphia; 
placing  it  on  a  small  piece  of  raw  cotton,  moistened  with  creosote  or 
spirits  of  camphor,  and  sealing  up  the  cavity  with  white  or  yellow 
wax.  At  the  expiration  of  seven  or  eight  hours,  he  removes  the  wax 
and  arsenic,  and  afterward  the  pulp  of  the  tooth.  If  the  portion  in 
the  root  is  still  sensitive,  he  applies  it  a  second  time ;  but  he  seldom 
finds  it  necessary  to  do  so. 

Treatment  Preparatory  to  Filling  the  Boots  of  Teeth. —  The  following 
is  the  method  of  treatment,  preparatory  to  filling  the  root,  pursued  by 
Prof.  Gorgas,  of  the  Baltimore  College :  "  I  remove  carefully  all  dis- 
organized pulp  and  decomposed  dentine ;  also  all  discolored  dentine,^ 


376      FILLING  PULP-CAVITIES  AND   ROOTS  OF  TEETH. 


provided  it  does  not  weaken  the  walls  of  the  cavity.  Then,  syringing 
out  all  loose  particles  of  the  debris  with  tepid  water,  I  dry  the  canal 
to  the  apex  of  the  root  with  floss  silk ;  being  careful  to  leave  an  end 
projecting  so  as  to  permit  its  easy  removal.  Several  such  pieces  being 
used,  a  shorter  piece  is  then  saturated  with  creosote  and  2iassed  to  the 
end  of  the  canal,  leaving  a  slight  projecting  piece  in  the  pulp-cavity, 
so  that  it  may  be  seized  with  pliei's  when  it  is  to  be  removed. 

"I  then  introduce  into  the  pulp-cavity  a  temporary  filling  of  Hill's 

stopping,  gutta -  percha, 
^^'      "'  or    cotton    mixed   with 

wax,  or  saturated  with 
sandarach  or  shell -lac 
varnish.  In  twenty-four 
hours  the  canal  is  ex- 
amined, and  the  creo- 
sote renewed  if  neces- 
sary. When  not  the 
slightest  odor  of  puru- 
lent secretion  is  percep- 
tible, I  then  apply  on 
the  floss  silk  chloroform 
mixed  with  white  of  egg,  replace  the  filling,  and  wait  for  several  days. 
"  If  at  the  end  of  this  time  there  is  no  trace  of  diseased  action,  I 
fill  the  canal  with  gold  ;  then  wait  a  few  days  until  all  chance  of  irri- 
tation from  the  pressure  used  in  the  operation  has  passed  away,  and 
then  complete  the  filling.  But  not  unfrequently  it  is  necessary  to  re- 
peat this  course  of  treatment  several  times.  In  one  case,  two  months 
were  required  before  the  tooth  was  in  a  condition  to  warrant  me  in 
filling  it. 

"In  some  cases  I  deem  it  prudent  to  insert  a  filling  of  'Hill's  stop- 
ping' for  several  months,  especially  when  there  is  the  slightest  doubt 
of  the  arrest  of  the  disease ;  for  the  gold  once  introduced  into  the 
canal,  it  is  exceedingly  tedious  and  difficult  to  remove  it.  Disease  on 
the  outside  of  the  extremity  of  the  root  may  be  controlled  by  creosote 
and  nitrate  of  silver,  applied  through  the  fistulous  or  an  artificial 
opening  in  the  alveolus. 

"  Chloride  of  zinc  may  be  used  instead  of  creosote  when  the  smell 
of  the  latter  is  particularly  repulsive  to  the  patient ;  and  chlorinated 
lime  or  soda  are  excellent  antiseptics.  Any  trace  of  the  living  nerve 
should  be  treated  with  arsenic,  a  minute  portion  of  which  may  be  in- 
troduced upon  floss  silk  before  commencing  the  creosote  treatment." 

Fig.  132  represents  a  set  of  Dr.  B.  F.  Arlington's  nerve  extractors, 
of  drawn  and  spring  temper. 


FILLING  PULP-CAVITIES  AND   ROOTS   OF  TEETH.      377 

Filling  Pulp-  Cavities  and  Boots  of  Teeth.  —  The  method  pursued  by 
the  author  in  filling  the  pulp  cavities  and  canals  is  the  same  as  that  of 
Dr.  Maynard,  which  is  characterized  by  great  neatness  and  dexterity. 
His  instruments  are  of  the  most  delicate  kind,  and  are  adapted  to 
reach  to  the  end  of  the  canal,  although  it  may  not  be  entirely  straight. 
In  filling  these  roots,  he  uses  very  heavy  gold,  from  No.  12  to  30.  This 
is  cut  into  strips  corresponding  to  the  diameter  of  the  cavity,  and  is 
not  doubled.  The  end  of  one  of  the  strips  is  laid  upon  the  end  of  one 
of  his  delicate  pluggers,  and  carefully  carried  to  the  upper  extremity 

Fig.  133. 


of  the  root.     This  being  effected,  the  instrument  is  withdrawn  a  slight 

distance,  then  returned,  carrying  with  it  another  portion,  till  the  strip 

is  exhausted.     In  this 

,,         ,1  ,    •  Fig.  134. 

way  the  whole  root  is 

filled ;    the  cavity   in 

the  crown  is  then  filled 

in  the  usual  manner. 

Fig,  133  represents 
a  set  of  instruments 
contrived  by  Dr.  Palm- 
er, forming  the  ca- 
nals in  the  roots  of  the 
teeth. 

Fig.  134  represents 
Dr.    Hunter's   set   of 
pulp  canal  pluggers,  some  of  which  are  of  drawn  and  others  of  spring 
temper. 


378      FILLIXG  PULP-CAVITIES   AND   ROOTS  OF  TEETH. 

After  the  cavity  of  decay  in  the  crown  has  been  properly  prepared, 
by  means  of  the  instruments  represented  in  Fig.  133,  the  pulp  chamber 
can  be  excavated  and  so  shaped  as  to  assist  in  the  retention  of  the 
gold,  as  well  as  the  canals  leading  from  this  chamber  through  the  roots. 
Some  operators  drill  out  these  canals,  and  thus  give  them  the  same 
diameter  from  their  orifice  at  the  pulp  chamber  to  the  apex  of  the 
root. 

Others  are  satisfied  with  cleansing  them  perfectly  of  all  debris  and 
decomposed  dentine.  Whichever  method  is  pursued,  care  is  necessary 
that  the  instrument  is  not  passed  beyond  the  foramen,  which  is  more 
liable  to  occur  in  the  case  of  young  patients,  when  the  teeth  are  not 
fully  developed,  than  afterward ;  for  then  there  is  generally  such  a 
decided  contraction  of  the  root  canal  near  the  apex  as  to  arrest  the 
progress  of  the  instrument. 

When  the  cavity  in  the  crown  and  the  pulp  chamber  and  canals 
are  prepared,  the  gold  is  introduced  by  means  of  the  instruments 
represented  in  Fig.  134.  Besides  the  method  of  filling  the  roots,  de- 
scribed as  Dr.  Maynard's,  there  are  several  others,  one  of  which  consists 
in  rolling  strips,  or  folds,  of  gold  on  a  fine  broach  in  such  a  manner  as 
to  form  cone-shaped  cylinders,  somewhat  longer  than  the  canal  is  deep, 
of  different  sizes  and  density.  The  soft  rolled  are  first  introduced 
by  means  of  the  pliers,  and  carried  up  as  near  to  the  apex  of  the  root 
as  is  safe,  each  one  being  condensed  against  the  side  of  the  canal.  Suc- 
cessive cylinders  are  introduced  in  this  manner  and  condensed  until 
the  canal  is  filled,  the  last  ones  which  form  the  centre  of  the  filling 
being  dense.  Pure  gold  wire  is  sometimes  employed  for  filling  these 
canals,  so  shaped  as  to  correspond  in  size  and  taper  with  the  cavity. 

It  sometimes  happens  that  the  canals  in  the  buccal  roots  of  the 
superior  molars  are  so  small  as  to  preclude  the  introduction  even  of  a 
small-sized  bristle.  In  cases  of  this  kind  it  is  impossible  to  fill  them, 
and  fortunately,  from  their  small  size,  they  cannot  serve  as  reservoirs 
for  the  accumulation  of  morbid  matter.  The  canal  in  the  palatine  root 
is  always  much  larger  than  in  either  of  the  buccal  roots,  and  in  a  ma- 
jority of  the  cases  is  filled  wnth  comparative  ease.  After  the  canals 
are  filled,  some  days  should  elapse  before  the  operation  of  filling  the 
crown  cavity  is  performed.  Although  gold  is  the  only  metal  suitable 
for  filling  root  canals,  yet  some  non-metallic  substances  have  answered 
w^ell  when  employed  for  this  purpose,  principally  on  account  of  their 
non-conducting  property,  such  as  Hill's  stopping  and  os-artiftciel.  For 
bleaching  teeth  which  have  become  discolored  from  loss  of  vitality, 
the  reader  is  referred  to  the  chapter  on  "Necrosis." 


TOOTHACHE.  379 


CHAPTER  V. 

TOOTHACHE. 

PAI!N  in  a  tooth,  toothache,  or  odontalgia,  as  it  is  technically  termed, 
is  a  symptom  of  some  functional  or  structural  disturbance,  either 
of  the  organ  in  which  the  pain  is  seated,  or  of  some  other  part  or 
parts  of  the  hody,  but  more  frequently  of  the  former  than  of  the  lat- 
ter. So  variable  is  the  character  of  the  sensation,  that  any  descrip- 
tion would  fall  to  convey,  to  one  who  has  never  experienced  it,  a  cor- 
rect idea  of  its  nature.  The  pain  sometimes  amounts  only  to  slight 
uneasiness ;  at  other  times  the  agony  is  almost  insupportable.  It  may 
be  dull,  deep-seated,  boring,  throbbing,  or  lancinating.  It  may  be 
slight  at  first,  gradually  increasing  in  severity  until  it  amounts  to  the 
most  excruciating  torture,  or  it  may  come  on  without  any  premonition 
whatever.  It  may  be  confined  to  a  single  tooth,  or  it  may  affect  sev- 
eral at  the  same  time.  It  may  commence  in  one  tooth,  and  pass  from 
thence  to  another,  and  continue  until  every  one  in  turn  has  been  at- 
tacked. It  may  continue  for  hours  and  days  with  scarcely  any  cessa- 
tion ;  or  it  may  be  intermittent,  the  paroxysms  recurring  at  stated  or 
irregular  intervals,  and  each  lasting  from  thirty  minutes  to  one,  two, 
or  more  hours. 

CAUSES. 

The  causes  of  toothache  are  almost  as  numerous  as  are  the  varieties 
of  chai-acter  which  it  exhibits.  Irritation  and  inflammation  of  the 
pulp,  and  inflammation  of  the  investing  membrane,are  among  the  most 
frequent;  but  it  is  sometimes  referable  to  a  morbid  condition  of  the 
nerve  or  nerves  going  to  a  single  tooth,  or  of  the  trunk  from  which 
several  teeth  are  supplied ;  also  to  derangement  of  the  digestive  organs, 
to  increased  nervous  susceptibility  of  the  uterus  resulting  from  preg- 
nancy, amenorrhcea,  etc.,  and  to  certain  diatheses  of  the  general 
system. 

Dr.  Hullihen  enumerates  the  following  as  the  causes  of  toothache: 
1,  exposure  of  the  nerve ;  2,  fungus  of  the  nerve ;  3,  confinement  of 
pus  ii?.  the  internal  cavity ;  4,  a  diseased  state  of  the  periosteum  cov- 
ering the  root;  and,  5,  sympathy.  Dr.  Heilden  attributes  it  to  conges- 
tion or  inflammation,  or  to  a  lesion  of  the  nerves  of  the  lining  mem- 
brane and  pulp,  or  of  the  peridental  membrane. 

Inflammation  of  the  lining  membrane  and  pulp  may  be  produced 
by  a  blow  upon  a  tooth,  or  by  powerful  impressions  of  heat  and  cold 


380  TOOTHACHE. 

communicated  through  the  enamel  and  dentine,  or  through  a  metallic 
filling;  but  it  is  more  frequently  occasioned  by  pressure,  or  by  the 
direct  contact  of  irritating  agents,  such  as  carious  portion  of  the  tooth, 
particles  of  food,  acrid  humors,  and  other  irritating  external  substances. 
But  inflammation  is  not  always  a  necessary  consequence  of  such  im- 
pressions. Pain  may  be  produced  by  them  when  inflammation  does 
not  exist ;  in  this  case  it  usually  subsides  soon  after  the  removal  of  the 
irritant.  Indeed,  the  pulp  of  a  tooth  may  be  exposed  for  months,  and 
subjected  several  times  every  day  to  the  contact  of  foreign  substances, 
without  becoming  the  seat  of  inflammatory  action  ;  and  in  the  absence 
of  this,  the  pain,  though  coming  on  with  the  suddenness  of  an  electric 
flash,  and  often  of  the  most  excruciating  kind,  is  seldom  of  long  du- 
ration. 

But  when  inflammation  exists,  the  pain,  which  at  first  amounts  only 
to  a  slight  gnawing  sensation,  is  more  constant ;  after  a  while,  it  as- 
sumes a  throbbing  character,  and  if  not  promptly  arrested,  it  increases 
in  severity,  and  continues  until  suppuration  of  the  lining  membrane 
and  pulp  takes  place.  So  long  as  it  is  confined  to  the  parts  within  the 
pulp-cavity,  the  pain  is  not  increased  by  pressure  on  the  tooth,  nor  is 
the  tooth  started  fi-om  the  socket,  as  in  periodontitis.  The  locality  of 
the  inflammation  may  also  be  distinguished  by  the  fact  that  cold  water 
or  ice  applied  to  the  tooth  generally  gives  relief.  But  the  inflamma- 
tion rarely  confines  itself  long  to  the  interior  of  the  tooth  ;  it  usually 
soon  extends  to  the  periosteum  of  the  root  and  its  socket,  when  a 
somewhat  different  train  of  phenomena  are  developed.  Suppuration, 
however,  having  taken  place,  an  abscess  soon  forms  at  the  extremity 
of  the  root. 

The  severity  of  the  pain  attending  odontitis  (as  inflammation  of  the 
pulp  is  technically  termed,  from  the  supposition  that  every  part  of  the 
organ  is  involved  in  the  diseased  action),  is,  doubtless,  owing  to  the  fact 
that  this  exceedingly  sensitive  structure,  as  its  vessels  become  injected, 
is  prevented  from  expanding  by  the  unyielding  nature  of  the  walls 
of  the  cavity  in  which  it  is  situated.  Its  capillaries  being  thus  dis- 
tended, must,  as  a  necessary  consequence,  press  upon  the  nerves  which 
are  everywhere  distributed  through  it,  and  the  excruciatingly  painful 
throbbing  sensation,  by  which  this  variety  of  toothache  is  characterized, 
is  produced  by  the  pulsation  of  these  vessels.  Hence,  increased  action 
of  the  heart  and  arteries,  from  whatever  cause,  pi'oduced,  augments  the 
pain;  it  is  also  more  severe  at  night,  while  the  body  is  in  a  recumbent 
posture,  than  during  the  day,  because  this  position  gives  an  increased 
fulness  to  the  arteries  of  the  head.  The  phenomena  attending  the 
inflammation,  however,  are  influenced  very  much  by  the  condition  of 
the  tooth  and  the  habit  of  body  of  the  patient. 


TOOTHACHE.  381 

When  the  inflammation  is  acute,  it  extends  to  every  part  of  the  pulp 
and  lining  membrane.  It  also  occurs  more  frequently  before  than  after 
these  tissues  have  become  exposed,  and  generally  terminates  in  suppu- 
ration. Chronic  inflammation  usually  arises  from  partial  exposure  of 
the  pulp,  and  may  exist  for  months  -without  being  attended  with  pain ; 
but  the  pulp,  when  thus  affected,  is  more  susceptible  of  injury  by  heat 
or  cold,  and  by  irritating  substances ;  and  the  liability  of  the  tooth  to 
ache,  especially  at  night,  is  greatly  increased. 

Toothache  caused  by  acute  inflammation  of  the  investing  membrane 
is  characterized  by  pain,  at  first  dull,  afterward  acute  and  throbbing, 
soreness  and  elongation  of  the  tooth,  redness  and  tumefaction  of  the 
gums,  and  sometimes  by  swelling  of  the  cheek ;  indicating  the  forma- 
tion of  alveolar  abscess.  In  this  variety  of  odontalgia,  the  tooth  is 
often  so  much  raised  in  its  socket  as  to  interfere  more  or  less  with  mas- 
tication. 

The  pain  attending  the  foregoing  pathological  conditions,  when  severe 
and  protracted,  is  often  accompanied  by  constipation,  headache,  dryness 
of  the  skin,  flushed  cheeks,  fulness  and  increased  rapidity  of  pulse,  and 
other  constitutional  symptoms. 

The  nervous  susceptibility  of  the  teeth  is  sometimes  so  much  increased 
by  organic  and  even  functional  disturbances  of  other  and  often  remote 
parts,  that  the  mere  contact  of  the  minute  nerves  of  the  pulp  and  the 
lining  membrane  against  the  wall  of  dentine  which  encases  them,  is 
attended  with  severe  pain.  This  variety  of  odontalgia  is  termed  sym- 
pathetic, and  is  supposed  to  be  the  result  of  the  transfer  of  nervous 
irritation,  or,  more  properly,  of  exalted  sensibility  of  the  dental  nerves, 
arising  from  a  morbid  condition  or  functional  disturbance  of  some  other 
part.  If  this  hypothesis  be  true,  it  is  probable  that  with  this  height- 
ened nervous  excitability  there  is  a  slight  increase  of  vascular  action 
in  the  pulp,  with  a  corresponding  increase  of  size  in  its  capillaries;  in 
consequence  of  which,  it  is  fair  to  presume,  the  nervous  filaments  sup- 
plying these  tissues  would  be  apt  to  respond  painfully  to  the  undue 
pressure.  Though  pain,  arising  from  this  cause,  may  have  its  seat  in 
sound  as  well  as  in  decayed  teeth,  it  occurs  more  frequently  in  the  lat- 
ter than  the  former,  owing  to  the  fact  that  any  structural  alteration  in 
the  dentine  adds  to  their  already  increased  nervous  excitability. 

Persons  of  highly  excitable  nervous  temperaments,  pregnant  females, 
and  individuals  laboring  under  derangement  of  the  digestive  organs, 
are  particularly  subject  to  this  variety  of  toothache.  Odontalgia,  arising 
from  pathological -conditions  or  functional  disturbances  of  other  parts, 
assumes  a  great  variety  of  forms.  The  pain  may  be  continued,  but 
more  frequently  it  is  periodical ;  it  may  be  confined  to  a  single  tooth, 
or  it  may  attack  half  a  dozen  or  more  at  the  same  time.    It  sometimes 


382  TOOTHACHE. 

also  alternates  with  the  paroxysms  of  rheumatism  or  gout,  the  pain  in 
such  cases  assuming  the  specific  character  of  these  diseases. 

Mr.  W.,  aged  forty,  for  fifteen  years  the  victim  of  gout,  came  to  me 
in  1830.  Tiie  first  right  upper  molar  was  cariou.s,  hut  the  pulp  not 
exposed.  Ten  or  twelve  days  before  each  attack  of  gout,  recurring 
every  three  or  six  months  during  the  last  five  years,  this  tooth  was  the 
seat  of  a  peculiar  grinding,  lancinating  pain  ;  becoming  gradually 
more  severe,  but  ceasing  entirely  as  the  gout  symptoms  came  on  ;  it 
returned  as  these  subsided,  and  continued  for  two  weeks.  Filling  the 
tooth  gave  temporary  relief  only,  and  it  was  found  necessary  to  extract  it. 

In  what  is  termed  neuralgic  toothache,  "the  pain,"  says  Dr.  Wood, 
"is  usually  of  the  acute  character;  sometimes  mild  in  the  beginning, 
gradually  increasing  in  intensity,  and  as  gradually  declining,  but  usu- 
ally very  irregular ;  at  one  time  moderate,  at  another  severe,  and  occa- 
sionally darting  with  excruciating  violence  through  the  dental  arches. 
Not  unfrequently  it  assumes  a  regular  intermittent  form.  Instead  of 
pain,  strictly  speaking,  the  sensation  is  sometimes  of  that  kind  which 
is  indicated  when  we  say  that  the  teeth  are  on  edge,  and  is  apt  to  be 
excited  by  certain  harsh  sounds,  such  as  that  produced  in  the  filing  of 
a  saw,  or  by  mental  inquietude,  and  by  the  contact  of  acids  or  other 
irritant  substances.  Neuralgic  toothache  sometimes  persists,  with 
intervals  of  exemption,  for  a  great  length  of  time.  The  diagnosis  is 
occasionally  difficult.  "When,  howevei',  it  occurs  in  sound  teeth,  is  par- 
oxysmal in  its  character,  is  attended  with  little  or  no  swelling  of  the 
external  parts,  occupies  a  considerable  portion  of  the  jaw,  and  especi- 
ally when  it  alternates  or  is  associated  with  pain  of  the  same  character 
in  other  parts  of  the  face,  there  can  be  little  doubt  as  to  its  real  nature." 
This  variety  of  sympathetic  toothache  is  perhaps  induced  by  caries,  or 
by  the  manner  in  which  the  teeth  are  arranged  in  the  alveolar  arch, 
or  by  some  peculiar  susceptibility  of  the  parts ;  as  is  shown  by  the  fact 
that  the  pain  usually  ceases  on  the  removal  of  all  such  causes  of  irri- 
tation. 

But  while,  on  the  one  hand,  pain  in  the  teeth  may  be  caused  by  a 
morbid  condition  of  other  organs,  these  organs,  on  the  other  hand, 
frequently  sympathize  with  the  diseased  condition  of  the  teeth,  and 
become,  to  quote  the  language  of  Mr.  Bell,  "the  apparent  seat  of  pain. 
I  have  seen  this  occur  not  only  in  the  face,  over  the  scalp,  in  the  ear, 
and  underneath  the  lower  jaw,  but  down  the  neck,  over  the  shoulder, 
and  along  the  whole  length  of  the  arm."  Cases  of  this  sort  are  fre- 
quently met  with. 

In  treating  of  toothache.  Dr.  Good  observes :  "  This  is  often  an  idio- 
pathic affection,  dependent  upon  a  peculiar  irritability  (from  a  cause 
we  cannot  easily  trace)  of  the  nerves  subservient  to  the  aching  tooth, 


TOOTHACHE.  383 

or  of  the  tunics  by  which  it  is  covered,  or  of  the  periosteum,  or  the 
fine  membrane  that  lines  the  interior  of  the  alveoli.  But  it  is  more 
frequently  a  disease  of  sympathy,  produced  by  pregnancy,  or  chronic 
rheumatism,  or  acrimony  in  the  stomach,  in  persons  of  an  irritable 
habit.  It  is  still  less  to  be  wondered  at  that  the  nerves  of  the  teeth 
should  often  associate  in  the  maddening  pain  of  facial  neuralgia,  or 
tic  douloureux,  as  the  French  writers  sometimes  term  it ;  for  here  the 
connection  is  both  direct  and  immediate.  In  consequence  of  this,  the 
patient,  in  most  instances,  regards  the  teeth  themselves  as  the  salient 
points  of  pain  (as  they  unquestionably  ma^  be  in  some  cases),  and 
rests  his  only  hope  of  relief  upon  extraction ;  but  when  he  applies  to 
the  operator,  he  is  at  a  loss  to  fix  upon  any  particular  tooth.  Mr. 
Fox  gives  a  striking  example  of  this,  in  a  person  from  whom  he  ex- 
tracted a  tooth  which  afforded  little  or  no  relief;  in  consequence  of 
which  his  patient  apiolied  to  him  only  two  days  afterward  and  requested 
the  removal  of  several  adjoining  teeth,  which  were  perfectly  sound. 
This  he  objected  to,  and  suspecting  the  real  nature  of  the  disease,  he 
immediately  took  him  to  Sir  Astley  Cooper,  who,  by  dividing  the 
afiected  nerve,  produced  a  radical  cure  in  a  few  days."  The  author 
is  acquainted  with  a  gentleman  similarly  aflfected.  He  has  had  all 
his  teeth  on  the  right  side  of  both  jaws  extracted,  without  obtaining 
any  relief. 

There  is  still  another  cause  of  toothache,  which  Ave  should  not  omit 
to  mention  —  exostosis;  but  from  the  obscurity  of  the  diagnosis,  the 
existence  of  the  affection  can  seldom  be  determined  with  positive  cer- 
tainty, except  by  the  removal  of  the  tooth.  As  we  have  already  had 
occasion  to  treat  of  this  disease,  it  is  unnecessary  in  this  place  to  dwell 
upon  the  subject. 

Finally,  some  teeth,  from  peculiar  constitutional  idiosyncrasy,  are 
more  liable  to  odontalgia  than  others.  It  sometimes  happens  that 
every  tooth  in  the  mouth  is  destroyed  by  caries  without  being  affected 
with  pain,  while  at  other  times  teeth  apparently  sound  become  the 
seat  of  the  most  agonizing  torture. 

TREATMENT. 

The  first  thing  to  be  attended  to  in  the  treatment  of  toothache  is 
the  removal  of  the  causes  which  have  given  rise  to  it ;  this  can  only 
be  done  by  carrying  out  the  curative  and  remedial  indications  of  the 
morbid  conditions  and  functional  disturbances  with  which  it  is  con- 
nected. While  these  continue,  it  will  be  impossible  to  obtain  perma- 
nent relief.  The  sensibility  of  the  nerves  supplying  a  tooth  may  often 
be  obtunded,  and  the  pain  palliated  by  the  application  of  stimulating 
and  anodyne  agents  to  the  exposed  pulp ;  but  the  relief  thus  procured 


384  TOOTHACHE. 

is  seldom  of  long  duration.  When  their  effects  subside,  the  pain  usu- 
ally returns  with  increased  severity.  When  the  pain  arises  from  chronic 
inflammation  and  irritation,  produced  by  external  agents  on  an  ex- 
posed portion  of  the  lining  membrane,  such  applications  may  often  be 
employed  with  great  advantage ;  and  among  those  which  have  been 
used  for  this  purpose  are  creosote,  the  oil  of  cloves,  cinnamon,  etc., 
laudanum,  spirits  of  camphor,  tannin,  ether,  and  chloroform.  But  of 
all  the  remedies  prescribed  by  the  author,  he  has  found  none  more  use- 
ful in  allaying  the  pain  than  the  following : 

Sulphuric  isther,         .         .    5!.  Sulphuric  oether,         .         .    gi. 

Powdered  camphor,         .        ^ij.  Creosote,         .         .         .        ^ss. 

Powdered  alum,  .         .    ^ij.  Ext.  of  nutgalls,  .         .    31. 

Sulphate  of  morphia,      .        grs.  ij.        Powdei-ed  camph.,    .        .        ^ss. 
The  alum  should  be  very  finely  powdered,  and  all  the  ingredients  well  mixed 
before  use. 

After  removing  all  foreign  matter  and  carefully  diyiug  the  cavity 
of  the  tooth,  a  small  bit  of  cotton  or  lint  dipped  in  either  of  the 
above  mixtures  may  be  applied,  and  renewed  several  times  a  day,  if 
necessary.  The  relief  obtained  is,  in  the  majority  of  cases,  almost 
instantaneous ;  but,  as  the  effect  is  only  temporary,  the  i:)ain  is  apt  to 
recur.  The  author  has  sometimes  used  a  thick  solution  of  gutta-jiercha 
in  chloroform.  The  application  of  a  drop  or  two  of  this  to  the  ex- 
posed pulp  is  usually  followed  by  the  immediate  cessation  of  pain, 
and  as  the  chloroform  evaporates,  a  thin  layer  of  gutta-percha  re- 
mains, and  serves  for  a  time  as  a  sort  of  protection  to  the  pulp. 

But  the  only  way  in  which  permanent  exemption  from  pain  can  be 
procured  is  by  the  extraction  of  the  tooth  or  the  destruction  of  the 
pulp ;  it  often  becomes  necessary  to  have  recourse  to  the  latter,  as 
there  are  many  cases  in  which  the  patient  cannot  be  prevailed  upon 
to  submit  to  the  former,  and  as  there  are  others  in  which  the  retention 
of  the  organ  is  called  for  by  some  peculiar  necessity.  This  may  be 
effected  either  by  immediate  extirpation  with  a  small,  sharp-pointed 
elastic  stilet  or  probe,  by  the  actual  cautery,  arsenious  acid,*  cobalt, 
or  chloride  of  zinc.  Immediate  extirpation,  arsenic,  or  cobalt  are  the 
means  usually  employed  for  the  purpose ;  but  we  have  already  de- 
scribed the  manner  in  which  the  destruction  of  the  pulp  is  effected  by 
each  of  these. 

*  The  employment,  of  arsenious  acid  for  the  destruction  of  an  exposed  dental 
pulp,  and  the  relief  of  the  pain  arising  therefrom,  originated  with  the  late  Dr. 
Spooner,  of  Montreal;  and  in  1835  it  w-as  recommended  to  the  profession  by  his 
brother,  Dr.  S.  Spooner,  of  New  York,  in  an  excellent  popular  treatise  upon 
the  teeth. 


TOOTHACHE.  385 

Pain  in  a  tooth  arising  from  acute  inflammation  of  the  pulp  and 
lining  membrane,  can  only  be  relieved  by  the  extraction  of  the* tooth, 
the  destruction  of  the  pulp,  or  by  subduing  the  inflammatory  action  ; 
the  last  can  seldom  be  done  except  by  the  most  energetic  treatment  in 
the  very  beginning  in  cases  where  the  decay  has  not  penetrated  to  the 
pulp-cavity.  The  propriety  or  impropriety  of  extraction  will  be  de- 
termined by  the  amount  of  pain,  the  progress  made  by  the  inflamma- 
tion, the  condition  of  the  parts  with  which  the  tooth  is  immediately 
connected,  the  effect  of  the  local  disturbance  upon  the  general  system, 
the  situation  and  importance  of  the  tooth,  and  the  extent  of  structural 
alteration  which  has  taken  place  in  the  crown.  If  the  retention  of 
the  tooth,  on  account  of  its  location,  or  the  loss  of  several  other  teeth, 
is  of  great  importance  to  the  patient,  and  the  circumstances  of  the 
case  justify  a  well-grounded  belief  that  it  can  be  preserved  and  ren- 
dered useful,  without  acting  as  a  morbid  irritant,  the  operation,  if  pos- 
sible, should  be  avoided.  In  this  case,  supposing  the  inflammation 
to  have  proceeded  too  far  to  be  arrested,  the  pulp  may  be  destroyed 
and  the  tooth  treated  in  the  manner  described  in  another  chapter. 

When  the  inflammation  is  produced  by  other  causes  than  exposure 
of  the  pulp  and  the  contact  of  external  irritants,  it  may  perhaps  be 
successfully  combated.  The  treatment  is  similar  to  that  for  local  in- 
flammation in  other  parts  of  the  body ;  the  administration  of  saline 
cathartics,  the  application  of  leeches  to  the  gum  of  the  affected  tooth, 
abstinence  from  animal  food  and  from  stimulating  drinks.  If  the 
pulse  is  full  and  hard,  blood  may  be  taken  from  the  arm  with  advan- 
tage. Should  these  means  flul  to  arrest  the  inflammation,  and  suppu- 
ration take  place,  the  formation  of  alveolar  abscess  may  be  prevented 
by  promptly  perforating  the  crown  of  the  tooth  for  the  escape  of  the 
matter ;  but  such  cases  usually  terminate  in  periodontitis,  which  per- 
haps arises  as  frequently  from  this  as  from  any  other  cause. 

As  the  treatment  of  periodontitis  or  inflammation  of  the  investing 
membrane  is  described  in  another  chapter,  it  is  unnecessary  to  repeat 
it.  But  when  the  formation  of  alveolar  abscess  is  threatened,  the- 
removal  of  the  tooth,  in  many  cases,  will  be  found  necessary.  If  it  be- 
an  incisor  or  cuspid,  however,  the  operation  should  be  performed  as  a 
last  resort. 

Toothache  assuming  a  rheumatic  or  goiity  character  calls  for  a  some- 
what different  plan  of  treatment.  In  addition  to  the  local  means 
already  described,  it  may  be  necessary  to  adopt  the  constitutional 
treatment  applicable  to  rheumatism  and  gout.  When  the  pain  arises 
from  increased  vascular  action  and  nervous  irritation  of  the  pulp,  oc- 
casioned by  a  disordered  condition  of  the  digestive  organs,  and  assumes 
an  intermittent  form,  an  emetic  or  cathartic,  followed  by  the  use  of 
25 


386  EXTRACTION    OF    TEETH. 

quinine,  will  generally  afford  relief,  provided  caries  has  not  penetrated 
to  the*  pulp-cavity.  If  dependent  on  general  nervous  irritability  of 
the  system,  tonics,  exercise,  change  of  air,  or  such  other  constitutional 
measures  as  the  peculiarities  of  the  case  may  indicate,  should  be  re- 
commended. 

The  extraction  of  the  tooth  is  the  only  remedy  that  can  be  relied 
upon  for  relief  of  pain  arising  from  exostosis  of  the  root.  Dr.  Good, 
however,  thinks  it  may  be  cured  in  the  early  stages  by  the  use  of 
leeches  and  mercurial  ointment,  and  others  recommend  the  internal 
use  of  iodide  of  potassium. 


CHAPTER  YI. 

EXTRACTIOX   OF  TEETH. 


THERE  are  few  operations  in  surgery  that  excite  stronger  feelings 
of  dread,  and  to  which  most  persons  submit  with  more  reluc- 
tance, than  the  extraction  of  a  tooth.  Many  endure  the  tortures  of 
toothache  for  weeks  and  even  months  rather  than  undergo  the  opera- 
tion ;  and,  indeed,  when  we  take  into  consideration  the  frequent  acci- 
dents occurring  in  its  performance  by  awkward  and  unskilful  individ- 
uals, it  is  not  surprising  that  it  should  be  approached  with  apprehen- 
sion. But  when  performed  by  a  skilful  hand  and  with  a  suitable 
instrument,  the  operation  is  always  safe,  and  in  a  large  majority  of  the 
cases  may  be  effected  with  ease. 

Dr.  Fitch  relates  a  case  which  will  serve  to  illustrate  the  above  re- 
marks. The  subject,  a  resident  of  Botetourt  County,  Va.,  in  having 
the  second  right  superior  molar  extracted  by  a  blacksmith,  had  a  large 
portion  of  the  jaw  and  five  other  teeth  removed  at  the  same  time. 
"The  roots  of  his  tooth,"  says  Dr.  Fitch,  "were  greatly  bifurcated 
and  dovetailed  into  the  jaw,  and  would  not  pass  perpendicularly  out, 
though  a  slight  lateral  motion  would  have  moved  them  instantly.  The 
jaw  proved  too  weak  to  support  the  monstrous  pull  upon  it,  and  gave 
way  between  the  second  and  first  molars,  and  with  it  came  both  the 
anterior  and  posterior  plates  of  the  antrum.  The  broken  portion  ex- 
tended to  the  spongy  bones  of  the  nose,  and  terminated  at  the  lower 
edge  of  the  socket  of  the  left  front  incisor,  containing  six  sound  teeth, 
namely,  the  first  molar,  the  bicuspids,  cuspid,  and  incisors  of  the  right 
side — six  in  all.  The  soft  parts  were  cut  away  with  a  knife.  A  severe 
hemorrhage  ensued,  but  the  patient  soon  recovered,  though  with  excess- 
ive deformity  of  his  face  and  mouth." 


EXTRACTIOISr    OF    TEETH.  387 

Dr.  Cross,  of  North  Carolina,  related  to  tlie  author,  in  1838,  a  case 
very  similar  to  the  one  just  quoted.  The  operator  in  this,  as  in  th3 
other  instance,  was  a  blacksmith ;  in  attempting  to  extract  one  of  the 
superior  molar  teeth,  he  brought  away  a  piece  of  the  jaw  containing 
five  other  teeth,  together  with  the  floor  of  the  antrum  and  its  posterior 
and  anterior  walls. 

We  have  adverted  to  these  cases  to  show  the  impropriety  and  dan- 
ger of  intrusting  the  operation  to  individuals  possessing  neither  knowl- 
edge of  its  principles  nor  skill  in  its  performance.  Injuries  occasioned 
by  the  operations  of  such  persons  have  frequently  come  under  the 
immediate  observation  of  the  author,  with  whom  it  has  always  been  a 
matter  of  surprise  that  an  operation,  to  which  such  universal  repug- 
nance is  felt,  should  ever  be  confided  to  them. 

The  removal  of  a  wrong  tooth,  or  of  two  or  three,  instead  of  one,  are 
such  common  occurrences,  that  it  were  well  if  the  precautions  given 
by  the  illustrious  Ambrose  Pare  were  more  generally  observed.  So 
fearful  was  he  of  injuring  the  adjacent  teeth,  that  he  always  isolated 
the  tooth  to  be  extracted  with  a  file  before  he  attempted  its  removal. 
He  regard2d  it  as  of  the  greatest  importance  that  a  person  who  extracted 
teeth  should  be  expsrt  in  the  use  of  his  "  tooth  mullets  ;  for  unless  he 
knows  readily  and  cunningly  how  to  use  them,  he  can  scarcely  so  carry 
himself  but  that  he  will  not  force  out  three  teeth  at  once."  Although 
great  improvements  have  been  made  since  his  time  in  the  construction 
of  extracting  instruments,  yet  even  now  the  accidents  to  which  he 
alludes  are  of  almost  daily  occurrence. 

It  is  surprising  that  an  operation  so  frequently  called  for  should 
receive  so  little  attention  from  medical  practitioners,  by  whom,  though 
not  strictly  belonging  to  their  province,  it  must  frequently  be  per- 
formed. This  neglect  can  only  be  accounted  for  by  the  too  general 
prevalence  of  the  idea  that  little  or  no  surgical  skill  is  necessary  to 
its  performance.  But  every  physician  residing  in  the  country,  or 
where  the  services  of  a  skilful  dentist  cannot  always  be  commanded, 
should  provide  himself  with  the  pi'oper  instruments,  and  make  himself 
acquainted  with  the  manner  of  performing  this  operation. 

INDICATIONS   FOR   THE   EXTRACTION   OF   TEETH. 

With  regard  to  the  indications  that  determine  the  propriety  of  ex- 
traction, the  author  does  not  deem  it  necessary  to  say  much  in  this 
place,  as  they  are  fully  pointed  out  in  other  parts  of  the  work.  It  may 
be  well,  however,  to  briefly  mention,  in  this  connection,  a  few  of  the 
circumstances  which  call  for  the  operation. 

Beginning  with  the  teeth  of  first  dentition,  it  will  be  sufficient  to 
state,  that  when  a  tooth  of  replacement  is  about  to  emerge  from  the 


388  EXTRACTION    OF    TEETH. 

gum*!,  or  has  actually  made  its  appearance,  either  before  or  behind  the 
carrespondiug  milk  tooth,  the  latter  should  at  once  be  removed  ;  and 
when  the  aperture  formed  by  the  loss  of  this  is  so  narrow  as  to  pre- 
vent the  former  from  acquiring  its  proper  position,  it  may  sometimes 
be  necessary  to  extract  an  adjoining  temporary  tooth.  For  more  ex- 
plicit directions  upon  this  subject,  the  reader  is  referred  to  the  chapter 
on  the  management  of  second  dentition.  Alveolar  abscess,  necrosis 
of  the  Avails  of  the  alveolus,  and  pain  in  a  temporary  tooth,  which 
cannot  be  cured  by  any  of  the  usual  remedies,  may  be  regarded  as  in- 
dications which  call  for  the  operation. 

The  principal  conditions  which  should  determine  the  extraction  of 
a  permanent  tooth  may  be  enumerated  in  the  following  order:  First, 
when  a  molar,  from  the  loss  of  its  antagonizing  tooth,  or  from  other 
causes,  has  become  partially  disi:)laced,  or  is  a  source  of  constant  irri- 
tation to  the  surrounding  parts. 

Second,  a  constant  discharge  of  fetid  matter  from  the  nerve-cavity, 
through  a  carious  opening  in  the  crown.  There  may,  however,  be 
circumstances  which  Avould  justify  a  practitioner  in  jDermitting  or 
even  advising  the  retention  of  such  a  tooth  ;  as,  for  example,  when  the 
discharge  of  fetid  matter  is  not  very  considerable;  also,  where  the 
tooth  is  situated  in  the  anterior  part  of  the  mouth,  aud  cannot  be 
securely  replaced  with  an  artificial  substitute.  The  secretion  of  fetid 
matter  may,  in  some  cases,  by  judicious  treatment  be  arrested,  the 
tooth  preserved  for  many  years  by  plugging  ;  and  so  the  morbid  in-, 
fluence  it  would  otherwise  exert  upon  the  surrounding  parts  may  be 
counteracted.  A  front  tooth  should  not  be  sacrificed  unless  called  for 
by  some  very  urgent  necessity  ;  neither  sliould  an  upper  incisor  nor 
cuspid  be  permitted  to  remain  in  the  mouth,  if  it  exerts  a  manifestly 
morbid  action  upon  the  surrounding  parts :  for  in  this  case  the  conse- 
quences resulting  from  its  retention  in  the  mouth  may  be  Avorse  than 
the  loss  of  the  tooth. 

Third,  a  tooth  which  is  the  cause  of  an  incurable  alveolar  abscess, 
should  not  be  permitted  to  remain ;  but  if  it  be  an  incisor  or  cuspid, 
and  the  discharge  of  matter  through  the  gum  is  small,  occurring  only 
at  long  intervals,  and  especially  if  the  organ  cannot  be  securely  re- 
placed Avith  an  artificial  substitute,  it  may  be  permitted  to  remain. 
An  incurable  abscess  in  the  socket  of  a  bicuspid  or  molar  should 
always  be  considered  as  a  sufficient  indication  for  the  remoA'al  of  the 
tooth. 

Fourth,  irregularity  in  the  arrangement  of  the  teeth,  arising  from 
disproportion  betAveen  the  size  of  the  teeth  and  the  size  of  the  ah^eo- 
lar  arch,  usually  requires  for  its  correction  the  extraction  of  some  one 
or  more  teeth.     But  with  regard  to  the  teeth  most  proper  to  be  re- 


EXTEACTION    OF    TEETH.  389 

moved,  the  reader  is  referred  to  the  chapter  on  irregularity,  where  he 
will  find  full  directions  for  the  management  of  such  cases. 

Fifth,  all  dead  teeth  and  roots  of  teeth  which  act  as  irritants,  and 
teeth  which  have  become  so  much  loosened  from  the  destruction  of  their 
sockets  as  to  be  a  constant  source  of  disease  to  the  adjacent  parts;  or 
teeth  otherwise  diseased,  that  are  a  cause  of  neuralgia  of  the  face,  dis- 
ease of  the  maxillary  sinus,  dyspepsia,  or  any  other  local  or  constitu- 
tional disturbance,  such  teeth  should,  as  a  general  rule,  be  extracted. 

There  are  other  indications  which  call  for  the  extraction  of  teeth, 
but  the  foregoing  are  among  the  most  common ;  they  will  be  found 
sufficient,  in  most  instances,  to  determine  the  propriety  or  impropriety 
of  the  operation.  Cases  are,  however,  continually  presenting  them- 
selves, to  which  no  fixed  rules  would  be  found  applicable,  and  where 
sm  experienced  judgment  alone  can  determine  the  practice  proper  to 
be  pursued. 

In  conclusion,  it  is  scarcely  necessary  to  say,  that  Avhenever  a  tooth 
can  be  restored  to  health,  it  should  always  be  done ;  but  tampering 
with  such  as  cannot  be  rendered  healthy  and  useful,  and  which,  by 
remaining  in  the  mouth,  exert  a  deleterious  influence,  not  only  upon 
the  adjacent  parts,  but  also  upon  the  general  health,  cannot  be  too 
strongly  deprecated. 

rN'STRUMENTS   EMPLOYED    IN   THE    OPERATION. 

Difierent  operators  employ  difierent  instruments.  For  about  fifty 
years,  the  key  of  Garengeot  was  almost  the  only  instrument  used  in 
the  performance  of  the  operation  ;  but  this  has  in  a  great  measure 
been  superseded  by  forceps,  which,  when  properly  constructed,  are  far 
preferable;  yet  as  the  key  is  still  used  by  some,  and  by  them  is  con- 
sidered, in  certain  cases,  a  valuable  instrument,  a  brief  description  of 
"'t  is  here  given. 

KEY   INSTRUMENT. 

"The  common  tooth-key,"  says  Dr.  Arnot,  "may  be  regarded  in  the 
light  of  a  wheel  and  axle;  the  hand  of  the  operator  acting  on  two 
spokes  of  the  wheel  to  move  it,  while  the  tooth  is  fixed  to  the  axle  by 
the  claw,  and  is  drawn  out  as  the  axle  turns.  The  gum  and  alveolar 
process  cf  the  jaw  form  the  support  on  which  the  axle  rolls." 

Different  dentists  have  their  keys  differently  constructed,  but  the 
principle  upon  which  they  all  act  is  precisely  the  same.  Some  prefer 
the  bent  shaft  (Fig.  135),  others  the  straight.  Some  give  a  decided 
preference  to  the  round  fulcrum,  others  to  the  flat;  and  though  the 
success  of  the  operator  depends  greatly  upon  the  perfection  of  the 
instrument,  yet  he  may  remove  a  tooth  more  expertly  by  means  of  a 


390 


EXTRACTION    OF    TEETH. 


key  with  Avhich  he  is  familiar,  than  one  to  which  he  is  unaccustomed, 
though  its  construction  be  even  better.    Fig.  135  represents  a  key  with 

bent  shaft  and 
two  hooks,  one 
for  molars  and 
the  ether  for  bi- 
cuspids. 

The  author 
has  tried  almost 
every  variety  of 
key  instrument 
that  has  been 
used  in  this  coun- 
try, and  thinks 
the  straight  shank,  with  a  small  round  fulcrum  slightly  flattened  on 
each  side,  decidedly  preferable  to  any  other.  The  objection  raised  by 
some  to  the  use  of  such  a  key,  that  it  is  liable  to  interfere  with  the 
front  teeth,  is  without  good  foundation.  It  can  be  used  with  as  much 
safety  as  a  key  of  any  construction,  and  in  most  cases  can  be  as  easily 
applied.  The  round  is  certainly  preferable  to  the  flat  fulcrum,  because 
it  is  less  liable  to  injure  the  gums  and  the  alveolus.  In  size  it  should 
be  a  little  larger  than  a  half-ounce  bullet. 

Every  key  instrument  should  be  supplied  with  several  hooks,  differ- 
ing in  size,  to  suit  the  teeth  upon  which  they  are  to  be  applied.  The 
hook  described  by  Dr.  Maynard  *  is  preferable  to  any  which  the 
author  has  seen.  It  very  nearly  resembles  the  eagle's  claw,  except 
that  its  curvature  is  rather  greater.  The  edge  of  the  hook  is  about  the 
sixteenth  of  an  inch  in  width,  and  divided  into  two  points  by  a  shallow 
notch.  A  hook  of  this  description  is  less  liable  to  slip,  and  can  be 
more  readily  applied  to  a  tooth  than  those  ordinarily  used. 

With  regard  to  the  merits  of  the  key  instrument,  or  of  any  other 
instrument  having  the  same  principle  of  action,  as  compared  with  the 
forceps  presently  to  be  described,  the  author  does  not  entertain  a  very 
high  opinion.  The  following  remarks,  quoted  from  the  late  wotk  of 
M.  Desirabode,  accord  with  the  views  which  he  has  held  and  promul- 
gated for  many  years :  "  One  of  the  most  common  causes  of  fracture 
of  the  alveoli  is  a  badly  performed  operation  in  the  mouth  ;  although 
not  a  very  flattering  acknowledgment  for  our  art,  it  is  necessary  to  say 
it.  If  it  be  necessary  to  specify  causes,  we  would  not  hesitate  to  name, 
in  the  first  place,  the  use  of  the  key  of  Garengeot ;  for  we  shall  prove, 
in  treating  of  the  extraction  of  teeth,  that  this  dangerous  implement, 
Avhich  is  only  fit  to  mask  the  unskilfulness  of  the  operator,  is  one  of 


*  See  Am.  Jour.  Dent.  Sci.,  No.  3,  vol.  iii. 


EXTRACTION    OF    TEETH.  391 

the  most  defective  of  surgical  instruments ;  and  no  practitioner  of  good 
sense,  being  convinced  of  its  mode  of  action,  would  attempt  to  use  it 
even  to  extract  a  nail  from  a  board,  if  he  did  not  desire  to  break  the 
surrounding  material."  Perhaps  this  condemnation  is  too  sweeping. 
The  principle  of  action  of  the  key  is  in  fact  not  unlike  that  of  a  nail 
drawer  or  tack  puller,  and  is  well  adapted  to  a  certain  class  of  cases ; 
namely,  where  one  wall,  either  the  inner  or  outer,  is  decayed  below  the 
alveolus,  while  the  opposite  one  is  still  standing.  The  fulcrum,  with  a 
folded  napkin  or  other  soft  substance  interposed,  is  placed  against  the 
gum  on  the  side  of  the  tooth  most  decayed,  and  the  hook  adjusted  to 
the  neck  of  the  tooth  on  the  opposite  side. 

MANNER   OF   USING   THE   KEY   INSTRUMENT. 

The  directions  required  for  the  use  of  the  key  are  few  and  simple, 
but,  as  cases  frequently  occur  to  which  no  general  rules  can  be  applied, 
much  will  depend  on  the  practical  judgment  and  surgical  tact  of 
the  operator.  The  first  step  to  be  taken  in  the  operation  is  to  separate 
the  gum  from  the  neck  of  the  tooth,  down  to  the  alveolus ;  this  should 
be  done,  not  on  two  sides  onlv,  but  round  the  entire  tooth.  For  this 
purpose  suitable  lancets  should  be  provided.  A  straight,  narrow- 
bladed  knife,  pointed  at  the  end,  and  with  one  cutting  edge,  will  be 
found  most  convenient  for  performing  the  operation  on  the  approximal 
sides  ;  it  may  be  most  effectively  used  by  passing  the  point  of  the  knife 
between  the  neck  of  the  tooth  and  gum,  down  to  the  alveolus,  with 
its  back  downward,  then  cutting  in  the  direction  of  the  crown.  In 
this  way  the  connection  of  the  gum  to  the  sides  of  the  neck  of  the 
tooth  may  be  thoroughly  severed.  The  same  kind  of  knife,  or  a  com- 
mon gum-lancet,  may  be  used  for  separating  the  gum  from  the 
remaining  sides  of  the  tooth.  If  the  gum  is  not  well  separated,  there 
will  be  danger  of  lacerating  it  in  the  removal  of  the  tooth. 

After  the  tooth  has  been  thus  prepared,  the  key,  with  the  proper 
hook  attached,  should  be  firmly  fixed  upon  it;  the  fulcrum,  on  the 
inside,  resting  upon  the  edge  of  the  alveolus,  the  extremity  of  the  claw 
on  the  opposite  side,  pressed  down  upon  the  neck.  The  handle  of  the 
instrument  is  then  grasped  with  the  right  hand,  and  the  tooth  raised 
from  its  socket  by  a  firm,  steady  rotation  of  the  wrist.  The  claw 
should  be  pressed  down  with  the  forefinger  or  thumb  of  the  left  hand 
of  the  operator,  until,  by  the  rotation  of  the  instrument,  it  becomes 
securely  fixed  upon  the  tooth.  This  precaution  is  necessary  to  prevent 
it  from. slipping,, an  accident  that  frequently  happens,  and  one  that  is 
always  more  or  less  embarrassing  to  the  dentist. 

If  the  tooth  is  situated  on  the  left  side  of  the  mouth,  the  position  of 
the  operator  should  be  at  the  right  side  of  the  patient ;  but,  if  it  be  on 


392  EXTRACTION    OF    TEETH. 

the  right  side,  he  shouhl  stand  before  hira.  For  the  removal  of  a 
tooth  ou  the  left  side  of  the  lower  jaw,  or  the  right  side  in  the  upper, 
the  palm  of  the  hand  should  be  beneath  the  handle  of  the  instrument; 
in  the  extraction  of  one  on  the  right  side  of  the  lower  jaw,  or  on  the 
left  side  in  the  upper,  it  should  be  above.  The  manner  of  grasping 
the  instrument  is  of  more  importance  than  many  suppose.  If  impro- 
perly held,  the  operator  loses,  to  a  great  extent,  his  control  over  it. 

The  directions  here  given  are,  in  some  respects,  different  from  those 
laid  down  by  other  writers  ;  but  we  are  convinced,  from  mucli  experi- 
ence, that  they  will  be  found  more  conducive  to  the  convenience  of  the 
operator  and  the  success  of  the  operation  than  those  usually  given  for 
the  use  of  this  instrument. 

There  is  a  diversity  of  opinion  as  to  whether  a  tooth  should  be  re- 
moved inwardly  or  outwardly.  Some  direct  the  fulcrum  of  the  instru- 
ment to  be  placed  to  the  outside  of  the  tooth,  others  to  the  inside,  while 
others  again  regard  it  as  of  little  importance  on  which  side  it  is  placed. 
Experience  has  taught  us  that  it  should,  in  the  majority  of  cases,  be 
placed  on  the  inside,  especially  of  the  lower  teeth,  as  they  almost 
always  incline  toward  the  interior  of  the  mouth.  Moreover,  the  edge 
of  the  alveolus  is  usually  a  little  higher  on  the  exterior  edge  of  the 
jaw  than  on  the  interior ;  so  that  the  first  motion  of  the  instrument, 
with  its  fulcrum  on  the  outside,  brings  the  side  of  the  tooth  against  its 
socket ;  thus  nearly  double  the  amount  of  power  is  required  to  remove 
it,  while,  at  the  same  time,  the  pain  and  the  chances  of  injury  to  the 
alveolar  processes  are  very  much  increased. 

It  is,  however,  frequently  necessary  to  place  the  bolster  of  the  key 
on  the  outside  of  the  tooth;  when,  for  instance,  it  is  decayed  in  such  a 
way  as  not  to  afford  a  sufficiently  firm  support  for  the  claw  of  the 
instrument.  But,  whenever  it  is  possible  to  remove  a  tooth  inwardly, 
it  should  be  done.  The  alveolar  walls  of  the  upper  teeth  are,  gener- 
ally, thinner  than  those  of  the  lower,  and  do  not  aflford  so  strong  a 
support  to  the  fulcrum  of  the  instrument. 

FORCEPS. 

Forceps  were  not  very  generally  or  extensively  employed,  except  for 
the  extraction  of  the  front  teeth,  until  about  the  year  1830 ;  but  the 
improvements  made  in  their  construction  since  that  period  are  so 
great,  that  their  use  has  now,  among  dentists,  superseded  that  of  the 
key. 

The  forceps  formerly  used  were  so  awkwardly  shaped,  and  so  badly 
adapted  to  the  teeth,  that  the  extraction  of  a  large  molar  with  an  in- 
strument of  this  description  was  regarded  as  exceedingly  difficult,  and 
even  dangerous ;  even  its  practicability  was  doubted  by  many  of  the 


EXTRACTION    OF    TEETH.  393 

most  experienced  practitioners,  and  lience  the  key  was  almost  the  only 
instrument  resorted  to  for  the  purpose. 

When  we  consider  the  strong  prejudice  that  so  recently  existed 
against  the  use  of  forceps,  it  is  not  at  all  wonderful  that  their  employ- 
ment should  have  been  resorted  to  with  caution.  Nor  is  it  surprising 
that  a  gentleman  of  Mr.  Bell's  intelligence  and  practical  experience 
should,  so  late  as  the  period  of  the  publication  of  the  first  edition  of 
this  work,  1830,  tell  us  that  the  key  is  the  only  instrument  to  be  relied 
upon  for  the  removal  of  teeth  that  are  much  decayed  ;  and  that  those 
who  have  heaped  the  most  opprobrium  upon  it  are  glad  to  have  a 
concealed  recourse  to  its  aid. 

This  may  have  been  true  at  the  time  Mr.  B.  wrote,  but  not  now. 
On  the  contrary,  cases  are  daily  occurring  of  the  extraction  of  teeth 
with  forceps,  upon  which  the  key  had  been  previously  unsuccessfully 
employed.  It  is  generally  supposed  that  a  greater  amount  of  force  is 
necessary  to  remove  a  tooth  with  forceps  than  with  the  key,  but  this  is 
a  mistake,  'it  does  not  ordinarily  require  as  much.  The  leverage 
gained  by  the  action  of  the  key  is  more  than  counterbalanced  by  the 
greater  amount  of  resistance  encountered  in  the  lateral  direction  of  the 
force  exerted  in  the  removal  of  the  tooth  by  that  instrumen't.  But 
with  forceps,  the  direction  of  the  power  being  in  the  line  of  the  axis 
of  the  tooth,  an  amount  sufficient  to  break  up  the  connection  with  the 
sockets  and  to  overcome  the  resistance  of  the  walls  of  the  alveolus  is 
all  that  is  required. 

The  author  has  used  forceps  exclusively  since  1834,  and  he  does 
not  hesitate  to  affirm  that  any  tooth  can  be  extracted  with  them  that 
can  be  removed  with  the  key;  and  that,  too,  in  the  majority  of  cases, 
with  greater  ease  to  the  operator  and  less  pain  to  the  patient. 

In  order  that  forceps  may  be  used  with  ease,  it  is  necessary  they 
should  be  properly  constructed.  Every  operator  should  possess  a 
number  of  pairs  (nine  at  least),  each  with  a  differently  shaped  beak, 
adapted  to  the  necks  of  the  teeth  to  which  they  are  respectively 
designed  to  be  applied. 

The  improvements  made  in  the  shape  of  the  beaks  of  the  upper  and 
lower  molar  forceps,  by  Mr.  Snell,  are  very  valuable ;  to  which  he  is 
entitled  to  much  more  credit  than  the  profession  generally  have  ac- 
corded. For  the  upper  molars  two  (Fig,  136)  are  required,  one  for 
each  side,  curved  just  below  the  joint,  so  that  the  beak  shall  form  an 
angle  of  twenty  or  twenty-five  degrees  with  the  handles,  just  enough 
to  clear  the  lower  teeth.  The  inner  blade  is  grooved  to  fit  the  neck 
of  the  palatine  root ;  the  outer  blade  has  two  grooves,  with  a  point  in 
the  centre  to  fit  the  depressions  just  below  the  bifurcation  of  the  two 
buccal  roots.     Another  valuable  improvement  of  his  consists  in  having 


394 


EXTRACTION    OF    TEETH. 


one  of  the  handles  bent  so  as  to  form  a  hook.     This  passes  round  the 
operator's  little  finger,  to  prevent  the  hand  from  slipping. 


Fig.  136. 


Fig.  137  represents  another  form  of  superior  molar  forceps,  right 
and  left,  with  a  greater  curvature  in  the  handles  than  the  Harris 
pattern,  which  many  consider  an  improvement. 


Fig.  137. 


The  handles  should  be  wide,  and  large  enough  to  prevent  them  from 
springing  under  the  grasp  of  the  hand,  to  which  they  should  be  accu- 
rately fitted.  Every  dentist,  therefore,  in  having  forceps  manufac- 
tured, should  give  special  directions  with  regard  to  their  shape  and 
size.  The  beak  should  be  bent  no  more  than  is  absolutely  necessary 
to  prevent  the  handles  from  coming  in  contact  with  the  teeth  of  the 
lower  jaw  ;  for  in  proportion  to  the  degree  of  curvature  will  the  mus- 
cular power  of  the  operator  be  disadvantageously  exerted. 

Each  blade  of  the  beak  of  the  lower  molar  forceps  has  two  grooves, 
with  a  point  in  the  centre,  so  situated  that  in  grasping  the  tooth  it 


EXTEACTION    OF    TEETH. 


395 


comes  between  the  two  roots  just  at  the  bifurcation.  Mr.  Snell  em- 
ployed two  pairs  for  the  extraction  of  the  lower  as  well  as  for  the 
upper  molars,  in  order,  as  he  said,  to  have  a  hook  to  turn  round  the 
little  finger,  which  he  supposed  must  be  on  opposite  sides  of  the 
instrument.  But  this  is  rendered  unnecessary  by  an  improvement 
made  by  the  author  in  1833,  which  consists  in  having  the  handles  of 
the  instrument  so  bent  that  it  may  be  as  readily  applied  to  one  side 
of  the  mouth  as  the  other,  while  the  operator  occupies  a  position  to 
the  right  and  a  little  behind  the  patient.  By  this  improvement,  the 
necessity  for  two  pairs  is  wholly  superseded;  it,  moreover,  enables 
him  to  control  the  head  of  the  patient  with  his  left  arm  and  the  lower 
jaw  wdth  his  left  hand,  rendering  the  aid  of  an  assistant  wholly 
unnecessary. 

The  shape  of  the  instrument,  as  improved  by  the  author,  is  shown 
in  Fig.  138.  It  is  now  used  by  many  hundreds  of  operators,  who 
prefer  it  to  any  other  instrument  they  have  ever  employed.  When 
applied  to  a  tooth,  the  handles  turn  toward  the  operator,  at  an  angle 
of  about  twenty-five  or  thirty  degrees.  Without  this  curvature  in  the 
handles,  the  arm  of  the  operator  would  often  be  thrown  so  far  from 
his  body  as  to  prevent  the  proper  control  over  the  instrument.  It  is 
also  important  that  the  handles  should  be  wide  and  accurately  fitted 
to  the  hand. 

Fig.  138. 


Fig.  139  represents  Wolverton's  inferior  molar  forcep  for  either 
side,  with  longer  points  in  the  centre  of  each  blade  of  the  beak. 


Fig.  139. 


396 


EXTEACTION    OF    TEETH. 


Fig.  140  represents  inferior  molar  forceps  for  the  right  and  left  sides 
of  the  mouth,  which  some  prefer  to  the  single  forcep. 


Fig.  140. 


Fig.  141  represents  a  lower  molar  forcep  with  plain  beaks,  for  use 
on  either  side. 

Fig.  141. 


For  the  extraction  of  the  upper  incisors  and  cuspids,  one  pair  only 
is  necessary.  (Fig.  142.)  These  should  be  straight,  with  grooved  or 
crescent-shaped  jaws,  accurately  fitted  to  the  necks  of  the  teeth.  The 
beaks  should  also  be  thin,  so  that  they  may  be  easily  introduced  under 
the  gum,  up  to  the  edge  of  the  alveolus.  And,  like  the  superior  and 
inferior  molar  forceps,  the  handles  should  be  large  enough  to  prevent 
them  from  springing  in  the  hand  of  the  operator,  with  a  hook  formed 
at  the  end  of  one  of  them. 

Fig.  142. 


For  the  extraction  of  the  lower  incisors,  a  pair  of  very  narrow- 
beaked  forceps  are  necessary,  to  prevent  interfering  with  the  teeth  ad- 
joining the  one  to  be  removed.     The  beak  below  the  joint  of  the 


EXTRACTION    OF    TEETH.  397 

instrument  should  be  bent  downward  at  an  angle  of  about  twenty-five 
deo-rees  with  the  handles.  (Fig.  143.)  This  is  also  a  very  valuable 
instrument  for  the  extraction  of  the  roots  of  teeth. 


An  instrument  similarly  shaped,  but  wdth  the  beak  much  longer, 
makes  one  of  the  most  universally  applicable  instruments  that  can  be 
devised.    (Fig.  144.)   The  beak  should  be  made  strong,  but  very  narrow. 


Fig.  144. 


Fig.  145  represents  an  inferior  incisor  hawk-bill  forcep,  which  is  a 
very  convenient  instrument  for  the  removal  of  these  teeth.  It  is  also 
used  for  the  removal  of  the  lower  cuspids. 


Fig.  145. 


Forceps  for  the  extraction  of  bicuspids  should  have  their  jaws  so 
bent  as  to  be  easily  adapted  to  these  teeth  ;  they  should  be  narrow,  and 
have  a  deeper  groove  on  the  inside  than  those  for  the  upper  incisors 
and  cuspids;  like  them,  they  should  be  thin,  yet  strong  enough  to 
sustain  the  pressure  which  it  may  be  necessary  to  apply.  One  pair 
will  answer  for  the  right  and  left  bicuspids  of  the  upper  jaw.  (Fig.  146.) 

For  the  removal  of  the  cuspids  and  bicuspids  of  the  lower  jaw,  the 
hawk's-bill  forcep  (Fig.  145),  with  crescent -shaped  beaks,  is  often 
employed  ;  but  the  instrument  represented  in  Fig.  147  is,  we  think, 
better  suited  to  the  extraction  of  these  teeth,  and  can  be  more  conve- 


398  EXTRACTION    OF    TEETH. 

niently  applied.     No  separate  instrument,  therefore,  is  required  for 
tlie  removal  of  the  inferior  cuspids. 

Fig.  HG. 


The  dentes  sapientise  can,  in  a  large  majority  of  cases,  be  extracted 
with  the  bicuspid  forceps;  but  there  is  another  kind  of  forceps  which 


Fia.  147. 


may  be  more  conveniently  employed  for  the  removal  of  the  upper 
wisdom  teeth.     The  beak  of  these  is  bent  above  the  joint,  forming 


Fig.  148. 


nearly  two  right  angles,  as  shown  in  Fig.  148.     These  forceps  were, 
we  believe,  invented  bj  Dr.  Edward  P.  Church,*  about  the  year  1830, 

*  Dr.  Church  was  an  ingenious  and  talented  man,  and  during  the  four  years 
of  his  brief  professional  career  he  acquired  a  reputation  for  skill  which  few,  in 
so  short  a  time,  have  been  able  to  achieve;  had  his  life  been  spared,  he  would 
soon  have  ranked  among  the  very  first  pr.actitioners  in  the  country.  Born  in 
the  western  part  of  the  State  of  New  York,  he  chose  the  Mississippi  Valley  as 
the  field  of  his  professional  labors,  intending  ultimately  to  locate  in  Cincinnati; 
but  while  on  a  visit  to  his  family,  in  1832,  he  fell  a  victim  to  the  Asiatic  cholera, 
in  the  twenty-sixth  year  of  his  age. 


EXTRACTION    OF    TEETH. 


399 


and  in  those  cases  where  the  superior  dentes  sapientise  are  consid- 
erably shorter  than  the  second  molars,  they  can  be  successfully  and 
advantageously  employed ;  and  indeed,  in  many  cases,  they  cannot  be 
reached  with  any  of  the  above  described  extracting  instruments.  The 
handles  of  these,  as  of  all  other  forceps,  should  be  no  longer  than 
is  absolutely  necessary  for  the  accommodation  of  the  hand  of  the 
operator. 

For  the  removal  of  the  inferior  dentes  sapientise,  the  forcep  repre- 
sented in  Fig.  138,  Harris's  pattern,  or  the  ones  represented  in  Figs. 
140  and  141,  may  be  employed.  Fig.  149  represents  Physick's  dentes 
sapientise  for  either  side,  which  is  used  as  an  elevating  forcep. 

Fig.  149. 


For  the  removal  of  the  roots  of  teeth,  the  inferior  incisor  forceps, 
represented  in  Figs.  143  and  144,  are  very  useful ;  also  the  forms  repre- 
sented in  Fi";s.  150  and  151. 


Fig.  150. 


Fig.  151. 


Figs.  152,  153,  154,  155,  and  156  represent  Parmley's  patterns  of 
alveola  forceps  for  cutting  through  the  alveolar  process  to  the  roots  of 
the  teeth. 

Fig.  157  represents  a  forcep  for  separating  the  diverging  roots  of 
molar  teeth. 

There  is  scarcely  any  instrument  used  in  dentistry  that  has  called 


400 


EXTRACTION    OP    TEETH, 
Fig.  152. 


Fig.  153. 


Fig.  156. 


Fig.  157. 


EXTRACTION    OF    TEETH.  401 

forth  more  ingenuity  in  devising  various  shapes  than  forceps.  Almost 
every  practitioner  has  some  peculiar  pattern  of  his  own,  which  will 
accomplish  what  no  other  can.  Doubtless  many  of  these  instruments 
are  very  excellent ;  but  it  often  happens  that  an  inventor  learns,  by 
dint  of  practice,  to  do  with  some. pet  forceps  of  his  own  contrivance 
what  might  as  easily  have  been  done  with  a  simpler  one  already  in 
use.  We  would  not,  however,  be  understood  as  saying  that  patterns 
in  present  use  admit  of  no  improvement.  What  we  do  assert  is,  that 
skill  in  the  use  of  a  few  instruments  is  preferable  to  crowding  one's  case 
with  an  unnecessary  number. 

MANNER   OF   USING   THE   FORCEPS. 

In  describing  the  manner  of  using  these  instruments,  we  shall  com- 
mence with  the  extraction  of  the  incisors  of  the  upper  jaw.  These  are 
generally  more  easily  removed  than  any  of  the  other  teeth. 

The  use  of  the  gum  lancet  should  generally  precede  the  application 
of  either  the  forceps  or  the  key.  JMany  dentists  object  to  the  opera- 
tion as  unnecessarily  inflicting  double  pain.  Some  have  their  forceps 
made  with  thin  sharp  blades  so  as  to  sever  the  gum  on  tw^o  sides  iu 
the  act  of  pressing  up  the  instrument.  This  practice  may  be  admis- 
sible, perhaps  necessary,  in  certain  exceptional  cases  ;  as  with  chil- 
dren, or  nervous  persons,  whom  the  act  of  lancing  might  deter  from, 
permitting  the  operation  to  be  completed.  But  we  are  fully  satisfied 
that  as  a  rule  it  is  very  objectionable,  either  in  the  use  of  the  key  or- 
of  forceps.  After  separating  the  gum  from  the  neck  of  the  tooth,  it 
should  be  grasped  with  a  pair  of  straight  forceps  (Fig.  142),  and  pressed, 
several  times,  in  quick  succession,  outward  and  inward,  giving  it  at  the 
same  time  a  slight  rotary  motion,  which  should  be  continued  until  it 
begins  to  give  way;  then,  by  a  slight  doAvnward  pull,  it  is  easily  re- 
moved. If  the  tooth  is  much  decayed,  it  should  be  grasped  as  high^ 
up  under  the  gum  as  possible,  and  no  more  pressure  apf)lied  to  the 
handles  of  the  instrument  than  may  be  necessary  to  prevent  it  from 
slipping.  Teeth  are  often  unnecessarily  broken  by  not  attending  to 
this  precaution. 

The  same  directions  will,  in  most  cases,  be  found  applicable  for  the 
removal  of  a  lower  incisor.  But  the  arrangement  of  these  teeth  is- 
sometimes  such  as  to  render  their  extraction  rather  more  difficult. 
The  forceps  best  calculated  for  their  removal  are  represented  in  Figs. 
143  and  145. 

For  the  extraction:  of  a  cuspid,  more  force  is  usually  required  than 

for  the  removal  of  an  incisor,  because  of  the  greater,  size  and  length 

of  its  root.     The  straight  forceps  (see  Fig.  142)  should  be  employed. 

for  the  removal  of  the  superior,  and  the  curved-beaked,  forceps  (Figs.. 

26 


402  EXTRACTION    OF    TEETH. 

143  and  147)  for  tho  inferior  cuspids.  In  the  extraction  of  these 
teeth,  less  rotary  motion  should  be  given  to  the  liand  than  in  the 
removal  of  the  incisors :  in  every  other  respect,  the  operation  is  per- 
formed in  the  same  manner.  The  inferior  cuspids  usually  have  longer 
roots,  and  are  more  difficult  to  remove  than  the  superior. 

Very  little  rotary  motion  can  be  given  to  a  bicuspid,  especially  an 
upper  one,  in  its  extraction.  After  it  has  been  pressed  outward  and 
inward  several  times,  or  until  it  begins  to  give  way,  it  should  be  re- 
moved by  pulling  in  the  direct  line  of  its  axis.  For  the  extraction  of 
the  upper,  the  forceps  represented  in  Fig.  142,  and  for  the  lower,  those 
represented  in  Fig.  147,  are  the  proper  instruments  to  be  employed ; 
unless  the  crown  has  become  so  much  weakened  by  decay  that  it  will 
not  bear  the  requisite  amount  of  pressure.  In  this  case,  the  gum 
on  each  side  should  be  separated  from  the  alveolus  about  an 
eighth  or  three-sixteenths  of  an  inch,  and  slitted  so  as  to  permit  the 
application  of  the  narrow-beaked  forceps,  Fig.  143.  With  these,  the 
alveolar  wall  on  each  side  may  be  easily  cut  through,  and  a  sufficiently 
firm  hold  obtained  upon  the  root  of  the  tooth  for  its  removal.  These 
forceps  will  also  be  found  better  adapted  for  the  removal  of  the  molars, 
when  in  a  similar  condition,  than  any  other  instrument. 

The  upper  molars,  having  three  roots,  generally  require  a  greater 
amount  of  force  for  their  removal  than  any  of  the  other  teeth.  They 
should  be  grasped  as  high  upas  possible,  with  one  of  the  forceps  repre- 
sented in  Fig.  136  or  137,  and  then  pressed  outward  and  inward,  until 
the  tooth  is  well  loosened,  Avhen  it  may  be  j)ulled  from  the  socket.  If 
the  forceps  used  for  the  extraction  of  the  upper  molars  are  of  the  right 
description  and  properly  applied,  they  will  be  found  the  safest  and 
most  efficient  instruments  that  can  be  employed  for  their  removal. 

The  superior  dentes  sapientise  are  usually  less  firmly  articulated  to 
the  jaw  than  are  the  first  and  second  molars ;  they  are  therefore  more 
easily  removed.  When  their  crowns  are  sufficiently  long  to  admit  of 
being  grasped  with  the  bicuspid  forceps  (Fig.  146),  they  should  be 
removed  with  this  instrument;  but  when  this  cannot  be  applied  with- 
out interfering  with  the  anterior  teeth,  the  forceps  represented  in  Fig. 
148  may  be  substituted. 

The  inferior  molars,  although  they  have  but  two  roots,  are  often 
very  firmly  articulated,  and  require  considerable  force  for  their  re- 
moval ;  and  it  sometimes  happens  that,  when  the  approxiraal  side  of 
one  has  been  destroyed  by  caries,  the  adjoining  tooth  has  impinged 
upon  it  in  such  a  manner  as  to  constitute  a  formidable  obstacle  to  its 
extraction.  Two  teeth  are  often  removed  in  attempting  to  extract  one 
thus  situated,  unless  the  precaution  is  taken  of  filing  off"  the  side  of  the 
-enci'oaching  tooth.     This  should  never  be  omitted  in  the  extraction  of  a 


EXTRACTION    OF    TEETH.  403 

lower  molar  or  bicuspid  locked  in  the  manner  just  described.  It 
sometimes,  though  less  frequently,  happens  that  the  upper  teeth  im- 
pinge upon  each  other  in  the  same  manner ;  in  this  case,  also,  the 
adjoining  tooth  should  be  filed  sufficiently  to  liberate  the  one  that  is  to 
be  extracted  before  attempting  its  removal.  In  applying  forceps  to  an 
inferior  molar,  the  points  on  the  beak  of  the  instrument  should  be 
forced  down  between  the  roots  ;  after  having  obtained  a  firm  hold,  the 
tooth  should  be  forced  outward  and  inward  several  times  in  quick  suc- 
cession, until  its  connection  with  the  jaw  is  partially  broken  up,  and 
then  raised  from  the  socket.  If  the  tooth  has  decayed  down  to  the 
neck,  the  points  of  the  beak  may  include  the  upper  edge  of  the  alve- 
olus, through  which  they  will  readily  pass,  on  applying  pressure  to  the 
handles,  and  in  this  manner  a  secure  hold  will  be  obtained  upon  the 
tooth.  The  same  should  also  be  done  in  the  extraction  of  a  superior 
molar  in  this  condition. 

The  dentes  sapientise  in  the  lower  jaw,  when  situated  far  back  under 
the  coronoid  processes,  are  oftentimes  exceedingly  difficult  to  extract ; 
but  with  forceps  like  those  represented  in  Fig.  143  they  may  always 
be  grasped  by  an  expert  operator,  except  in  those  cases  where  their 
crowns  have  been  destroyed  by  caries,  when  a  portion  of  the  alveolus 
should  be  cut  away,  either  with  forceps  or  a  strong  sharp-pointed 
instrument,  previously  to  attempting  their  removal.  It  occasionally 
happens  that  the  roots  of  these  teeth  are  bent  in  such  a  manner  as  to 
constitute  a  considerable  obstacle  to  their  removal.  But  when  this  is 
the  case,  the  roots  are  almost  always  turned  posteriorly  toward  the 
coronoid  processes  ;  so  that  after  starting  the  tooth,  if  the  operator  is 
unable  to  lift  it  perpendicularly  from  the  socket,  he  will  have  reason 
to  suspect  its  retention  to  be  owing  to  an  obstacle  of  this  nature.  To 
overcome  this,  as  he  raises  his  hand,  he  should  push  the  crown  of  the 
tooth  backward,  making  it  describe  the  segment  of  a  circle;  for  should 
he  persist  in  his  efforts  to  remove  it  directly  upward,  the  root  will  be 
broken  and  left  in  the  jaw.  Fig.  149  represents  an  elevating  forcep 
useful  in  removing  the  dentes  sapientise  when  they  are  but  partially 
erupted  or  badly  decayed. 

It  sometimes  happens  that  the  roots  of  the  first  and  second  molars 
of  both  jaws,  and  those  of  the  superior  dentes  sapientise,  are  bent,  or 
else  diverge  or  converge  so  much  as  to  render  their  extraction  exceed- 
ingly difficult.  The  convergency  of  these  roots  is  often  so  great  that; 
in  their  removal,  the  intervening  wall  of  the  alveolus  is  brought  away; 
but  neither  from  this,  nor  from  the  removal  of  a  portion  of  the  ex- 
terior wall,  will  any  unpleasant  results  follow.  Similar  malformations 
are  occasionally  met  with  in  the  roots  of  the  bicuspids,  the  cuspids, 
and  even  the  incisors. 


404 


EXTRACTION    OF    TEETH. 


Other  obstacles  sometimes  present  themselves  in  the  extraction  of 
teeth,' which  the  judgment  and  tact  of  the  operator  alone  will  enable 
him  to  overcome.  The  nature  and  peculiarity  of  each  case  will  sug- 
gest the  method  of  procedure  most  proper  to  be  pursued.  The  dentist 
should  never  hesitate  to  embrace  a  portion  of  the  alveolus  between  the 
jaws  of  the  forceps,  when  necessary  to  enable  him  to  obtain  a  firm 
hold  upon  the  tooth.  The  removal  of  the  upper  edge  of  the  socket  is 
never  productive  of  injury,  as  it  is  always  subsequently  removed,  more 
or  less  rapidly,  by  the  process  of  absorption.  When  the  crown  of  a 
tooth  has  become  so  much  weakened  by  disease  that  it  will  not  bear 
the  pressure  of  the  instrument,  it  may  be  removed  in  this  manner 
without  inflicting  upon  the  patient  half  the  pain  that  would  be  caused 
by  the  attempt  to  spare  the  thin,  perishable  alveolar  walls. 


MANNER   OP    EXTRACTING   ROOTS   OF   TEETH. 

The  extraction  of  roots  of  teeth  is  sometimes  attended  with  con- 
siderable difficulty ;  but  generally  they  are  more  easily  removed  than 
the  whole  teeth,  especially  the  roots  of  the  molars ;  for,  after  the  de- 
struction of  their  crowns,  an  effort  is  usually  made  by  the  economy 
to  expel  them  from  the  jaws.  This  is  done  by  the  gradual  absorption 
of  the  alveolus,  together  with  the  filling  up  of  the  socket  by  a  depo- 
sition, of  ossific  matter  at  the  bottom  ;  whereby  the  articulation  of  the 
root  becomes  weakened,  and  its  removal  rendered  proportionably 
easier-  The  alveolar  cavities  are  often  wholly  obliterated  in  the 
course  of  two  or  three  years  after  the  destruction  of  the  crowns  of  the 
teeth,  and;  the  roots  retained  in  the  mouth,  simply  by  their  connection 
with  the  gums  ;  so  that  for  their  removal  little  more  is  necessary  than 
to  sever  this  bond  of  union  Avith  a  lancet  or  shai-p-pointed  knife. 

The  instruments  usually  employed  in  the  extraction  of  roots  of 
teeth  are  the  hook,  punch,  elevator,  and  screw,  all  of  which  are  rep- 
resented in  Figs.  158  and  159.  Although  every  dentist  has  them 
made  to  suit  his  own  peculiar  notions,  the  manner  of  using  them,  and 
the  principle  upon  which  they  act,  are  the  same.  It  will,  therefore, 
be  sufficient  to  say  that  they  should  be  of  a  convenient  size,  made  of 
good  steel,  and  so  tempered  as  neither  to  bend  nor  break. 

Fig.  158. 


EXTRACTION    OF    TEETH. 


405 


The  hook  a,  Fig.  158,  is  chiefly  used  for  the  extraction  of  the  roots 
of  molar  and  bicuspid  teeth  on  the  left  side  of  the  mouth  ;  the  punch 


Fig.  159, 


h,  Fig.  158,  for  the  removal  of  those  on  the  right  side ;  the  elevator 
e.  Fig.  159,  for  the  extraction  of  roots  on  either  side,  as  occasion  may 
require ;  and  the  screw  d,  Fig.  159,  for  the  removal  of  those  of  the 
upper  front  teeth. 

Considerable  tact  is  necessary  for  the  skilful  use  of  these  instru- 
ments, and  this  can  only  be  obtained  by  practice.  Great  care  is  requi- 
site in  using  the  punch  and  elevator  to  prevent  them  from  slipping, 
and  injuring  the  "mouth  of  the  patient.  Whenever,  therefore,  either 
of  these  are  used,  the  forefinger  of  the  left  hand  of  the  operator 
should  be  wrapped  with  a  napkin  and  placed  on  the  side  of  the  root 
opposite  to  that  against  which  the  instrument  is  applied,  so  as  to 
catch  the  point  in  case  it  should  slip. 

But  for  the  removal  of  the  roots  of  bicuspids  and  molars,  and  often 
for  those  of  the  cuspids  and  incisors,  the  narrow-beaked  forceps,  recom- 
mended for  the  extraction  of  the  lower  incisors  (see  Fig.  143),  may  be 
used  more  efiectively  than  any  other  instrument.  When  the  root  is 
<lecayed  down  to  the  alveolus,  the  gum  should  be  separated  from  it, 
■  tnd  so  much  of  it  as  may  be  necessary  to  obtain  a  secure  hold  upon 
ihe  root  included  between  the  beaks  of  the  forcep ;  for  these,  being 
very  narrow,  readily  pass  through  the  alveolus,  and  a  firm  hold  is  at 
once  obtained  upon  the  root;  then,  after  moving  it  a  few  times,  out- 
ward and  inward,  it  may  easily  be  removed  from  its  socket. 

There  are  some  cases,  however,  in  which  the  punch,  hook,  and  ele- 
vator may  be  advantageously  used.  We  have  also  occasionally  met 
with  cases  where  we  have  succeeded  in  removing  roots  of  teeth  with 
great  ease  by  means  of  an  elevator  shaped  like  the  blade  of  a  knife, 
first  forcing  it  into  the  socket  by  the  side  of  the  root,  and  then  turning 
it  so  as  to  make  tliB  back  press  against  the  former  and  the  edge  against 
the  latter.  When  this  instrument,  represented  in  Fig.  160,  is  used, 
the  blade  should  not  be  more  than  an  inch  in  length,  and  it  should  be 
straight,  short  at  the  point,  and  have  a  very  thick  back,  that  it  may 


406 


EXTRACTION    OF    TEETH. 


not  break  in  the  operation.     In  using  the  common  elevator,  it  is  neces« 
sary  that  there  should  be  an  adjoining  tooth  or  root  to  act  as  a  fulcrum. 


Fig.  100. 


When  this  can  be  employed,  a  root,  or  even  a  ^vhole  tooth,  may  some- 
times be  removed  with  it ;  but,  as  a  general  rule,  forceps  should  be 
preferred  to  any  of  these  instruments. 

For  the  extraction  of  the  roots  of  the  upper  front  teeth,  after  they 
have  become  so  much  funnelled  out  by  decay  as  to  render  their  walls 
incapable  of  sustaining  the  pressure  of  forceps,  the  conical  screw  is  inval- 
uable. With  this  a  sufficiently  firm  hold  for  the  removal  of  the  root 
can  be  obtained  by  screwing  it  into  the  cavity.  But  before  it  is  intro- 
duced, the  soft  decomposed  dentine  should  be  removed  from  the  inte- 
rior of  the  root  with  a  triangular-pointed  instrument  like  the  one 
represented  in  Fig.  161. 

Fig.  161. 


Dr.  S.  P.  Hullihen  has  invented  a  most  valuable  and  useful  instru- 
ment for  the  removal  of  the  roots  of  the  superior  incisors  and  cuspids 
when  in  the  condition  just  described.-  It  combines  the  advantages  both 
of  the  screw  and  forceps,  as  may  be  seen  by  the  accompanying  cut. 
It  is  thus  described  by  the  author:  "Lengthwise,  within,  and  between 
the  blades  of  the  beak  is  a  steel  tube,  one  end  of  w^hich  is  open,  the 
other  solid  and  flat,  and  jointed  in  a  mortice  in  the  male  part  of  the 
joint  of  the  forceps.  When  the  forceps  are  opened,  this  joint  permits 
the  tube  to  fall  backward  and  forward  from  one  blade  of  the  beak  to 
the  other,  without  any  lateral  motion.  Within  this  tube  is  a  spiral 
spring,  which  forces  a  shaft  up  two-thirds  of  the  tube,  the  other  part 
is  a  well-tapered  or  conical  screw.  .  .  The  shaft  and  tube  are  so  fitted 

together,  and  to  the  beak 
Fig.  162.  of  the  forceps,  that  one- 

half  of  the  rounded  part 
of  the  shaft  projects  be- 
yond the  end  of  the  tube, 
so  that  the  shaft  may  play 
up  and  down  upon  the 
spring  about  half  an  inch, 


EXTEACTION    OF    TEETH. 


407 


and  the  screw  or  shaft  be  embraced  between  the  blades  of  the  beak  of 
the  instrument." 

Dr.  Hullihen's  instrument  is  represented  in  Fig.  162. 

"The  forceps,"  says  Dr.  H.,  "are  used  by  first  embracing  the  shaft 
between  the  blades.*  Then  screwing  it  as  gently  and  deeply  into 
the  root  as  possible,  the  blades  are  opened,  and  pushed  up  on  the  root, 
which  is  then  seized  and  extracted.  The  screw  thus  combined  with 
the  forceps,  prevents  the  root  from  being  crushed.  It  acts  as  a  powerful 
lever  when  a  lateral  motion  is  given;  it  is  likewise  of  advantage  when 
a  rotary  motion  is  made ;  it  prevents  the  forceps  from  slipping  or  from 
losing  their  action  should  one  side  of  the  root  give  way  in  the  act  of 
extracting  it;  and  is  used  with  equal  advantage  where  one  side  of  the 
root  is  entirely  gone." 

The  opportunities  which  the  author  has  had  of  testing  the  value  of 
this  instrument,  have  been  sufficient  to  justify  him  in  stating  that  its 
merits  are  not  overrated  by  the  inventor.  Every  practitioner  would, 
therefore,  do  well  to  provide  himself  with  one  of  them. 

Fig.  163. 


Fig.  163  represents  Dubs'  screw  forceps :  1.  Conical  screw,  with 
square  ratchet  shaft.  2.  Beaks  of  forceps,  grooved  inside.  3.  Socket, 
with  square  hole  to  receive  shaft.  4.  Spring  trigger,  by  which  the 
screw  can  be  detached  at  pleasure  at  any  given  point. 

For  the  extraction  of  the  roots  of  the  upper  molars,  before  they 
have  become  separated  from  each  other  by  decay,  the  forceps  f  Fig. 
164),  invented  by  Dr.  Maynard,  will  be  found  highly  valuable.  The 
outer  beak  of  each  instrument  is  brought  to  a  sharp  point,  for  per- 
forating the  alveolus  between  the  buccal  roots,  and  for  securing  between 
them  a  firm  hold,  while  the  inner  beak  is  intended  to  rest  upon  the 
edge  of  the  alveolus  and  embrace  the  palatine  root.  By  this  means 
a  sufficiently  firm  hold  is  secured  to  enable  the  operator  to  remove  the 
roots  of  an  upper  molar  without  difficulty.     Two  pairs,  as  represented 

*  The  author  has  a  pair  constructed  so  that  the  blades  of  the  beak  of  the  forceps 
gi'asp  the  upper  extremity  of  the  screw  instead  of  the  shaft. 


408 


EXTRACTION    OF    TEETH. 
Fig.  164. 


in  the  engraving,  one  for  the  right  and  one  for  the  left  side,  are  re- 
quired. The  advantage  to  be  derived  from  forcejDS  of  this  description 
must  be  apparent  to  every  dentist. 


EXTRACTION  OF  THE  TEMPORARY  TEETH. 

The  temporary  teeth  should  be  extracted  in  the  same  manner  as  the 
permanent,  and  with  the  same  instruments.  If  the  power  be  properly 
directed,  very  little  force  is  required  for  their  removal  ;  because  tlie 
roots  of  these  teeth  have  generally  suffered  more  or  less  loss  of  sub- 
stance before  the  operation  is  called  for ;  and  when  they  remain,  the 
alveolar  processes,  at  this  early  age,  are  so  soft  and  yielding  as  to  offer 
little  resistance  to  the  tooth. 

The  operator  should  be  careful  not  to  injure  the  pulps  of  the  perma- 
nent teeth,  or  the  jaw-bone.  Serious  accidents  sometimes  occur  from 
an  improper  or  awkward  removal  of  these  teeth.  But,  as  has  been 
before  remarked,  their  extraction  is  seldom  required.  It  should  only 
be  resorted  to  for  the  relief  of  toothache,  the  cure  of  alveolar  abscess,  to 
prevent  irregularity  in  the  permanent  teeth,  or  in  case  of  necrosis  of 
the  socket.  And  even  in  such  cases  it  is  necessary  to  exercise  much 
judgment  in  deciding  how  far  pain  and  inconvenience  should  be  en- 
dured rather  than  extract  the  offending  tooth  ;  or  how  far  the  chance 
of  injury  to  the  permanent  teeth  demands  the  removal  of  the  diseased 
milk  teeth.  Their  premature  extraction  is  so  often  followed  by  a 
crowded  state  of  the  permanent  teeth,  that  their  indiscriminate  removal, 
for  trifling  causes,  cannot  be  too  strongly  condemned. 

HEMORRHAGE   AFTER   EXTRACTION. 

It  rarely  happens  that  excessive  hemorrhage  follows  the  extraction 
of  a  tooth.     Indeed,  it  is  oftener  more  desirable  to  promote  bleeding 


EXTRACTION    OF    TEETH.  409 

by  rinsing  the  mouth  with  warm  water  than  to  attempt  its  suppression. 
Nevertheless,  cases  do  sometimes  occur  in  which  it  becomes  excessive 
and  alarming.  It  has  been  known,  ia  some  instances,  to  terminate 
fatally  ;  this,  however,  does  not  appear  to  be  dependent  upon  the  man- 
ner in  which  the  operation  is  performed,  but  rather  upon  a  hemor- 
rhagic diathesis  of  body,  attributable  to  a  deficiency  in  the  coagulating 
property  of  the  blood.  Hence,  whenever  a  tendency  to  it  exhibits  it- 
self in  one  member  of  a  family,  it  is  usually  found  to  exist  in  all.  Of 
the  many  cases  which  have  fallen  under  our  own  observation,  we  shall 
mention  only  the  following  : 

In  the  fall  of  1834,  Miss  I.,  fifteen  years  of  age,  had  the  second 
molar  on  the  left  side  of  the  upper  jaw  removed.  The  hemorrhage, 
immediately  after  the  operation,  was  not  greater  than  usually  occurs, 
and  in  the  course  of  half  or  three-quarters  of  an  hour  it  ceased  alto- 
gether. But  at  about  twelve  o'clock  on  the  following  night  it  com- 
menced again,  the  blood  flowing  so  profusely  as  to  excite  considerable 
alarm.  A  messenger  was  immediately  sent  to  ask  our  advice,  and  we 
directed  that  the  alveolar  cavities  should  be  filled  with  pledgets  of 
lint,  saturated  with  tincture  of  nutgalls.  Two  days  after,  at  about 
six  o'clock  in  the  morning,  we  were  hastily  sent  for  by  the  young  lady's 
mother,  and  when  we  arrived  at  her  residence,  we  were  informed  that 
the  bleeding  had  then  been  going  on  for  about  four  hours.  During  this 
time  more  than  two  quarts  of  blood  had  been  discharged.  The  blood 
was  still  oozing  very  fast.  After  we  had  removed  the  coagulum,  we 
filled  the  socket  with  pieces  of  sponge,  saturated,  as  the  lint  had  been, 
with  tincture  of  nutgalls.  When  firmly  pressed  in,  and  secured  by  a 
compress,  the  hemorrhage  ceased.  These  were  permitted  to  remain 
until  they  were  expelled  by  the  suppurative  and  granulating  processes. 
We  afterward  had  occasion  to  extract  one  tooth  for  a  sister,  and  two 
for  the  mother  of  the  young  lady,  and  a  hemorrhage,  similar  to  that 
just  described,  occurred  in  each  case. 

We  have  had  perhaps  some  thirty  or  forty  cases  of  this  description, 
but  never  found  it  necessary,  except  in  one  instance,  to  adopt  any 
other  course  of  treatment  than  that  described  in  the  case  just  narrated. 
More  powerful  remedies,  however,  are  sometimes  employed.  Some 
use  a  solution  of  the  sulphate  of  copper,  or  of  the  nitrate  of  silver, 
while  others  employ  the  actual  cautery.  Tannic  acid  is  an  excellent 
styptic,  and  will  answer  well  in  combination  with  tlie  compress  of 
lint  or  cotton  for  most  cases.  For  more  obstinate  cases  the  persul- 
phate of  iron  will  be  found  to  be  the  most  potent  styptic  of  the  ma- 
teria medica.  But  if  pressure  be  so  applied  as  to  act  directly  upon 
the  mouths  of  the  bleeding  vessels,  it  will  almost  always  arrest  the 


410  USE    OF    ANAESTHETIC    AGENTS. 

hemorrhage.  Tlie  author  has,  in  two  cases,  found  it  necessary  to  have 
recourse  to  the  actual  cautery. 

The  following  case  is  quoted  by  Dr.  Fitch,  from  "  Le  Dcntiste  Ob- 
servateur,  par  H.  G.  Courtois,"  Paris,  1775: 

"  A  person  living  in  Paris  called  on  me  to  extract  a  canine  tooth 
for  him.  On  examining  his  mouth,  I  thought  that  the  man  was 
attacked  with  scurvy  ;  but  this  did  not  seem  sufficient  to  hinder  the 
patient  from  having  his  tooth  extracted ;  nor  would  he  consent  to  its 
remaining,  on  account  of  the  pain  which  it  gave  him.  After  the  tooth 
was  extracted,  it  did  not  appear  to  me  that  it  bled  more  profusely  than 
is  customary  after  similar  operations.  The  following  night  I  was  called 
upon  to  see  the  patient,  who  had  continued  to  bleed  ever  since  he  left 
me.  I  employed,  for  stopping  this  hemorrhage,  agaric  from  the  oak 
bark,  which  I  commonly  used  with  success.  The  following  day  I  was 
again  sent  for ;  the  bleeding  still  continued.  After  having  disbur- 
dened the  mouth  of  all  the  lint-pledgets,  which  I  used  for  making 
compression  at  the  place  where  the  blood  appeared  to  come  from,  I 
made  the  patient  take  some  mouthfuls  of  water  to  clear  his  mouth  of 
all  the  clots  of  blood  with  which  it  was  filled  ;  I  perceived  then  that 
the  blood  came  no  longer  from  the  place  wdiere  I  had  extracted  the 
tooth,  but  from  the  gums  ;  there  was  not  a  single  place  in  the  whole 
mouth  from  which  the  blood  did  not  issue.  I  called  in  the  physician, 
who  ordered  several  bleedings  in  succession,  besides  astringents,  taken 
internally,  and  gargles  of  the  same  nature;  but  all  these  attempts  to 
improve  the  coagulability  of  the  blood  were  made  to  no  pui'pose.  It 
was  not  possible  to  stop  the  hemorrhage.  The  patient  died  the  ninth 
or  tenth  day  after  the  extraction  of  the  tooth." 

Mr.  Snell  mentions  a  similar  case,  which  also  terminated  fatally. 


CHAPTER  VII. 


THE   USE   OF   AN-a:STHETIC  AGENTS   IN   THE   EXTRACTION   OF 

TEETH. 

OF  the  various  agents  that  have  been  employed  for  the  prevention 
of  pain  during  surgical  operations,  sulphuric  ether  and  chloroform 
have  proven  more  successful  and  been  more  generally  used  than  any 
others.  The  practicability  of  producing  anaesthesia  with  ether  was 
first  demonstrated  by  Dr.  Horace  Wells,  of  Hartford,  Conn.,  in  1846, 
and  soon  afterward  brought  prominently  before  the  medical  and  dental 


USE    OF    ANESTHETIC    AGENTS.  411 

professions  by  Dr.  W.  G.  S.  Morton,  of  Boston,  Mass.,  both  practical 
dentists;  and  Avith  chloroform,  in  1847,  by  Prof  J.  Y.  Simpson,  ot 
Edinburgh,  Scotland.  The  anaesthetic  effect  is  obtained  by  inhalation 
of  the  vapor,  and  is  supposed  to  be  nothing  more  than  a  transient  state 
of  intoxication,  which  usually  disappears  almost  immediately  after 
the  discontinuance  of  the  administration,  though  in  many  cases  it  has 
proved  fatal.  For  this  reason,  we  do  not  think  that  agents  capable 
of  producing  such  powerful  and  dangerous  effects  as  ether  and  chlo- 
roform should  bs  used  in  so  simple  an  operation  as  the  extraction  of 
a  tooth.  The  first,  however,  is  less  dangerous  than  the  second ;  but 
its  ansesthetic  effect  is  less  certain  and  prompt,  from  seven  to  ten 
minutes  being  usually  required,  whereas,  with  the  other,  it  is  obtained 
in  from  thirty  seconds  to  two  minutes.  When  ether  is  used,  from  six 
to  ten  or  fifteen  ounces  are  employed  ;  but  with  chloroform,  it  is  rarely 
necessary  to  administer  more  than  from  thirty  to  one  hundred  and 
fifty  drops.  What  we  have  said  about  sulphuric  ether  applies  equally 
to  chloric  ether,  a  substance  very  extensively  used,  if  not  first  proposed, 
by  the  late  Prof.  Warren,  of  Boston. 

A  number  of  instruments  have  been  gotten  up  for  the  inhalation  of 
the  vapor  of  these  agents;  but  the  simplest  and,  we  think,  the  best 
method  of  administration  is  from  a  hollow  sponge,  a  napkin,  or  a 
j)Ocket-handkerchief. 

It  may  not  always  be  possible  for  any  one,  in  the  administration  of 
either  of  the  foi'egoing  agents,  even  to  a  person  supposed  to  be  free 
from  any  special  proclivity  to  disease  from  organic  derangement,  to 
pronounce,  cL  priori,  that  no  bad  effect  will  result  from  it ;  but  all 
agree  that  it  is  unsafe  to  give  it  to  a  patient  laboring  under  disease 
of  the  heart,  brain,  or  lungs.  The  practitioner,  therefore,  whether 
medical  or  dental,  should  be  well  assured,  before  giving  ether  or  chlo- 
roform, and  especially  the  latter,  that  these  organs  are  not  only  free 
from  disease,  but  also  from  any  morbid  tendency,  as  ignorance  with 
regard  to  this  matter  might  lead  to  fatal  consequences.  It  should  be 
given  cautiously  under  any  circumstances,  and  the  pulse  should  never 
be  permitted  to  fall,  during  the  inhalation,  below  sixty,  or,  at  most, 
fifty-five  beats  a  minute  ;  but  if  from  carelessness,  or  any  other  cause, 
the  patient  should  sink  and  the  pulsation  cease,  the  agent  should  be 
immediately  removed  from  the  mouth,  and  if  occupying  a  sitting 
posture,  he  should  be  placed  in  a  reclining  position,  air  freely  admitted, 
cold  water  dashed  in  the  face,  the  feet  and  hands  rubbed  with  hot  salt 
or  mustard,  and,  if  necessary,  artificial  respiration  made  and  galvanism 
applied.  In  addition  to  these  means  the  tongue  should  be  depressed 
and  drawn  forward  by  a  finger  thrust  deeply  into  the  mouth,  as  recom- 
mended by  Ricord;  or  Dr.  Marshall's  "ready  method"  may  be  faith- 


412  USE    OF    ANESTHETIC    AGENTS. 

fully  and  patiently  practised.  Ellis  gives  the  following  simplified 
formula  of  this  method  for  cases  of  asphyxia  from  drowning :  "  In- 
stantly place  the  patient  on  the  face  and  side,  supporting  the  head. 
Unfasten  the  clothes  about  the  neck  and  chest,  braces,  etc.  Wipe 
and  clean  the  mouth  and  nostrils.  Raise  and  support  the  chest  on 
a  folded  coat  or  bundle.  Roll  the  patient  constantly  and  gently  from 
the  face  to  the  side,  and  back  again,  occasionally  changing  the  side, 
supporting  the  head.  On  the  completion  of  each  turn  to  the  face 
make  a  brisk  pressure  on  the  back,  between  and  below  each  shoulder- 
blade.      Dry  and  rub  the  patient  briskly,  rubbing  upward." 

It  is  thought  by  those  who  have  had  most  experience  in  the  use  of 
ether  and  chloroform  as  autesthetic  agents  that  their  administration 
is  attended  with  less  danger  when  the  patient  is  in  a  reclining  than 
when  in  a  sitting  posture.  It  would  be  well,  therefore,  when  either  is 
used  preparatory  to  the  extraction  of  teeth,  to  place  the  patient  as 
nearly  as  possible  in  such  a  position  ;  Avhen  the  dentist  is  provided 
with  an  operating  chair  having  a  movable  back  this  can  be  very 
readily  done. 

The  aniesthetic  effect  of  nitrous  oxide,  or  laughing  gas,  was  first 
suggested  by  Sir  Humphrey  Davy,  iu  1776,  and  practically  demon- 
strated by  Dr.  Horace  Wells.  This  gas  is  manufactured  from  the 
salt  nitrate  of  ammonia,  either  in  a  fused  or  granulated  form,  by 
slowly  melting  and  boiling  it  in  a  glass  retort,  over  a  sand  bath,  until 
nearly  all  of  the  nitrate  is  decomposed.  The  gas,  on  leaving  the  retort, 
passes  through  several  wash  bottles,  one  of  which  contains  either  a 
solution  of  the  sulphate  of  iron  or  caustic  potash,  and  the  other  two 
pure  water,  for  the  purpose  of  purifying  it  before  it  enters  a  holder  and 
receiver,  from  which  it  is  administered  to  the  patient  by  means  of  an 
inhaling  tube.  One  pound  of  the  granulated  nitrate  of  ammonia  will 
produce  about  thirty  gallons  of  the  gas,  which  should  be  administered 
to  the  patient  in  a  pure  state  —  unmixed  with  atmospheric  air. 

Fig.  165  represents  a  nitrous  oxide  gas  apparatus. 

In  administering  this  gas  for  dental  operations,  the  patient  is  seated 
in  an  operating  chair  with  a  movable  back,  a  cork  or  piece  of  wood 
to  which  a  string  is  attached  placed  between  the  jaws,  and  the  mouth- 
piece of  the  inhaler  between  the  lips,  which  he  is  directed  to  close 
tightly  around  it.  The  operator,  who  occupies  a  position  -on  the  right 
side  of  the  patient,  supports  the  inhaler  with  his  right  hand,  some  of 
the  fingers  of  which  press  the  lower  lip  tightly  about  the  mouth-piece. 
The  thumb  and  index-finger  of  the  left  hand  close  the  nostrils,  while 
the  remaining  fingers  press  the  upper  lip  about  the  mouth-piece  of  the 
inhaler.     The  patient  is  then  instructed  to  make  long,  but  at  the  same 


USE    OF    ANESTHETIC    AGENTS. 


413 


time  natural,  inspirations,  one  of  the  valves  of  the  inhaler  permitting 
the  exhalations  to  pass  off. 

Fig.  165. 


After  thus  inhaling  the  gas  for  a  few  minutes,  its  ansesthetic  effects 
are  shown  by  strong  involuntary  respirations  attended  by  a  snoring 
sound,  owing  to  the  relaxation  of  the  muscles  of  the  pharynx.  Then 
follows  a  livid  appearance  of  the  lips,  from  the  discolored  blood  in  the 
capillaries.  A  spasmodic  twitching  of  the  muscles  is  observed  at  this 
stage  in  many  patients,  when  complete  narcosis  follows.  The  narcotic 
effects  of  the  gas  continue  from  thirty  seconds  to  one  and  a  half  minutes. 


414  USE    OF    ANESTHETIC    AGENTS. 

and  the  number  of  teeth  which  can  be  extracted  varies  from  four  to 
twelve.  It  is  no  unusual  occurnuice,  however,  for  the  extraction  of 
one  tooth  to  consume  the  entire  time  the  patient  is  under  the  narcotic 
influence  of  the  gas,  while,  in  other  cases,  more  than  the  highest  number 
just  mentioned  may  be  removed  before  the  patient  becomes  conscious 
to  pain.  Nitrous  oxide  gas  is  considered  to  be  the  safest  general  anses- 
tlietic  now  in  use,  and  does  not  produce  the  nauseating  and  debilita- 
ting effects  wliich  are  often  caused  by  ether  and  chloroform.  Ex- 
treme caution,  however,  is  necessary  in  administering  this  gas  under 
circumstances  which  prohibit  the  use  of  other  general  ansesthetic 
agents.  The  greatest  objection  to  its  use,  aside  from  the  question  of 
safety,  is  the  rapidity  in  operating  which  its  transient  effect  necessitates; 
and  it  is  much  better  to  carefully  extract  a  few  teeth  than  to  attempt 
the  removal  of  many  by  an  operation  which  may  be  attended  with 
severe  laceration  of  the  gums  and  fracture  of  the  alveolus. 

Several  years  since,  Dr.  B.  "\V.  Richardson,  of  London,  introduced 
an  anaesthetic  agent,  known  as  the  bichloride  of  methylene,  which  is 
formed  by  the  action  of  sulphuric  acid  on  zinc  in  chloroform.  It  dif- 
fers, however,  from  chloroform  in  the  circumstance  that  one  atom  of 
chlorine  is  replaced  by  one  atom  of  hydrogen.  Bichloride  of  methy- 
lene produces  as  great  a  degree  of  insensibility  as  chloroform,  and  its 
action  is  more  rapid  and  the  narcotism  very  prolonged.  It  also  inter- 
feres less  with  muscular  irritability  than  either  ether  or  chloroform, 
and  the  recovery  from  its  effects  is  sudden,  but  more  of  it  is  required. 
When  it  destroys  life,  as  it  has  in  several  cases,  the  respiring  and  cir- 
culating functions  are  equally  paralyzed. 

Considerable  interest  has  of  late  been  manifested  in  an  an£Bsthetic 
compound  known  as  the  hydrate  of  chloral.  Chloral  is  by  no  means 
a  new  ansesthetic,  Liebig  having  discovered  it  in  1830 ;  but,  as  Dr.  B. 
"\V.  Eiehardson  states,  the  introduction  of  it  into  medicine  is  a  fact  of 
the  present  year,  its  introducer  being  Liebreich,  of  Berlin. 

The  hydrate  is  made  from  the  chloral  by  the  simple  addition  of  a 
little  water,  and  on  the  application  of  heat  solidifies  into  a  white  crys- 
talline substance. 

The  manner  in  which  hydrate  of  chloral  is  administered  is  in  solu- 
tion with  Avater,  either  by  the  mouth  directly  into  the  stomach,  or  by 
subcutaneous  injection.  The  best  solution  is  made  by  mixing  one  grain 
of  the  hydrate  with  two  of  water.  Dissolved  in  an  excess  of  water,  the 
taste  is  agreeable,  with  the  odor  of  a  ripe  melon.  It  is  administered 
to  human  subjects  in  doses  varying  from  twenty-five  to  thirty  grains, 
causing  unconsciousness  to  pain,  and  a  profound  sleep  lasting  over  sev- 
eral hours.  The  sleep  is  gentle  and  quiet,  induced  without  distress, 
and  leaving  no  other  symptom  behind  except  nausea,  which  is  occa- 


USE    OF    ANESTHETIC    AGENTS, 


415 


sionally  experienced  after  recovery.  In  administering  this  agent,  it 
appears  to  act  more  promptly  when  subcutaneously  injected  than  when 
administered  directly  by  the  mouth ;  and  as  chloral  dissolved  in  water 
is  slightly  caustic,  it  cannot  be  administered  by  the  mouth  when  there 
are  lesions  of  mucous  membrane  or  ulcerated  tracts  of  intestinal  canal. 
In  administering  hydrate  of  chloral  to  the  human  subject.  Dr.  Richard- 
son states  that  allowance  will  have  to  be  made  not  only  in  relation  to 
size  and  weight,  but  to  obesity  or  leanness,  to  natural  habit  and  actual 
state  of  body  in  respect  to  sensibility. 

Fig.  166. 


Fig.  166  represents  the  full  size  of  a  hypodermic  syringe  with  grad- 
uated rod  and  steel  points. 

Suspension  of  nervous  sensibility,  induced  by  inhaling  the  vapor  of 
the  above-mentioned  agents,  is  general,  every  part  of  the  body  being 
affected  alike;  but  partial  or  local  anaesthesia  may  be  procured  by 
other  and  less  dangerous  means.  Congelation  or  freezing,  first  pro- 
posed and  employed  in  the  Charite  Hospital,  Paris,  by  an  interne  of 
M.  Velpeau,  and  subsequently  recommended  by  Dr.  James  Arnott, 
of  London,  has  been  resorted  to  for  several  years,  both  by  surgeons 
and  dentists,  and  practised  to  a  limited  extent,  with  some  success. 
This  may  be  effected  by  applying  a  mixture  of  pounded  ice  and  com- 
mon salt,  in  the  proportion  of  two  or  three  parts  of  the  former  to  one 
of  the  latter,  to  the  part  on  which  the  operation  is  to  be  performed. 
But  in  the  use  of  this,  care  is  necessary  to  prevent  reducing  the  tem- 
perature too  much,  as  in  this  case  loss  of  vitality  would  be  occasioned 
by  it.  "We  have  heard  of  a  few  cases  in  which  this  has  occurred,  but 
we  believe  it  was  owing,  in  every  instance,  to  carelessness  or  want  of 
judgment  on  the  part  of  the  operator  as  to  the  length  of  time  the 
application  of  the  mixture  should  be  continued. 

Several  instruments  have  been  invented  for  the  application  of  the 
freezing  rnixture  to  teeth  preparatory  to  extraction.  The  one  which 
we  consider  best  adapted  for  the  purpose  was  designed  by  Dr.  Branch, 
of  Chicago,  111.  It  consists  of  a  hollow  tube  about  an  inch  or  a  little 
more  in  diameter,  with  about  five-eighths  of  an  inch  cut  out  at  one  end 


416  USE    OP    ANESTHETIC    AGENTS. 

on  either  side,  that  it  may  readily  be  placed  over  a  tooth.  To  this  is 
attached  a  sac  of  finely-prepared  moinl)raiie  large  enough  to  hold  a 
table-spoonful  of  the  mixture.  The  hollow  of  the  tube  is  occupied  by 
a  steel  wire  spiral  spring.  Just  before  using  it,  a  sufficient  quantity 
of  the  freezing  mixture  is  put  in  the  tube;  the  end  of  the  latter  is 
placed  over  the  tooth,  when  the  ice  and  salt  are  forced  up  gently 
around  it  by  pressing  on  the  spring  at  the  other  extremity  of  the 
instrument.  Two  tubes  are  employed,  one  straight  for  teeth  in  the 
anterior  part  of  the  mouth,  the  other  bent  near  one  end  for  the  more 
convenient  application  of  the  mixtui-e  to  a  molar  tooth. 

The  sudden  application  of  such  intense  cold  to  a  sensitive  tooth,  or 
to  one  which  has  not  lost  its  vitality,  is  often  productive,  at  first,  of 
severe  pain ;  on  this  account  many  object  to  the  use  of  it,  j-jreferring 
the  momentary  suffering  consequent  upon  the  operation  of  extraction 
than  that  occasioned  by  the  freezing  mixture.  But  this  effect  is  rarely 
experienced  in  its  use  on  dead  teeth  or  the  roots  of  teeth  wliich  have 
lost  their  vitality;  hence,  the  application  of  it  has  to  such  proved  more 
satisfactory  than  to  living  teeth. 

^Y'lth  the  view  of  obviating  the  above  objection  to  the  use  of  cold 
as  an  ancesthetic  agent,  Messrs.  Home  and  Thornthwaite,  opticians, 
at  the  suggestion  of  Mr.  Blundell,  dentist,  of  London,  contrived  and 
constructed  an  apparatus  by  which  the  temperature  may  be  gradually 
diminished  ;  say  from  98°,  or  blood  heat,  down  to  zero,  or  any  required 
degree,  thus  preventing  the  pain  consequent  upon  the  sudden  applica- 
tion of  the  freezing  agent.  The  apparatus  is  thus  described:  "The 
required  amount  of  water  is  cooled  down,  by  means  of  ice  and  salt,  to 
about  zero,  in  a  vessel  called  the  refrigerator.  To  this  vessel  is  attached 
another,  called  a  graduator,  containing  warm  water  at  about  100°,  and 
so  constructed  as  to  allow  the  slow^  admixture  of  its  contents  with  the 
chilled  water  in  the  refrigerator,  and  thus  produce  a  gradually  dimin- 
ishing temperature,  for  the  purpose  of  preventing  sudden  shock  and 
pain  to  the  teeth,  which  a  direct  application  of  cold  would  inevitably 
cause.  A  tube  conveys  this  graduating  current  into  a  terminal  portion 
constructed  of  very  fine  membrane,  which  adapts  itself  to  the  form  of 
the  gums,  and  wholly  surrounds  the  tooth  to  be  withdrawn.  The  fluid 
then  passes  away  through  an  exit  tube.  In  this  manner  a  constant 
current  of  cold,  at  a  decreasing  temperature,  is  made  to  pass  over  the 
part,  abstracting  therefrom  all  heat,  and  with  it  the  power  of  feeling." 
The  gum  and  alveolar  membrane  being  now  in  a  frozen  condition,  and, 
consequently,  devoid  of  sensibility,  the  extracting  instrument  is  apj)lied 
and  the  tooth  removed. 

In  the  early  part  of  the  year  1858,  Mr.  J.  B.  Francis,  dentist,  of 
Philadelphia,  announced  the  discovery  of  an  original  method  of  pro- 


USE    OF    ANESTHETIC    AGENTS.  417 

ttucing  local  anaesthesia,  said  to  be  peculiarly  applicable  to  the  extrac- 
tion of  teeth,  which  consists  in  passing  an  electro-galvanic  current 
through  the  tooth  at  the  moment  of  its  removal.  The  discovery  was 
submitted  to  the  Franklin  Institute,  Philadelphia,  and  the  committee 
to  whom  it  was  referred  for  examination,  composed  in  part  of  dentists, 
reported  favorably  in  regard  to  the  claims  of  the  invento-r.*  One  of 
the  members  of  this  committee,  W.  S.  Wilkinson,  states'  that  he  had 
extracted  between  four  and  five  hundred  teeth,  applying  the  electric 
current ;  and  that  in  ninety-five  jDcr  cent,  of  the  cases  it  was  done 
without  pain  to  his  patient. 

The  method  of  applying  it  is  very  simple.  One  pole  (the  negative 
is  preferable)  of  the  electro-galvanic  machine  is  attached  to  one  of  the 
handles  of  the  forceps  by  means  of  a  flexible  conductor,  while  the 
metallic  handle  of  the  other  is  grasped  by  the  patient ;  the  power  of 
the  current  being  previousl}''  to  the  operation  graduated  by  the  piston 
of  the  coil,  while  the  patient  holds  the  forceps  in  the  other  hand.  The 
current  should  only  be  sufficiently  powerful  to  be  distinctly  felt.  The 
circuit  through  the  tooth  is  not  made  until  at  the  instant  the  operation 
begins.  The  closing  and  breaking  of  the  galvanic  circuit  is  managed 
either  by  the  foot  of  the  operator  or  by  an  assistant. 

A  small  electro-galvanic  battery,  arranged  for  this  purpose,  having 
been  placed  in  the  office  of  the  author,  soon  after  the  announcement 
of  the  discovery,  he  has  had  frequent  oj)portunities  of  applying  this 
new  agent  in  the  extraction  of  teeth.  Thus  far,  about  nine  out  of  ten 
of  those  who  were  placed  under  its  influence,  while  undergoing  the  opera- 
tion, assured  him  that  they  either  experienced  no  pain  at  all,  or  only 
very  little  — not  a  tenth  part  of  what  they  had  experienced  under  the 
operation  on  former  occasions.  In  almost  every  case  in  which  the  tooth 
was  grasped,  allowing  the  instrument  to  come  in  contact  with  only  the- 

*  The  following  is  an  extract  from  the  report  referred  to  above:  "The  com- 
mittee is  satisfied,  from  the  observation  and  experiment  of  its  members,  that  in 
a  large  majority  of  cases  of  extraction  with  this  apparatus,  no  pain  zohatever  is 
felt  by  the  patient. 

"  To  test  the  question  whether  the  effect  might  not  be  simply  mental,  the  cir- 
cuit was  brolven  without  the  patient  being  aware  of  it,  when  the  usual  pain  was 
experienced,  although,  in  the  same  patient,  and  on  the  same  occasion,  teeth  had 
been  removed,  while  the  current  was  flowing,  without  causing  pain. 

"In  the  less  successful  cases,  the  teeth  were  broken  and  diseased  below  the 
level  of  the  gum,  and  the  pain,  in  adjusting  the  forceps  previous  to  the  comple- 
tion of  the  circuit  and  the  extraction,  was  considerable. 

"The  sensation  produced  by  the  passage  of  the  current  is  not  painful,  it  being" 
so  adjusted  as  to  lie  just  perceptible  to  the  patient.     The  committee  believes  its  use 
to  be  entirely  without  danger,  and  not  likely  to  be  followed,  by  any  unpleasant. 
after  effects." 
27 


418  USE    OF    ANiESTHETIC    AGENTS. 

edge  of"  the  gum,  the  operation  appeared  to  be  painless,  or  nearly  so. 
But  when  pushed  up  a  considerable  distance  between  it  and  the  tooth, 
the  suffering  was  not  appreciably  diminished,  the  electric  current  in 
such  cases  seeming  to  be  too  much  diffused.  It  is  stated  by  those  who 
have  made  the  experiment,  that  this  diffusion  of  the  electric  current 
may  be  prevented  by  insulating  the  outer  portion  of  the  instrument 
with  a  coating  of  gutta-percha,  or  by  japanning.  The  author  has  not 
tried  this  expedient. 

How  it  is  that  the  passage  of  an  electric  current  through  a  tooth 
should  prevent  pain  may  be  explained  by  supposing  the  subtle  fluid  to 
exhaust  the  sensibility  of  the  nerves  of  the  parts  comprised  in  the  opera- 
tion ;  and  that  it  does,  in  a  majority  of  cases,  is  attested  by  many  who 
have  been  placed  under  its  influence.  It  may  be  nothing  more  than  a 
mere  substitution  of  one  sensation  for  another ;  but  whether  its  apjili- 
cation  will  become  general,  or  its  efiicacy  as  an  anaesthetic  agent  be 
fully  established,  remains  for  future  experience  to  settle. 

The  experience  of  the  profession  may  be  briefly  summed  up  thus : 
In  one-fourth  the  cases  it  relieves  or  neutralizes  the  peculiar  pain  of 
extraction,  in  one-half  it  has  but  little  effect,  and  in  the  remaining 
fourth  it  very  decidedly  aggravates  the  pain.  It  has,  however,  the 
advantage  over  chloroform  and  the  freezing  process,  of  being  without 
any  serious  sequelae. 

Several  years  since,  Di'.  B.  W.  Richardson,  of  London,  introduced  a 
much  more  speedy  and  effectual  method  of  congelation  than  those  before 
described,  by  taking  advantage  of  the  intense  cold  occasioned  by  the 
rapid  evaporation  of  ether  spray  when  forced  through  one  of  the  instru- 
ments invented  for  the  atomization  of  fluids. 

"The  principle,"  Dr.  Richardson  remarks,  "consists  in  directing  on 
a  part  of  the  body  a  volatile  liquid,  having  a  boiling  point  at  or  below 
blood  heat,  in  a  state  of  fine  subdivision  or  spray,  such  subdivision  being 
produced  by  the  action  of  air,  or  other  gaseous  substance,  on  the  vola- 
tile liquid  to  be  dispersed."  "  When  the  volatile  fluid,  dispersed  in  the 
form  of  spray,  falls  on  the  human  body,  it  comes  with  force  into  the 
most  minute  contact  with  the  surface  upon  which  it  strikes."  "As 
a  result  there  is  rapid  evaporation  of  the  volatile  fluid,  and  so  great  an 
evolution  of  heat  force  from  the  surface  of  the  body  struck,  that  the 
blood  cannot  supply  the  equivalent  loss."  "  The  part  consequently  dies 
for  the  moment,  and  is  insensible  as  in  death ;  but  as  the  vis-a-tergo  of 
the  body  is  unaffected,  the  blood,  as  soon  as  the  external  reducing 
agency  is  withdrawn,  quickly  makes  its  way  again  through  the  dead 
parts,  and  restoration  is  immediate."  "  The  extreme  rapidity  of  the 
..action  of  this  deadening  process  is  the  cause  of  its  safety." 

Fig.  167  represents  the  apparatus,  which  consists  of  a  spray-tube, 


USE    OF    ANESTHETIC    AGENTS. 


Aid 


bottle,  and  hand-bellows,  for  producing  local  ansestbesia  by  narcotic 
spray. 

Fig.  167. 


Either  absolute  ether  or  rhigolene  may  be  employed,  both  of  which 
are  highly  inflammable.  Some  prefer  rhigolene  on  account  of  its  action 
being  more  prompt  than  that  of  the  ether,  while  others  consider  the 
latter  more  agreeable  and  easily  controlled.  To  produce  the  local 
anaesthetic  effect  with  these  agents  in  the  form  of  spray  requires  from 
thirty  to  sixty  seconds.  Before  the  application  of  the  spray,  the  crown 
of  the  tooth  to  be  extracted  and  mucous  membrane  over  the  root  should 
be  carefully  dried,  otherwise  a  film  of  ice  may  be  formed  which  will 
prevent  the  full  influence  of  the  agent,  such  as  is  shown  by  the  blanch- 
ing of  the  gum. 

Local  bloodletting,  such  as  follows  lancing  of  the  gums,  prior  to  the 
application  of  the  spray,  is  said  to  prevent  desquamation. 

As  the  use  of  ansesthetic  agents  of  any  kind  in  the  extraction  of  teeth 
is  attended  with  inconvenience,  nearly  always  delaying  the  operation, 
the  author  is  of  opinion  that  their  employment,  as  a  general  thing, 
should  be  dispensed  with.  He  never  encourages  their  use,  and  rarely 
finds  it  necessary  to  employ  them.  In  the  case  of  females  with  a  highly 
nervous  organization,  it  may  now  and  then  be  advisable  to  give  a  tem- 
porary courage  to  endure  pain  by  the  administration  of  a  teaspoonful 
of  brandy.  But  we  have  found  less  trouble  with  delicate  females  than 
with  stalwart  men ;  and  to  the  latter  we  certainly  would  never  advise 
this  use  of  stimulants.  Indeed,  the  extraction  of  a  tooth  is  so  simple 
an  operation,  seldom  requiring  more  than  from  two  to  five  seconds  for 
its  performance,  that  most  persons  should  rather  submit  to  it  at  once, 
than  have  it  protracted  by  the  application  of  an  agent  for  the  preven- 
tion of  the  momentary  pain  which  it  occasions. 


420  IRREGULARITY    OF    THE    TEETH. 


CHAPTER  VIII. 

IRREGULARITY   OF   THE  TEETH. 

PECULIARITIES  in  the  Formation  and  Grmvth  of  the  Teeth.— In 
the  development  and  growth  of  the  various  parts  of  the  body, 
curious  and  interesting  anomalies  are  sometimes  observed ;  but  in  no 
portion  of  it  are  they  more  frequent  in  their  occurrence  or  diversified 
in  their  character  than  in  the  teeth.  But  aberrations  in  the  formation 
and  growth  of  these  organs  are,  for  the  most  part,  confined  to  the 
teeth  of  second  dentition. 

Mr.  Fox  gives  a  drawing  of  a  tooth  very  much  resembling  the  letter 
S.  The  malformation  w\as  caused  by  an  obstructing  temporary  tooth. 
The  author  has  also  met  with  several  examples  of  teeth  similarly 
deformed,  and  from  like  causes. 

The  molars  of  the  upper  jaw  sometimes  have  four  and  even  five 
roots,  and  those  of  the  lower,  three,  and  occasionally  four.  The  crowns 
of  the  teeth,  also,  frequently  present  deviations  from  the  natural  shape 
equally  striking  and  remarkable. 

The  next  peculiarity  to  be  noticed  is  that  of  size,  and  in  this  respect 
the  teeth  are  very  variable.  Even  in  the  same  mouth,  the  want  of 
relative  proportion  between  the  different  classes  of  teeth  is  sometimes 
quite  conspicuous.  But  examples  of  this  kind  are  not  very  frequent ; 
for  where  there  is  an  increase  or  diminution  in  the  size  of  the  teeth 
of  one  class,  there  is  generally  a  corresponding  change  in  that  of  the 
other. 

Aberrations  of  this  character  are  probably  dependent  upon  some 
diathesis  of  the  general  system,  whereby  the  teeth,  during  the  earlier 
stages  of  their  formation,  are  supplied  with  an  excessive  or  diminished 
quantity  of  nutriment. 

Some  very  remarkable  deviations  have  been  known  to  take  place  in 
the  growth  of  the  teeth.  The  most  singular  case  on  record  is  that 
related  by  Albinus.  "  Two  teeth,"  says  he,  "  between  the  nose  and  the 
orbits  of  the  eye,  one  on  the  right  side  and  the  other  on  the  left,  were 
inclosed  in  the  roots  of  those  processes  that  extend  from  the  maxillary 
bones  to  the  eminence  of  the  nose.  They  were  large,  remarkably 
thick,  and  so  very  like  the  canines  that  they  seemed  to  be  these  teeth, 
which  had  not  before  appeared ;  but  the  canines  themselves  were  also 
present,  more  than  usually  small  and  short,  and  placed  in  their  proper 
sockets.     The  former,  therefore,  appear  to  have  been  new  canines. 


IRKEGULAEITY  OF  THE  TEETH.         421 

which  had  not  penetrated  their  sockets,  because  they  were  situated 
where  these  same  teeth  are  usually  observed  to  be  in  children.  But 
what  is  still  more  remarkable,  their  points  were  directed  toward  the 
eyes,  as  if  they  were  the  new  eye  teeth  inverted.  And  they  were  also 
so  formed  that  they  were,  contrary  to  what  usually  happens,  convex 
on  the  posterior  and  concave  on  the  anterior."  A  case  of  a  somewhat 
similar  character  is  mentioned  by  Mr.  John  Hunter. 

The  following  case  is  in  the  words  of  Mr.  G.  Wait :  "  While  I  was 
prosecuting  my  anatomical  studies.  I  was  struck  with  the  appearance 
of  a  cuspid  of  the  upper  jaw  ;  it  was  short,  and  appeared  as  if  the  body 
of  the  tooth  was  in  the  jaw,  and  that  it  was  the  tip  of  the  root  that 
presented  itself.  Upon  further  examination  I  found  this  verified,  and 
after  the  cranium  and  lower  jaw  were  properly  macerated  and  cleansed, 
I  found  one  of  the  lower  bicuspids  in  the  same  position." 

The  author  can  readily  imagine  that  a  cuspid  of  the  upper  jaw 
might,  while  in  a  rudimentary  state,  by  some  false  or  unnatural  attach- 
ment of  the  dental  sac,  be  so  altered  in  its  position  as  to  pass  up,  in  its 
growth,  between  the  nose  and  orbit.  But  that  the  crown,  after  having 
been  thus  turned  round  in  the  socket,  should  remain  stationary,  while 
the  root  passed  down  and  appeared  outside  of  the  gum,  is  a  most  extra- 
ordinary and  remarkable  anomalism.  In  the  former  instance,  the 
tooth  might  still  continue  to  derive  the  nutriment  necessary  for  its 
vitality  from  the  dental  vessels ;  but  in  the  latter  case,  it  could  not  be 
so  nourished  without  difficulty,  because  the  apex  of  the  root,  the  place 
where  the  vessels  and  nerves  enter,  was  entirely  outside  of  the  gum. 

The  following  is  one  of  the  several  cases  of  deviation  in  the  growth  of 
the  teeth,  that  have  come  under  the  author's  observation  :  In  1840,  he 
was  requested  to  extract  a  tooth  for  a  lady  of  Baltimore,  under  the 
following  circumstances.  She  had,  for  a  time,  experienced  a  great  deal 
of  pain  in  her  upper  jaw,  and  supposed  it  to  originate  from  the  second 
molar  of  the  right  side,  but  which  was  perfectly  sound.  Meanwhile  her 
general  health  became  impaired,  and  her  attending  physician,  thinking 
that  the  local  irritation  might  have  contributed  to  her  debility,  advised 
the  extraction  of  the  tooth.  On  removing  it,  the  cause  of  the  pain  at 
once  became  apparent.  The  dens  sapientise,  which  had  not  hitherto 
appeared,  was  discovered  with  its  roots  extending  back  to  the  utmost 
verge  of  the  angle  of  the  jaw,  while  its  grinding  surface  had  been  in 
contact  with  the  posterior  surface  of  the  crown  and  neck  of  the  tooth 
just  extracted.     On  the  removal  of  the  wisdom  tooth,  the  pain  ceased. 

About  the  middle  of  December,  1849,  a  youth  aged  sixteen  applied 
to  the  author  to  extract  a  right  superior  bicuspid,  which,  he  said,  was 
ulcerated  at  the  root.  On  examining  his  mouth,  he  discovered  only 
one  bicuspid,  but  above  and  between  the  root  of  this  and  that  of  the 


422  IRREGULARITY    OF    THE    TEETH. 

first  molar,  he  observed  a  small  fistulous  opening.  On  introducing  a 
small  probe,  it  immediately  came  in  contact  with  the  crown  of  a  tooth 
looking  toward  the  malar  process  of  the  superior  maxillary,  which,  on 
extraction,  proved  to  be  the  second  bicuspid. 

The  author  has  in  his  possession  several  molar  and  bicuspid  teeth 
which  have  small  nodes  upon  their  necks,  covered  with  enamel ;  and 
there  is  a  jaw  in  the  museum  of  the  Baltimore  Dental  College  which 
has  five  teeth  presenting  this  anomaly. 

The  author  has  two  teeth  in  his  possession  of  most  singular  shape, 
presented  to  him  by  his  brother,  the  late  Di'.  John  Harris.  They  were 
extracted  in  July,  1822,  from  the  right  side  of  the  upper  jaw  of  a 
young  gentleman,  nineteen  years  of  age,  by  the  name  of  Crawford. 
They  occupied  the  place  of  the  first  and  second  bicuspids,  and  their 
crowns  are  almost  wholly  imbedded  in  lamellated  dentine,  that  should 
have  constituted  their  roots,  but  which  are  entirely  wanting.  Judging 
from  their  appearance,  one  would  be  inclined  to  suppose  that  their 
sacs  failing  to  contract,  they  remained  stationary  in  their  sockets,  and 
as  the  base  of  the  pulps  elongated,  they  came  in  contact  with  the  bot- 
tom of  the  alveoli,  and  were  caused  to  bulge  out  and  to  be  reflected 
upon  their  crowns,  to  the  enamel  of  which,  nearly  to  their  grinding 
surfaces,  they  are  perfectly  united.  For  some  time  previously  to  the 
extraction  of  these  teeth,  they  had  been  productive  of  considerable 
irritation  and  joain  in  the  gums  and  jaw',  and  it  was  for  the  relief  of 
the  suffering  which  their  presence  induced  that  they  were  removed. 

Since  the  publication  of  the  second  edition  of  this  work,  the  author 
has  seen  a  still  more  remarkable  deviation  in  the  growth  of  a  tooth. 
It  is  in  the  upper  jaw  of  an  adult  skull  in  the  Museum  of  the  Baltimore 
Dental  College.  The  natural  teeth  are  all  well  formed,  and  regularly 
arranged  in  the  alveolar  border,  but  between  the  extremities  of  the 
roots  of  the  superior  central  incisors,  in  the  substance  of  the  jaw,  there 
is  a  supernumerary  tooth,  the  crown  of  which  looks  upward  toward  the 
crest  of  the  nasal  plates  of  the  two  bones.  The  whole  tooth  is  about 
one  inch  in  length,  and  the  apex  of  the  crown  is  nearly  on  a  level  with 
the  floor  of  the  nasal  cavities.  There  is  also  in  the  museum  of  this 
institution  a  central  incisor  of  the  upper  jaw,  with  the  root  bent  upon, 
and  in  contact  with,  the  labial  surface  of  the  crown. 

Osseous  Union  of  the  Teeth.  —  Inclosed  as  each  tooth  is  in  a  distinct 
sac,  and  separated  on  either  side  by  a  bony  partition,  from  the  adjoin- 
ing teeth,  until  after  the  completion  of  the  formation  of  the  enamel,  it 
is  difficult  to  conceive  how  osseous  union  could  take  place  between  two 
of  these  organs,  and,  we  confess,  that  until  we  actually  witnessed  an 
example  of  it,  which  we  did  for  the  first  time  in  1836,  we  were  inclined 
<.o  doubt  the  possibility  of  such  an  occurrence. 


IRREGULARITY    OF    THE    TEETH.  423 

During  a  visit  to  the  city  of  Richmond,  Va.,  in  April  of  the  above 
mentioned  year,  we  had  an  opportunity  of  seeing  two  cases.  One  con- 
sisted in  the  union  of  the  crowns  of  the  central  incisors  of  the  upper 
jaw,  the  palatine  surface  of  which  presented  the  appearance  of  one 
broad  tooth,  while  anteriorly  they  had  the  semblance  of  two  teeth  ; 
the  other  case  consisted  in  the  union  of  the  right  central  and  lateral 
incisors  of  the  lower  jaw. 

A  professional  friend  in  Virginia  informed  the  author,  in  a  conversa- 
tion some  years  since,  that  he  had  met  with  a  case  of  osseous  union 
between  a  second  bicuspid  and  first  molar  of  the  lower  jaw,  which  was 
so  palpable  that  there  could  have  been  no  doubt  of  its  existence. 

Mr.  Fox  has  given  the  drawings  of  four  cases,  the  originals  of  which, 
as  Mr.  Bell  tells  us,  are  still  to  be  seen  in  the  museum  of  Guy's  Hospi- 
tal.    Mr.  B.  also  informs  us  that  he  has  seen  four  other  examples. 

Dr.  Koecker  is  skeptical  with  regard  to  the  existence  of  osseous  union 
of  the  teeth,  and  attributes  to  those  who  assert  that  they  have  met  with 
cases  of  it,  "a  weak  credulity,  a  love  of  the  marvellous,  or  a  desire  to 
impose  upon  the  world." 

Cases  of  this  sort,  it  is  true,  are  of  rare  occurrence,  and  a  connec- 
tion of  the  roots  of  two  teeth,  by  an  intervening  portion  of  the  alve- 
olus, is  very  easily  mistaken  for  osseous  union  of  the  roots  themselves. 
A  few  years  since,  in  extracting  a  second  molar  of  the  upper  jaw,  the 
author  brought  the  dens  sapientise  along  with  it.  At  first  he  thought 
there  was  osseous  union  of  the  roots,  but  upon  close  examination  found 
a  very  thin  portion  of  the  alveolar  wall  between,  to  which  their  roots 
were  firmly  attached.  Such  a  case  as  this  would,  in  many  instances, 
be  set  down  as  an  example  of  osseous  union. 

It  is  easy  to  account  for  a  lusus  naturce  of  this  kind,  by  supposing  a 
previous  union  of  the  pulp  of  the  tAvo  teeth.  But  from  the  order  in 
which  the  eruption  of  the  teeth  is  effected,  some  classes  appearing 
long  before  others,  it  would,  on  this  supposition,  seem  that  it  could 
only  occur  betw.een  the  central  incisors.  It  is  not,  however,  thus  lim- 
ited :  the  central  and  lateral  incisors,  the  bicuspids,  and  the  molars 
are  sometimes  united. 

An  osseous  union  of  the  teeth  is,  fortunately,  of  rare  occurrence;  if 
it  were  otherwise,  it  would  be  productive  of  many  accidents  in  the  ex- 
ti'action  of  teeth.  Apart  from  this  consideration,  it  can  be  of  but 
little  importance  either  to  the  practitioner  or  to  the  physiologist. 

Since  the  publication  of  the  first  edition  of  this  work,  a  number  of 
cases  of  osseous  union  of  the  teeth  have  fallen  under  the  observation 
of  the  author,  and  there  are  now  many  specimens  in  the  anatomical, 
collection  of  the  Baltimore  College  of  Dental  Surgery.  Among  them 
are  a  number  of  examples  of  osseous  union  of  the  temporary  teeth. 


424  IRREGULARITY    OP    THE'TEETH. 

Supernumerary  Teeth.  —  The  development  of  supernumerary  teeth  is 
usually  confined  to  the  anterior  part  of  the  mouth,  and  more  frequently 
to  the  upper  than  to  the  lowe^'  jaw.  They  sometimes,  however,  appear 
as  far  back  as  the  deutes  sapientise,  and  Hudson  says  he  has  seen 
them  behind  these  teeth.  "We  have  now  in  our  anatomical  collection, 
two  supernumerary  teeth  that  were  extracted,  one  from  behind  and 
the  other  at  the  side  of  one  of  the  upper  wisdom  teeth.* 

The  crowns  of  supernumerary  teeth  which  appear  in  the  anterior 
part  of  the  mouth  are  usually  of  a  conical  shape,  and  fur  the  most  part 
situated  between  the  central  incisors ;  they  usually  have  short,  knotty 
roots ;  sometimes,  however,  they  bear  so  strong  a  resemblance  to  the 
other  teeth  that  it  is  difficult  to  distinguish  the  one  from  the  other. 
We  once  saw  two  lateral  incisors  in  the  lower  jaw,  both  of  which  were 
so  well  arranged,  and  perfectly  formed,  that  it  was  impossible  to  de- 
termine which  of  the  two  ought  to  be  considered  as  the  supernumerary. 
Mr.  Bell  mentions  a  case  in  which  there  were  five  low^er  incisors,  all 
of  which  were  well  formed  and  regularly  arranged.  The  author  has 
met  with  several  examples  in  which  supernumerary  teeth  in  the  lower 
jaw  so  closely  resembled  the  natural  incisors  that  no  difference  could 
be  discerned  between  them.  He  has  also  seen  examples  of  three  lateral 
incisors  in  the  upper  jaw  where  it  was  impossible  to  determine  w^hich 
was  the  supernumerary. 

Supernumerary  cuspids  rarely  if  ever  occur,  but  supernumerary 
bicuspids  are  occasionally  met  with.  Delabarre  says  he  has  seen  them ; 
and  we  have  met  with  three  examples  of  the  sort ;  in  each  of  these 
instances  the  teeth  were  very  small,  not  being  more  than  one-fourth  as 
large  as  the  natural  bicuspids,  with  oval  crowns,  and  placed  partly  on 
the  outside  of  the  circle,  and  partly  between  the  bicuspids.  We  ex- 
tracted one  of  them,  and  have  it  still  in  our  possession.  Its  root  is 
short,  round,  and  nearly  as  thick  at  its  extremity  as  it  is  at  the  neck  of 
the  tooth. 

The  supernumerary  teeth  that  appear  further  back  than  the  bicus- 
pids, though  much  smaller,  bear  a  strong  resemblance  to  the  dentes 
sapientise. 

Supernumerary  teeth,  although  generally  imperfect  in  their  forma- 
tion, are  less  liable  than  other  teeth  to  decay.  This  may  be  attribut- 
able to  the  fact  that  they  are  harder,  and,  consequently,  not  so  sus- 
ceptible to  the  action  of  the  causes  that  produce  the  disease. 
.  Although  the  occurrence  of  supernumerary  teeth  rarely  disturbs  the 
arrangement  of  the  others,  their  presence  is  sometimes  productive  of 
the  worst  kind  of  irregularity;  and  even  when  they  do  not  have  this 

*  These  teeth  were  removed  by  Dr.  Chewning,  dentist,  of  Fredericksburg,  Va, 


IRREGULARITY  OF  THE  TEETH.         425 

effect,  they  impair  the  beauty  of  the  mouth,  and,  for  this  reason,  should 
be  extracted  as  soon  as  their  crowns  have  completely  emerged  from 
the  gums. 

To  the  practitioner  of  dental  surgery,  the  occurrence  of  supernu- 
merary teeth  is  interesting,  only  in  so  far  as  it  affects  the  beauty  of 
the  mouth  and  tlie  relationship  which  the  teeth  of  the  upper  jaw 
sustain  to  those  of  the  lower ;  but  -to  the  physiologist  it  involves  the 
question,  what  determines  their  development  ?  In  propounding  this 
interrogatory,  however,  it  is  not  our  intention  to  enter  upon  its  dis- 
cussion in  this  place,  as  it  forms  no  part  of  the  design  of  the  present 
treatise. 

Third  Dentition. —  That  nature  sometimes  makes  an  effort  to  produce 
a  third  set  of  teeth  is  a  fact  which,  however  much  it  may  be  disputed, 
is  now  so  well  established,  that  no  room  is  left  for  cavil  or  doubt. 

The  following  interesting  particulars  are  taken  from  "  Good's  Study 
of  Medicine :" 

"  We  sometimes,  though  rarely,  meet  with  playful  attempts  on  the 
part  of  nature  to  reproduce  teeth  at  a  very  late  period  of  life,  and 
after  the  permanent  teeth  have  been  lost  by  accident  or  by  natural 
decay. 

"This  most  commonly  takes  place  between  the  sixty-third  and 
eighty -first  year,  or  the  interval  which  fills  up  the  two  grand  climac- 
teric years  of  the  Greek  physiologist ;  at  which  period  the  constitu  tion 
appears  occasionally  to  make  an  effort  to  repair  other  defects  than  lost 
•teeth.     .     .     . 

"For  the  most  part,  the  teeth,  in  this  case,  shoot  forth  irregularly, 
few  in  number,  and  without  proper  roots,  and,  even  where  roots  are 
produced,  without  a  renewal  of  sockets.  Hence,  they  are  often  loose, 
and  frequently  more  injurious  than  useful,  by  interfering  with  the 
uniform  line  of  indurated  and  callous  gums,  which,  for  many  years 
perhaps,  had  been  employed  as  a  substitute  for  the  teeth.  A  case  of 
ithis  kind  is  related  by  Dr.  Bisset,  of  Knayton,  in  which  the  patient,  a 
female  in  her  ninety-eighth  year,  cut  twelve  molar  teeth,  mostly  in  the 
lower  jaw,  four  of  which  were  thrown  out  soon  afterward,  while  the 
rest,  at  the  time  of  examination,  were  found  more  or  less  loose. 

"In  one  instance,  though  not  in  more  than  one,  Mr.  Hunter  wit- 
nessed the  reproduction  of  a  complete  set  in  both  jaws  apparently  with 
a  renewal  of  their  sockets.  'From  which  circumstance,'  says  he,  'and 
another  that  sometimes  happens  to  women  of  this  age,  it  would  appear 
that  there  is  some  effort  in  nature  to  renew  the  body  at  that  time.' 

"  The  author  of  this  work  once  attended  a  lady  in  the  country,  who 
cut  several  straggling  teeth  at  the  age  of  seventy-four ;  and,  at  the 
same  time  recovered  such  an  acuteness  of  vision,  as  to  throw  away  her 


426  IRREGULARITY    OF    THE    TEETH. 

spectacles,  which  she  had  made  use  of  for  more  than  twenty  years,  and 
to  he  able  to  read  with  ease  the  smallest  print  of  the  newspapers.  In 
another  case,  that  occurred  to  him,  a  lady  of  seventy-six,  mother  to 
the  late  Henry  Hughes  Eryn,  printer  of  the  journals  of  the  House  of 
Commons,  cut  two  molars,  and  at  the  same  time  completely  recovered 
her  hearing,  after  having  for  some  years  been  so  deaf  as  to  be  obliged 
to  feel  the  clapper  of  a  small  hand-bell,  which  was  always  kept  by  her, 
in  order  to  determine  whether  it  rung  or  not. 

"The  German  Ephemerides  contain  numerous  examples  of  the  same 
kind ;  in  some  of  which  teeth  wei-e  produced  at  the  advanced  age  of  nine- 
ty, a  hundred,  and  even  a  hundred  and  twenty  years.  One  of  the  most 
singular  instances  on  record  is  that  given  by  Dr.  Slade,  which  occurred 
to  his  father,  who,  at  the  age  of  seventy-five,  reproduced  an  incisor, 
lost  twenty-five  years  before,  so  that,  at  eighty,  he  had  hereby  a  perfect 
row  of  teeth  in  both  jaws.  At  eighty-two,  they  all  dropped  out  suc- 
cessively ;  two  years  afterward,  they  were  all  successively  renewed,  so 
that  at  eighty-five  he  had  once  more  an  entire  set.  His  hair,  at  the 
same  time,  changed  from  a  w^hite  to  a  dark  hue ;  and  his  constitution 
seemed,  in  some  degree,  more  healthy  and  vigorous.  He  died  suddenly 
at  the  age  of  ninety  or  a  hundred. 

"  Sometimes  these  teeth  are  produced  A\'ith  wonderful  rapidity ;  but  in 
such  cases  with  very  great  pain,  from  the  callosity  of  the  gums  through 
which  they  have  to  force  themselves.  The  Edinburgh  Medical  Com- 
mentaries supply  us  with  an  instance  of  this  kind.  The  individual  was 
in  his  sixty-first  year,  and  altogether  toothless.  At  this  time,  his  gums 
and  jaw-bones  became  painful,  and  the  pain  was  at  length  excruciating. 
But  within  the  space  of  twenty-one  days  from  its  commencement,  both 
jaws  were  furnished  with  a  new  set  of  teeth,  complete  in  number." 

A  late  physician  of  Baltimore  informed  the  author,  in  18:^8,  that  an 
example  of  third  dentition  had  come  under  his  own  observation.  The 
subject,  a  female,  at  the  age  of  sixty,  he  assured  him,  erupted  an  entire 
set  in  each  jaw. 

The  following  extract  of  a  letter  from  a  professional  friend,*  de- 
scribes another  very  interesting  case  : 

"I  have  just  seen  a  case  of  third  dentition.  The  subject  of  this 
'playful  freak  of  nature,'  as  Dr.  Good  styles  it,  is  a  gentleman  residing 
in  the  neighborhood  of  Coleman's  Mill,  Caroline  County,  Virginia.  He 
is  now  in  his  seventy-eighth  year,  and,  as  he  playfully  remarked,  'is 
just  cutting  his  teeth.'  There  are  eleven  out,  five  in  the  upper  and 
six  in  the  lower  jaw.  Those  in  the  upper  jaw  are  two  central  incisors, 
one  lateral  and  two  bicuspids,  on  the  right  side.  Those  in  the  lower  are 
the  four  incisors,  one  cuspid  and  one  molar.    Their  appearance  is  that 

*  Dr.  J.  D.  McCabe. 


IRREGULARITY  OF  THE  TEETH.         427 

of  bone,  extremely  roiigli,  without  any  coating  or  enamel,  and  of  a 
dingy  brown  color." 

Two  cases  somewhat  like  the  foregoing  have  come  under  the 
author's  observation.  The  subject  of  the  first  was  a  shoemaker,  Mr. 
M.,  of  Baltimore,  who  erupted  a  lateral  incisor  and  cuspid  at  the  age 
of  thirty.  Two  years  before  this  time,  he  had  been  badly  salivated, 
and,  in  consequence,  lost  four  upper  incisors  and  one  cuspid.  The 
alveoli  of  these  teeth  exfoliated,  and,  at  the  time  he  first  saw  him,  were 
entirely  detached  from  the  jaw,  and  barely  retained  in  the  mouth  by 
their  adhesion  to  the  gums.  On  removing  them,  he  found  two  white 
bony  protuberances,  which,  on  examination,  proved  to  be  the  crowns 
of  an  incisor  and  cuspid.  They  were  perfectly  formed,  and  though 
much  shorter  than  the  other  teeth,  yet  up  to  1845,  they  remained 
quite  firm  in  the  jaw. 

The  subject  of  the  other  case  was  a  lady,  residing  near  Fredericks- 
burg, Virginia,  who  erupted  four  right  central  incisors  of  the  upper 
jaw  successively.  One  of  her  temporary  teeth,  in  the  first '  instance, 
had  been  permitted  to  remain  too  long  in  the  mouth,  and  a  permanent 
central  incisor,  in  consequence,  came  out  in  front  of  the  dental  arch. 
To  remedy  this  deformity,  the  deciduous  incisor  was,  after  some  delay, 
removed ;  and,  about  two  years  after,  the  permanent  tooth,  not  having 
fallen  back  into  its  proper  place,  was  also  extracted.  Another  two 
years  having  elapsed,  another  tooth  came  out  in  the  same  place  and  in 
the  same  manner,  and,  for  similar  reasons,  was  also  removed.  To  the 
astonishment  of  the  lady  and  her  friends,  a  fourth  incisor  made  its 
appearance  in  the  same  place  two  years  and  a  half  after  the  extrac- 
tion of  the  first  permanent  tooth.  When  it  had  been  out  about  eigh- 
teen months,  the  author  was  called  in  by  the  lady,  who  wished  him,  if 
possible,  to  adjust  it.  Finding  that  it  could  not  be  brought  within  the 
dental  circle,  he  advised  her  to  have  it  extracted,  and  an  artificial 
tooth  placed  in  the  proper  place  in  the  arch. 

In  the  second  number  of  the  eighth  volume  of  the  American  Jour- 
nal of  Dental  Science,  the  history  of  a  case  of  four  successive  denti- 
tions of  the  upper  central  incisors  is  given.* 

It  is  said  that  the  efforts  made  by  nature  for  the  production  of  a 
third  complete  set  of  teeth  are  so  great  that  they  exhaust  the  remain- 
ing energies  of  the  system,  and,  as  a  consequence,  that  occurrences  of 
this  kind  are  generally  soon  followed  by  death. 

The  author  is  not  aware  that  "any  attempt  has  ever  been  made  to 
explain  the  manner  of  the  origin  and  formation  of  the  teeth  of  third 
dentition.     The  rudiments  of  the  teeth  of  first  and  second  dentition 

*  Dr.  W.  H.  Dwiaelle. 


428         IRREGULARITY  OF  THE  TEETH. 

originate  from  mucous  membrane,  Avhile  those  of  third  dentition  would 
seem  to  be  the  product  of  periosteal  tissue  or  bone. 

In  obedience  to  what  law  of  developmental  anatomy  are  the  teeth 
of  third  dentition  formed  ?  Certainly  not  to  any  one  primitively 
impressed  upon  the  animal  economy,  as  they  have  never  been  known 
to  appear  while  the  teeth  of  second  dentition  remain  in  the  jaws.  If 
the  establishment  of  the  law  which  governs  the  development  of  a  part 
depends  upon  a  certain  condition  of  other  contiguous  parts,  it  is  possi- 
ble that  the  following  maybe  a  correct  explanation  of  the  phenomenon 
of  third  dentition.  Certain  parts,  in  certain  states  or  conditions,  and 
in  particular  locations,  perform  functions  peculiar  to  themselves.  In 
other  Avords,  the  condition  and  location  of  a  part  determines  the  func- 
tion or  functions  it  performs.  For  example,  when  the  mucous  mem- 
brane along  the  course  of  tlie  alveolar  border  begins  to  assume  a  dupli- 
cated or  grooved  condition,  which  it  does  at  about  the  sixth  week  of 
intra-uterine  existence,  dental  papillae  shoot  up  from  it;  and  when,  by 
a  similar  duj)lication  of  this  same  tissue,  behind  the  sacs  of  the  tem- 
porary teeth,  forming  what  Mr.  Goodsir  styles  "cavities  of  reserve," 
the  papillae  of  the  jDermanent  teeth,  one  from  the  bottom  or  distal 
extremity  of  each  duplication,  begin  to  be  developed.  Hence,  it 
would  seem  that  this  particular  state  or  condition  of  this  tissue,  and 
in  these  particular  locations,  is  necessary  to  determine  the  development 
of  teeth  germs.  This  arrangement  or  condition  of  mucous  membrane, 
in  these  particular  locations,  which  always  results  from  the  develop- 
ment of  the  foetus,  may  be  sometimes  produced  by  accidental  causes, 
after  all  the  organs  of  the  body  have  attained  their  full  size,  or  at  any 
time  during  life ;  and  when  it  does  occur,  it  is  not  unreasonable  to 
suppose  that  a  new  tooth  papilla  should  be  formed.  Proceeding  still 
farther,  the  development  of  a  dental  papilla  is  the  signal  for  the  pro- 
duction of  a  dental  follicle,  which  ultimately  becomes  a  sac,  and  then 
an  organ  to  supply  the  tooth  now  considerably  advanced  in  the  process 
of  formation,  with  a  covering  of  enamel.  But  as  the  maxillary  bone 
has  previously  attained  its  full  size,  it  rarely,  if  ever,  happens  that 
alveoli  are  formed  for  these  accidental  productions,  and,  consequently, 
they  seldom  have  roots,  or  if  they  do,  they  are  very  short  and  blunt. 
They  are  usually  connected  with  the  periosteum  of  the  alveolar  bor- 
der, and  this  union  is  sometimes  so  close  and  intimate  that  very  con- 
siderable force  is  necessary  for  their  removal,  or,  at  least,  so  far  as  our 
own  observations  go  upon  the  subject,  and  we  have  had  occasion  to 
extract  several  in  the  course  of  our  practice.  As  a  general  rule,  how- 
ever, they  become  loose  in  the  course  of  a  few  years  and  drop  out. 

But  it  may  be  asked,  how  are  such  accidental  duplications  of  the 
mucous  membrane  formed?     This  is  a  question,  we  admit,  which  it 


lEEEGULARITY  OF  THE  TEETH.         429 

may  not  be  easy  to  answer  satisfactorily ;  but  we  do  not  think  it  at  all 
improbable  that  they  sometimes  occur  during  the  curative  process  that 
follows  the  removal  of  one  or  more  teeth.  The  granulated  walls  of 
the  gums  surrounding  an  alveolus  from  which  a  tooth  has  been  ex- 
tracted, may  become  covered  with  this  tissue  before  the  socket  is  filled 
with  a  deposit  of  new  bone,  or  it  may  cover  the  surfaces  of  the  dupli- 
cated membrane  near  the  bone ;  and  whenever  such  arrangement  or 
condition  of  this  tissue  takes  place  upon  the  alveolar  border,  (and  that 
it  may,  occasionally,  we  think  there  can  be  no  question,)  it  is  probable 
that  a  new  tooth  papilla  is  produced,  which,  in  the  progress  of  its  devel- 
opment, induces  the  formation  of  the  various  appendages  necessary  to 
the  production  of  a  perfect  tooth. 

This,  in  the  opinion  of  the  author,  is  the  only  way  that  these  fortu- 
itous productions  can  be  accounted  for  in  accordance  with  true  physio- 
logical principles.  It  seems  impossible  to  explain  the  manner  of  their 
formation  in  any  other  way.  All  must  admit  that  the  presence  of 
mucous  membrane  is  necessary,  and  we  cannot  conceive  of  any  other 
way  by  which  its  presence  beneath  the  general  surface  of  the  gums 
can  be  accounted  for ;  but  if  we  admit  this  explanation  to  be  correct, 
the  question  is  at  once  solved.  We  believe  it  is  also  owing  to  the 
accidental  occurrence  of  a  certain  arrangement  or  condition  of  the 
mucous  membrane  concerned  in  the  production  of  the  permanent 
teeth,  consisting,  most  likely,  in  the  formation  of  "cavities  of  reserve" 
more  than  are  called  for  by  the  teeth  of  this  dentition,  that  the  de- 
velopment of  supernumerary  teeth  takes  place. 

The  operations  of  nature,  it  is  true,  are  so  secretly  carried  on,  that 
we  cannot  see  the  precise  modus  operandi  by  which  they  are  eflTected  ; 
yet  in  the  development  of  the  various  organs  and  structures  of  the 
body,  we  may  see  them  at  the  various  stages  of  their  growth,  and  note 
what  precedes  their  arrival  at  these  various  stages  in  the  progress 
of  their  formation,  and  upon  which  their  accretion  would  seem  to  be 
dependent.  The  periods  for  the  arrival  of  these  stages  of  develop- 
ment, though  somewhat  irregular,  occur  for  the  most  part  in  normal 
conditions  of  the  body,  at  certain  fixed  epochs.  Thus,  the  papilla  of 
the  first  temporary  molar  may  usually  be  seen  between  the  sixth  and 
seventh  weeks  of  intra-uterine  existence,  but  previously  to  this  time 
a  slight  groove  or  depression  is  observable  in  the  mucous  membrane 
of  the  part  from  whence  it  has  its  origin.  The  same  is  true  with 
regard  to  the  papillae  of  all  the  other  teeth,  though  the  time  for  the 
commencement  of  their  formation  occurs  at  later  periods.  The  pecu- 
liar change  which  takes  place  in  the  arrangement  of  the  mucous  tissue 
here,  as  well  as  the  periods  at  which  they  occur,  are  doubtless  de- 
termined by  certain  stages  in  the  development  of  other  parts,  and 


430  IRREGULARITY    OF    THE    TEETH. 

these,  verj'  likely,  may  determine  the  established  number  of  teeth  in 
both  dentitions. 

If  the  foregoing  views  which  we  have  advanced  be  correct,  these 
fortuitous  productions  are  not  the  re:?ult  of  a  mere  freak  of  nature, 
as  they  are  sometimes  facetiously  styled.  They  are  the  result  of  the 
operation  of  an  established  law  of  the  economy,  and  although,  after 
the  completion  of  the  teeth  of  second  dentition,  its  course  is  suspended, 
the  occurrence  of  a  similar  arrangement  or  condition  of  the  mucous 
tissue  in  the  parts  in  question  will  again  put  it  in  operation. 

Method  of  Directing  Second  Dentition. — There  is  nothing  more  de- 
structive to  the  beauty,  health,  and  durability  of  the  teeth,  and  no 
disturbance  more  easily  pi'evented,  than  irregularity  of  their  arrange- 
ment. Also,  in  proportion  to  the  deviation  of  these  organs  from  their 
proper  position  in  the  alveolar  arch,  are  the  features  of  the  face  and 
the  expression  of  the  countenance  injured.  It  also  increases  the  sus- 
ceptibility of  the  gums  and  xilveolo-dental  membrane  to  morbid  im- 
pressions. 

It  is  important,  therefore,  that  the  mouth,  during  second  dentition, 
should  be  properly  cared  for ;  and  so  thoroughly  convinced  is  the 
author  of  this,  that  he  does  not  hesitate  to  say,  that  if  timely  pre- 
cautions v^ere  used,  there  would  not  be  one  decayed  tooth  where  there 
are  now  a  dozen. 

Much  harm,  it  is  true,  may  be  done  by  improper  meddling  with  the 
teeth  during  this  period,  but  this,  so  far  from  inducing  a  total  neglect, 
should  only  make  those  having  the  care  of  children  more  solicitous 
in  securing  the  services  of  scientific,  accomplished  practitioners. 

For  the  judicious  management  of  second  dentition,  much  judgment 
and  a  correct  knowledge  of  the  normal  periods  of  the  eruption  of  the 
several  classes  of  teeth  are  required.  All  unnecessary  interference 
with  these  organs,  at  this  early  period  of  life,  should  certainly  be 
avoided,  as  it  will  only  tend  to  mar  the  perfection  at  which  nature 
ever  aims.  The  legitimate  duty  of  the  physician  being,  as  Mr.  Bell 
correctly  observes,  "  the  regulation  of  the  natural  functions  when 
deranged,"  he  should  never  anticipate  the  removal  by  nature  of  the 
temporary  teeth,  unless  their  extraction  is  called  for  by  some  pressing 
emergency,  such  as  a  deviation  of  the  permanent  ones  from  their 
proper  place,  alveolar  abscess,  or  exfoliation  of  the  alveolar  processes. 

The  mouth  should  be  frequently  examined  from  the  time  the  shed- 
ding of  the  deciduous  teeth  commences  until  the  completion  of  second 
dentition ;  and  when  the  growth  of  the  permanent  teeth  so  far  outstrips 
the  destruction  of  the  roots  of  the  temporary,  that  the  former  are 
caused  to  take  an  improper  direction,  such  of  the  latter  as  have  occa- 
sioned the  obstruction  should  be  immediately  removed.     In  the  denti- 


IREEGULAEITY  OF  THE  TEETH.         431 

tion  of  the  upper  front  teeth,  this  should  never  be  neglected;  for,  when 
they  come  out  behind  the  temporaries,  as  they  most  frequently  do,  and 
are  permitted  to  advance  so  far  as  to  fall  on  the  inside  of  the  lower 
incisors,  a  permanent  obstacle  is  offered  to  their  subsequent  proper 
adjustment. 

When  a  wrong  direction  has  been  given  to-  the  growth  of  the  lower 
front  teeth,  they  are  rarely  prevented  from  acquiring  their  proper  ar- 
rangement by  an  obstruction  of  this  sort.  They  should  not,  however, 
on  this  account  be  permitted  to  occupy  an  erroneous  position  too  long ; 
for  the  evil  will  be  found  easier  of  correction  while  recent  than  after 
it  has  continued  for  a  considerable  length  of  time.  The  irregularity 
should  be  immediately  removed. 

The  permanent  central  incisors  of  the  upper  jaw  being  larger  than 
the  temporaries  of  the  same  class,  it  might,  therefore,  be  supposed  that 
the  aperture  formed  by  the  removal  of  the  one  would  not  be  sufficient 
for  the  admission  of  the  other,  without  an  increase  in  the  size  of  this 
part  of  the  maxillary  arch.  It  should  be  recollected,  however,  that 
by  the  time  these  teeth  usually  emerge  from  the  gums,  the  crowns  of 
the  temporary  lateral  incisors  are  so  much  loosened  by  the  partial 
destruction  of  their  roots,  as  to  yield  sufficiently  to  the  pressure  of  the 
former,  to  permit  them  to  take  their  proper  position  within  the  dental 
circle.  When  this  does  not  happen,  the  temporary  laterals  should  be 
extracted. 

Under  similar  circumstances,  the  same  course  should  be  pursued  with 
the  permanent  lateral  incisors  and  the  temporary  cuspids,  and  also  with 
the  permanent  cuspids  and  the  first  bicuspids. 

But  from  the  fact  that  the  bicuspids  are  erupted  before  the  perma- 
nent cuspidati,  the  premature  extraction  of  the  temporary  cuspidati  is 
often  the  cause  of  the  projection  of  one  or  more  of  the  front  teeth  ;  some- 
times to  such  a  degree  as  to  produce  considerable  deformity. 

The  removal  of  the  temporary  cuspidati  should  therefore  be  avoided 
when  there  is  reason  to  believe  that  the  growth  of  the  jaw  will  provide 
sufficient  space  for  a  deviating  permanent  lateral  incisor  to  take  a 
proper  position  within  the  dental  arch. 

The  bicuspids  being  situated  between  the  roots  of  the  temporary 
molars  are  seldom  caused  to  take  an  improper  direction  in  their  growth. 
Nor  are  they  often  prevented  from  coming  out  in  their  proper  j^lace  for 
want  of  room. 

In  the  Aianageraent  of  second  dentition  much  will  depend  on  the 
experience  and  judgment  of  the  practitioner.  If  he  be  properly 
informed  upon  the  subject,  and  gives  to  it  the  necessary  care  and  atten- 
tion, the  mouth  will,  in  most  instances,  be  furnished  with  a  healthful, 
well  arranged,  and  beautiful  set  of  teeth.     At  this  time,  "an  opportu- 


432         IRREGULARITY  OF  THE  TEETH. 

nity,"  says  Mr.  Fox,  "  presents  itself  for  effecting  this  desirable  object," 
(the  prevention  of  irregularity,)  "  but  everytliing  tlepends  upon  a  cor- 
rect knowledge  of  the  time  when  a  tooth  requires  to  be  extracted,  and 
also  of  the  particular  tooth,  for  often  more  injury  is  occasioned  by  the 
removal  of  a  tooth  too  early  than  if  it  be  left  a  little  too  long;  because 
a  new  tooth,  which  has  too  much  room  long  before  it  is  required,  will 
sometimes  take  a  direction  more  difficult  to  alter  than  a  slight  irregu- 
larity occasioned  by  an  obstruction  of  short  duration." 

Mr.  Bell  objects  to  the  extraction  of  the  temporary  teeth,  especially 
in  the  lower  jaw,  to  make  room  for  the  permanent,  on  the  ground  that 
the  practice  is  harsh  and  unnatural  —  that  it  often  gives  rise  to  a  con- 
traction of  the  maxillary  arch. 

This  objection,  if  it  was  well  founded,  should  deter  every  dentist  from 
adopting  the  practice;  except  as  a  dernier  ressort,  as  the  lesser  of  two 
evils.  But  when  the  temporary  teeth,  by  remaining  too  long,  are  likely 
to  affect  the  arrangement,  and  consequently,  the  health  of  the  perma- 
nent teeth,  they  should  be  extracted  ;  because,  in  that  case,  their  pres- 
ence is  a  greater  evil  than  any  that  Avould  be  occasioned  by  their 
removal.  As  a  genei'al  ru]e,  they  should  be  suffered  to  remain  until 
their  presence  is  likely  to  injure  the  permanent  teeth  and  their  contigu- 
ous parts. 

When  the  permanent  teeth  are  crowded,  the  lateral  pressure  is  fre- 
quently so  great  as  to  fracture  the  enamel.  If  this  cannot  be  prevented 
in  any  other  way,  one  on  each  side  should  be  extracted.  It  is  better  to 
sacrifice  two  than  permanently  to  endanger  the  health  of  the  whole. 

The  file  should  never  be  used  with  a  view  to  remedy  irregularity; 
the  extraction  of  two  teeth,  one  on  each  side  of  the  jaw,  however  small 
the  space  required  to  be  gained  may  be,  is  far  preferable.  The  second 
bicuspids,  cceto/s  j)ar/6i(5,  should  always  be  removed  rather  than  the 
first,  but  sometime^  the  extraction  of  the  first  becomes  necessary. 

By  the  removal  of  the  teeth,  ample  room  will  be  gained  for  the 
arrangement  of  all  the  remaining  ones,  and  the  injury  resulting  from 
a  crowded  condition  of  the  organs  prevented. 

The  author  does  not,  however,  wish  to  be  understood  as  conveying  the 
idea  that  filing  the  teeth  necessarily  causes  them  to  decay,  for,  when  the 
file  is  used  for  any  other  purpose  than  to  gain  room,  the  apertures  may 
be  made  large  enough  to  prevent  the  appi'oximation  of  the  organs, 
and  thus  the  bad  effects  resulting  from  the  operation  will  be  prevented. 

The  extraction  of  the  root  of  a  superior  front  tooth,  a  cenfral  incisor, 
for  example,  when  the  crown  has  been  greatly  disfigured  or  wholly  de- 
stroyed by  mechanical  violence,  occasions  a  contraction  of  the  arch 
which  may  cause  the  superior  front  teeth  to  fall  behind  the  inferior 
teeth.     Should  the  contraction,  however,  occur  without  such  a  deform- 


lEEEGULAEITY    OF    THE    TEETH.  433 

ity  resulting,  it  frequently  happens  that  an  unsightly  space  is  left,  too 
small  for  the  insertion  of  an  artificial  tooth  to  correspond  in  size  with 
the  adjoining  natural  ones. 

To  avoid  such  results,  the  root  should  be  allowed  to  remain,  and  the 
proper  treatment  instituted  to  subdue  the  inflammation,  the  pulp  re- 
moved when  exposed,  and  the  root  filled  to  the  apex  with  gold  or  other 
suitable  material.  By  pursuing  such  a  course,  the  root  is  retained 
until  such  a  time  as  its  removal  will  not  afiect  the  adjoining  teeth.  In 
some  cases  the  portion  of  the  crown  destroyed  may  be  restored  with 
gold,  or  an  artificial  crown  inserted  on  a  pivot. 

On  filing  teeth,  to  prevent  irregularity.  Dr.  Fitch  judiciously  re 
marks :  "  I  consider  the  expediency  of  filing  or  not  filing  the  teetl, 
ought  to  be  a  subject  of  serious  deliberation  on  the  part  of  the  dental 
practitioner,  never,  especially  in  young  persons,  performing  the  opera- 
tion, unless  obliged  to  do  so,  to  cure  actual  disease.  I  was  greatly 
surprised,  therefore,  in  the  late  work  of  Mr.  Bell,  to  see  directions  to 
file  slightly  irregular  and  crooked  teeth  so  as  to  gain  the  room  of 
about  half  a  tooth. 

Nature,  when  permitted  to  proceed  with  her  work  without  interrup- 
tion, is  able  to  perform  her  operations  in  a  perfect  and  harmonious 
manner.  But  the  functional  operations  of  all  the  parts  of  the  body  are 
liable  to  be  disturbed  from  an  almost  innumerable  number  and  variety 
of  causes,  and  impairment  of  one  organ  often  gives  rise  to  derangement 
of  the  whole  organism.  For  the  relief  of  which  the  interposition  of 
art  not  unfrequently  becomes  necessary,  and  it  is  fortunate  for  the  well- 
being  of  man  that  it  can  in  so  many  instances  be  applied  with  success. 

In  sound  and  healthy  constitutions,  the  services  of  the  dentist  are 
seldom  required  to  assist  or  direct  second  dentition.  In  remarking 
upon  this  subject.  Dr.  Koecker  observes,  "that  the  children,  for  whom 
the  assistance  of  the  dentist  is  most  frequently  sought,  are  those  who 
are  in  a  delicate,  or  at  least  in  imperfect,  constitutional  health ;  in 
whom  the  state  not  only  of  the  temporary  teeth,  but  of  the  permanent 
also,  is  to  be  considered ;  and,  where  both  are  found  diseased,  the 
future  health  and  regularity  of  the  latter  require  the  greatest  consider- 
ation of  the  surgeon. 

"Irregularity  of  the  teeth  is  one  of  their  chief  predisposing  causes 
of  disease,  and  never  fails,  even  in  the  most  healthy  constitutions,  to 
destroy,  sooner  or  later,  the  strongest  and  best  set  of  te?th,  unless  pro- 
perly attended  to.  It  is  thus  not  only  a  most  powerful  cause  of  destruc- 
tion to  the  health. and  beauty  of  the  teeth,  but  also  to  the  regularity 
and  pleasing  symmetry  of  the  features  of  the  face ;  always  producing, 
though  slowly  and  gradually,  some  irregularity,  and  not  unfrequently 
the  most  surprising  and  disgusting  appearance." 
28 


434  IRREGULARITY    OF    THE    TEETH. 

Though  nature  is  generally  able  to  aceompHsh  the  task  assigned 
her,  yet  there  are  times  when  ehe  requires  aid,  and  it  is  then,  and  then 
only,  that  the  services  of  the  dentist  are  needed.  Therefore,  whilst,  on 
the  one  hand,  we  should  guard  against  any  uncalled  for  interference, 
we  should,  on  the  other,  always  be  ready  to  give  such  assistance  as 
the  nature  of  the  disturbance  presented  to  our  notice  may  require. 

Irregularity  of  Arrangement  of  the  Teeth.  —  The  temporary  teeth 
seldom  deviate  from  their  proper  place  in  the  alveolar  arch ;  but  irreg- 
ularity of  arrangement  is  of  frequent  occurrence  in  the  permanent 
teeth,  especially  the  cuspids  and  incisors.  The  first  and  second  molars 
are  seldom  irregular ;  for,  like  the  teeth  of  first  dentition,  they  rarely 
encounter  obstruction  in  their  growth  and  eruption.  The  first  molars 
being  the  first  of  the  permanent  set  to  appear,  the  ten  anterior  teeth 
are  limited  to  that  part  of  the  arch  occupied  by  the  ten  milk  teeth: 
if  this  space  is  too  small,  irregularity  must  of  necessity  ensue. 

The  deutes  sapientiie  are  sometimes  irregularly  erupted  in  conse- 
quence of  a  want  of  correspondence  between  the  development  of  the 
tooth  and  the  growth  of  the  maxilla.  The  tooth  in  such  cases  takes 
usually  the  direction  of  least  resistance,  the  crown  presenting  more  or 
less  obliquely  forward,  backward,  outward,  or  inward.  Of  these  four 
positions,  the  first  and  fourth  are  found  usually  in  the  lower  jaw  ;  the 
second  and  third  are  most  common  in  the  upper  jaw. 

When  a  bicuspid  is  forced  from  its  proper  place,  it  turns  inward  to- 
ward the  tongue,  or  outward  toward  the  cheek,  accordingly  as  it  is  in 
the  upper  or  lower  jaw.  The  cuspids,  when  prevented  from  coming 
out  in  their  proj)er  place,  make  their  appearance  either  before  or  be- 
hind the  other  teeth.  When  they  come  out  anteriorly,  which  they  do 
more  frequently  than  posteriorly,  they  often  become  a  source  of  annoy- 
ance to  the  upper  lip,  excoriating  and  sometimes  ulcerating  the  mucous 
membrane. 

The  incisors  of  the  upper  jaw  present  a  greater  variety  of  abnormal 
rarrangement  than  any  of  the  other  teeth.  The  centrals  come  out 
.sometimes  before  and  sometimes  behind  the  arch  ;  at  other  times,  their 
median  sides  are  turned  either  directly  or  obliquely  forward  toward 
the  lip.  The  laterals  sometimes  appear  half  an  inch  behind  the  arch, 
looking  toward  the  roof  of  the  mouth  ;  at  other  times,  they  come  out 
in  front  of  the  arch,  and  at  other  times,  again,  they  are  turned  obliquely 
or  transversely  across  it. 

When  any  of  the  upper  incisors  are  very  much  inclined  toward  the 
interior  of  the  mouth,  the  lower  teeth,  at  each  occlusion  of  the  jaws, 
•shut  before  them,  and  become  an  obstacle  to  their  adjustment.  This 
is  a  difficult  kind  of  irregularity  to  remedy,  and  often  interferes  with 
.the  lateral  motion  of  the  jaw. 


IRREGULARITY  OF  THE  TEETH.         435 

The  lower  incisors  sometimes  shut  in  this  manner  even  when  there 
is  no  inward  deviation  of  the  upper  teeth.  In  this  case  the  irregularity 
is  owing  to  preternatural  elongation  of  the  lower  jaw,  which  arises 
more  frequently  from  some  fault  of  dentition  than  from  any  congenital 
defect  in  the  jaw  itself. 

Sometimes  the  superior  maxillary  arch  is  so  much  contracted,  and 
the  front  teeth  in  consequence  so  prominent,  that  the  upper  lip  is  pre- 
vented from  covering  them.  Cases  of  this  kind,  however,  are  rarely 
inet  with  ;  but  when  they  do  occur,  it  occasions  much  deformity  of  the 
face,  and  forms  a  species  of  irregularity  very  difficult  to  correct.  From 
the  same  cause  the  lateral  incisors  are  sometimes  forced  from  the  arch, 
and  appear  behind  the  centrals  and  cuspids,  the  dental  circle  being 
filled  with  the  other  teeth. 

There  are  many  other  deviations  in  the  arrangement  of  the  incisors, 
Mr.  Fox  mentions  one  that  was  caused  by  the  presence  of  two  super- 
numerary teeth  of  a  conical  form,  situated  partly  behind  and  partly 
between  the  central  incisors,  which,  in  consequence,  were  thrown  for- 
ward, while  the  laterals  were  placed  in  a  line  with  the  supernumeraries. 
The  central  incisors,  though  half  an  inch  apart,  formed  one  row,  and 
the  laterals  and  supernumeraries  another.  Mr.  Fox  says  he  has  seen 
three  cases  of  this  kind.  This  description  of  irregularity  is  rarely 
met  with. 

M.  Delabarre  says  that  cases  of  a  transposition  of  the  germs  of  the 
teeth  occasionally  occur,  so  that  a  lateral  incisor  takes  the  place  of  a 
central,  and  a  central  the  place  of  the  lateral.  A  similar  transposition 
of  a  cuspid  and  lateral  incisor  is,  also,  sometimes  seen.  Two  cases  of 
this  sort  have  fallen  under  the  observation  of  the  author. 

The  incisors  of  the  lower  jaw  being  smaller  than  those  of  the  upper, 
and  in  other  respects  less  conspicuous,  do  not  so  plainly  show  an  irreg- 
ularity in  their  arrangement,  nor  is  the  appearance  of  an  individual 
so  much  affected  by  it.  Still  it  should  be  guarded  against ;  for  such 
deviation,  whether  in  the  upper  or  lower  jaw,  may  prove  injurious  to 
the  health  of  the  teeth  and  to  the  beauty  of  the  mouth.  The  growth 
of  the  inferior  permanent  incisors  is  sometimes  more  rapid  than  the 
destruction  of  the  roots  of  the  corresponding  temporaries.  In  this 
case  the  former  emerge  from  the  gums  behind  the  latter,  and  some- 
times so  far  back  as  greatly  to  annoy  the  tongue  and  interfere  with 
enunciation.  At  other  times  the  permanent  centrals  are  prevented 
from  assuming  their  proper  place,  because  the  space  left  for  them  by 
the  temporaries  is-  not  sufficient.  The  irregularity  in  the  former  of 
these  two  cases  is  greater  than  in  the  latter.  The  same  causes,  in  like 
manner,  affect  the  laterals. 

M.  Delabarre  mentions  a  defect  in  the  natural  conformation  of  the 


436         IRREGULARITY  OF  THE  TEETH. 

jaws,  by  which  the  upper  temporary  incisors  on  one  side  of  the  median 
line  are  thrown  on  the  outside  of  the  lower  teeth,  while  the  corres- 
ponding teeth,  on  the  other  side  of  the  same  line,  fall  within.  The 
same  arrangement,  lie  says,  may  be  expected,  unless  previously  reme- 
died, in  the  permanent  teeth.  The  author  has  met  with  but  two  cases 
of  this  sort,  and  the  subjects  of  these  he  did  not  see  until  after  they 
had  reached  maturity. 

Treatment  of  Irregularity.  — Orthodontia,  or  the  treatment  of  irreg- 
ularity, should  accord  with  the  indications  of  nature.  When  the 
irregularity  is  neither  great  nor  complicated,  and  its  causes  are  re- 
moved before  the  nineteenth  or  tw'cntieth  year,  the  teeth,  without  the 
aid  of  art,  will,  in  most  cases,  assume  their  proper  position.  When, 
however,  the  efforts  of  the  economy  are  unavailing,  recourse  should  be 
had  to  the  dentist,  who  can,  in  most  instances,  bring  the  deviating 
organs  to  their  proper  position  in  the  arch.  Teeth  incline  to  return  to 
their  place  on  the  removal  of  the  cause  of  irregularity.  They  may  be 
also  made  to  change  position  under  the  influence  of  pressure.  The 
pressure  must  be  constant;  it  must  be  sufficient  to  cause  motion,  yet 
not  so  great  as  to  set  up  destructive  inflammation ;  lastly,  it  must  be 
continued  until  the  teeth  can  be  kept  in  place  by  antagonism  with  the 
opposing  teeth  ;  or  in  case  there  is  no  such  antagonism,  the  regulating 
appliance  must  be  worn  more  or  less  constantly  for  a  year,  or  even 
longer.  The  regulating  appliance  should  be  as  simple  in  its  construc- 
tion as  is  possible  to  accomplish  the  purpose,  so  that  both  time  and 
labor  may  be  saved,  and  the  patient  be  able  to  attend  to  its  removal 
and  adjustment  when  it  becomes  necessary  to  cleanse  it ;  this  should 
frequently  be  done. 

Teeth  artificially  regulated  change  position  chiefly,  if  not  entirely, 
by  the  double  process  of  absorption  from  one  side  of  the  socket,  fol- 
lowed by  the  slower  process  of  ossific  deposit  on  the  opposite  side.  It 
is  therefore  essential  to  success  that  the  tooth  be  retained  in  its  new 
position,  either  by  the  other  teeth  or  by  mechanical  appliance,  until 
such  deposit  is  formed.  Many  cases  fail  from  a  want  of  persistence  on 
the  part  of  patient  or  dentist. 

How  far,  and  in  what  direction  a  tooth  may  be  moved,  will  depend 
partly  upon  the  position  of  the  apex  of  the  root;  partly  upon  the 
antagonism  of  the  opposing  teeth. 

Cuspids  growing  out  far  up  on  the  alveolar  arch  will  usually  be 
found  to  have  short  and  curved  roots.  The  attempt  to  move  them 
might  cause  the  curved  apex  to  pierce  the  alveolus.  Even  when  not 
curved,  the  root  is  short,  and  the  regulated  tooth  will  not  possess  that 
durability  which  is  characteristic  of  the  cuspids.  It  should  always  be 
boo-ne  in   mind  that  in  regulating  teeth  the  crown   is  the  movable 


lEEEGULARITY    OF    THE    TEETH.  437 

point,  whilst  the  apex  of  the  root  is  the  fixed  point,  and  must  deter- 
mine in  great  degree  the  extent  and  direction  of  motion. 

Again,  the  natural  or  artificial  movement  of  bicuspids  backward  to 
make  room  for  front  teeth  may  be  aided  or  hindered  by  the  opposing 
teeth.  An  upper  bicuspid,  for  instance,  once  carried  back,  so  that  the 
posterior  slope  of  the  lower  bicuspid  strikes  it,  will  retain  its  position 
or  may  be  thrown  even  farther  back. 

Upper  incisors  striking  inside  the  lower,  or  lower  incisors  unnatu- 
rally prominent,  may  be  regulated,  and  the  opposing  teeth  will  tend  to 
keep  them  in  their  corrected  position.  But  it  will  require  long  and 
patient  use  of  the  regulating  apparatus  to  keep  in  place  upper  incisors 
which  project  outward,  or  lower  incisors  inclining  inward. 

In  deciding  upon  the  removal  or  extraction  of  an  irregular  tooth,  it 
should  not  be  forgotten  that  a  tooth  moved  by  mechanical  appliance, 
especially  if  the  change  in  position  is  considerable,  will  not  prove  as 
durable  as  if  no  movement  had  been  necessary.  Hence  it  may  some- 
times be  advisable  to  extract  irregular  cuspids  in  cases  where  their 
correction  requires  much  change  in  their  position  and  that  of  the 
bicuspids. 

In  a  case  very  recently  presented  to  Prof  Austen,  the  superior  arch 
was  perfectly  regular  and  closely  filled  ;  but  both  cuspids  had  come 
out  above  the  arch.  The  cuspid  roots  were  normal,  and  it  seemed 
practicable  to  bring  these  teeth  down  into  the  places  of  the  first  bi- 
cuspids. But  the  four  bicuspids  were  sound,  and  the  first  bicuspids 
gave  very  much  the  appearance  of  the  natural  arrangement.  Hence, 
as  in  point  of  expression,  there  would  be  no  great  gain,  and  in  point 
of  durability,  a  probable  loss,  it  was  not  thought  advisable  to  subject 
the  patient  to  the  tedious  annoyance  of  regulation. 

The  practicability  of  altering  the  position  of  a  tooth,  after  the  com- 
pletion of  its  growth,  was  well  known  to  many  of  the  early  practi- 
tioners. But  before  the  commencement  of  the  present  century,  the 
principal  object  of  the  dentist  was  the  insertion  of  artificial  teeth ; 
orthodontia,  therefore,  met  with  litQe  attention.  Fauchard  and  Bourdet 
were  among  the  first  to  study  this  branch  of  dentistry.  They  invented 
a  variety  of  fixtures  for  adjusting  irregular  teeth  ;  but  most  of  these 
were  so  awkward  in  their  construction,  and  occasioned  so  much  incon- 
venience to  the  patient,  that  they  were  seldom  employed. 

Mr.  Fox  was  among  the  first  to  give  explicit  directions  for  remedy- 
ing irregularity  of  the  teeth,  and  his  method  of  treatment  has  formed 
the  basis  of  the  established  practice  for  more  than  fifty  years.  This 
long  trial  has  proved  it  to  be  founded  upon  correct  physiological  priur 
cipies  and  much  practical  experience. 

In  describing  the  treatment  of  irregularity,  we  shall   notice  the 


438         IRREGULARITY  OF  THE  TEETH. 

means  by  which  some  of  its  principal  varieties  may  be  remedied; 
otherwise,  tlie  application  of"  the  principles  of  treatment  would  not  be 
well  understood,  since  it  must  be  varied  to  suit  each  individual  case. 

As  a  general  rule,  the  sooner  irregularity  in  the  arrangement  of  the 
teeth  is  remedied  the  better  ;  for  the  longer  a  tooth  is  allowed  to  occupy 
a  wrong  position,  the  more  difficult  will  be  its  adjustment.  The 
position  of  a  tooth  may  sometimes  be  altered  after  the  eighteenth, 
twentieth,  or  even  the  thirtieth  year;  but  it  is  better  not  to  delay  the 
application  of  the  proper  means  until  so  late  a  period,  A  change  of 
this  kind  may  be  much  more  easily  effected  before  the  several  parts 
of  the  osseous  system  have  reached  their  full  development,  and  while 
the  formative  process  is  in  vigorous  operation,  than  at  a  later  period 
of  life.  The  age  of  the  subject,  therefore,  should  always  govern  the 
practitioner  in  forming  an  opinion  as  to  the  practicability  of  cor- 
recting irregularity.  Previously  to  the  twentieth  year,  the  worst  varie- 
ties of  irregularity  may,  in  most  cases,  be  successfully  treated. 

The  first  thing  claiming  attention  in  the  treatment  is  the  removal 
of  its  causes.  "Whenever,  therefore,  the  presence  of  any  of  the  tem- 
porary teeth  has  given  a  false  direction  to  one  or  more  of  the  perma- 
nent, they  should  be  extracted,  and  the  deviating  teeth  pressed  several 
times  a  day  with  the  finger,  in  the  direction  they  are  to  be  moved. 
This,  if  the  irregularity  has  been  occasioned  by  the  presence  of  a 
deciduous  tooth,  will,  generally,  be  all  that  is  required. 

But  when  it  is  the  result  of  narrowness  of  the  jaw,  either  natural 
or  acquired,  a  permanent  tooth  on  either  side  should  be  removed,  to 
make  room  for  such  as  are  improperly  situated.  All  the  teeth  being 
sound  and  well  formed,  the  second  bicusjDids  are  the  teeth  which  should 
be  extracted ;  but  if,  as  is  often  the  case,  the  first  permanent  molars 
are  so  much  decayed  as  to  render  their  preservation  impracticable,  or, 
at  least,  doubtful,  these  teeth  should  be  removed  in  their  stead.  After 
the  removal  of  the  second  bicuspids,  the  first,  usually,  very  soon  fall 
back  into  the  places  which  they  occupied,  and  furnish  ample  room  for 
the  cuspids  and  incisors.  But  if  they  fail  to  do  this,  they  may  be 
gradually  forced  back  by  inserting  wedges  of  wood  or  rubber  between 
them  and  the  cuspids,  or  by  means  of  a  ligature  of  silk,  or  gum  elastic, 
securely  fastened  to  the  first  molar  on  each  side.  These  should  be  re- 
newed every  day,  until  the  desired  result  is  produced. 

The  most  frequent  kind  of  irregularity,  resulting  from  narrowness 
of  the  jaw,  is  the  prominence  of  the  cuspids.  These  teeth,  with  the 
exception  of  the  second  and  third  molars,  are  the  last  of  the  teeth  of 
second  dentition  to  be  erupted  ;  consequently  they  are  more  liable  to 
be  forced  out  of  the  arch  than  any  others,  especially  when  it  is  so 
much  contracted  as  to  be  almost  entirely  filled  before  they  make  their 


lEEEGTJLAEITY    OF    THE    TEETH.  439 

appearance.  The  common  practice  in  such  cases  was  to  remove  the 
projecting  teeth.  But  as  the  cuspids  contribute  more  than  any  of  the 
other  teeth,  except  the  incisors,  to  the  heauty  of  the  mouth,  and  can, 
in  almost  every  case,  be  brought  to  their  proper  place,  the  practice  is 
injudicious.  Instead  of  removing  these,  a  bicuspid  should  be  extracted 
from  each  side.  When  the  space  between  the  lateral  incisor  and  the 
bicuspid  is  equal  to  one-half  the  width  of  the  crown  of  the  cuspid, 
the  second  bicuspid  should  be  removed,  but  when  it  is  less,  the  first 
should  be  taken  out ;  because,  although  the  crown  of  the  latter  may 
be  carried  far  enough  back  after  the  removal  of  the  former  to  admit 
the  crown  of  the  cuspid  between  it  and  the  lateral  incisor,  the  root 
of  this  tooth  will  remain  in  front  and  j)artly  across  the  root  of  the  first 
bicuspid ;  leaving  a  more  or  less  prominent  vertical  ridge  on  the 
anterior  part  of  the  alveolar  border,  which,  to  some  extent  at  least, 
acts  as  an  irritant  to  the  gums  and  periosteum. 

As  the  incisors  of  the  upper  jaw  are  more  conspicuous  than  those 
of  the  lower,  and  when  well  arranged  contribute  more  to  the  beauty 
of  the  mouth,  their  preservation  and  regularity  are  of  greater  relative 
importance.  Hence,  the  removal  of  a  lateral  incisor,  when  it  is  situ- 
ated behind  the  dental  arch,  as  is  often  done  with  a  view  to  remedy 
the  deformity  produced  by  false  position,  is  a  practice  which  cannot  be 
too  strongly  deprecated,  provided  sufficient  space  can  be  made  for  it 
between  the  cuspid  and  central  incisor,  by  the  removal  of  a  bicuspid 
from  each  side  of  the  jaw. 

In  describing  the  treatment  of  irregularity,  we  shall  commence 
with  an  incisor  occupying  an  oblique  or  transverse  position  across  the 
alveolar  ridge ;  so  that  the  cutting  edge  of  the  tooth,  instead  of  being 
in  a  line  with  the  arch,  forms  an  angle  with  it  of  from  forty  to  ninety 
degrees.  This  variety  of  deviation  is  rarely  met  with  in  both  centrals, 
but  often  occurs  with  one.  Some  dentists  have  recommended  in  cases 
of  this  sort,  when  the  space  between  the  adjoining  central  and  lateral 
incisor  is  equal  to  the  width  of  the  deviating  tooth,  to  turn  the  latter 
in  its  socket  with  a  pair  of  forceps,  or  to  extract  and  immediately  re- 
place it  in  its  proper  position.  It  is  scarcely  necessary  to  say  that  if 
a  tooth  is  extracted  or  turned  in  its  socket,  the  vessels  and  nerves  from 
which  it  derives  nourishment  and  vitality  are  severed ;  hence,  though 
its  connection  with  the  alveolus  may  be  partially  re-established,  it  will 
be  liable  to  act  as  a  morbid  irritant,  and  be  subject  to  inflammation 
from  comparatively  slight  causes. 

The  tooth,  however,  may  be  brought  to  its  proper  position,  without 
incurring  the  risk  of  injury,  by  accurately  fitting  a  gold  ring  or  band, 
with  knobs  on  the  labial  and  palatine  sides;  to  each  of  these  a  ligature 
should  be  attached.     Thus  fastened  to  the  ring,  each  end  should  be 


440 


IRREGULARITY    OF    TUE    TEETH. 


carried  back,  one  on  either  side,  in  front  and  behind  the  arch,  and 
secured  to  the  bicuspids  as  represented  in  Fig.  168,  so  as  to  act  con- 
stantly upon  the  irregular  tooth.  The  ligatures  should  be  renewed 
from  day  to  day,  until  the  tooth  assumes  its  proper  position.  Should 
the  space  not  be  sufficient  to  permit  the  use  of  the  band,  the  method 


Fio.  168. 


Fir..  1G9. 


practised  by  Mr.  Tomes,  as  shown  in  Fig.  169,  will  be  found  very 
effective.  A  plate  is  fitted  to  the  inside  of  the  arch,  and  a  band  car- 
ried in  front  and  soldered  to  projections  from  the  plate,  which  pass 
between  the  bicuspids.  On  each  side  of  the  irregular  tooth  a  metallic 
dovetail  is  fastened,  and  pieces  of  compressed  wood  inserted  into  them. 
The  swelling  of  the  wood  gradually  turns  the  tooth.  In  a  few  days 
the  metal  sockets  will  require  to  be  changed  in  position,  and  in  a  few 
weeks  the  tooth  may  be  thus  brought  nearly  or  quite  to  its  natural 
place. 

If  the  space  permits,  these  two  methods  may  be  advantageously  com- 
bined. Use  the  plate  as  in  Fig.  169  with  the  inner  dovetail  ;  but 
for  the  long  outside  band  substitute  the  band  (Fig.  168)  around  the 
tooth,  with  a  loop  on  the  median  side ;  from  this  pass  an  elastic  liga- 
ture to  a  hook  soldered  on  the  plate.  The  tooth  is  turned  on  its  axis 
by  the  combined  pull  of  the  ligature  and  thrust  of  the  wood. 

Before  attempting  to  turn  the  deviating  organ,  it  should  be  ascer- 
tained if  the  aperture  between  the  adjoining  teeth  is  sufficient  to  admit 
of  the  operation.  If  not,  it  should  be  increased  by  the  extraction  of  a 
bicuspid  from  each  side  of  the  jaw,  and  moving  the  teeth  in  front  of 
them  backward  until  sufficient  room  is  obtained.  The  time  required 
to  do  this  will  vary  from  three  to  eight  or  ten  wrecks,  depending  upon 
the  number  of  teeth  to  be  acted  on,  and  the  age  of  the  patient.  A 
sufficient  space  may  sometimes  be  gained  by  pressing  outward  the 
adjoining  teeth  in  cases  where  they  fall  within  the  normal  curve  of 
the  arch.  This  may  be  done  by  the  expansion  of  wood  or  rubber,  con- 
tained in  metal  sockets  attached  to  the  plate,  behind  each  tooth  to  be 
moved. 


\lcREGULARITY    OF    THE    TEETH. 


441 


Fig.  170. 


Narrowness  of  the  alveolar  border  is  a  frequent  cause  of  irregularity 
of  the  incisors.  In  this  case,  the  centrals  usually  project,  though  it 
sometimes  happens  that  some  are  in  front  and  some  behind  the  arch, 
producing  great  deformity.  To  remedy  which,  the  second  bicuspids 
should  be  removed,  unless  the  first  molars- are  so  much  affected  by 
caries  as  to  render  their  preservation  doubtful.  In  this  case,  they 
should  be  extracted,  in  place  of  the  second  bicuspids.  If  bicuspids 
and  first  molars  are  sound,  and  the  decision  turns  upon  the  probable 
relative  durability  of  the  teeth,  statistics  decide  very  positively  in  favor 
of  the  bicuspids,  especially  under  the  age 
of  fifteen.  But  the  position  of  the  first 
molar  is  too  far  back  to  permit,  in  all 
cases,  the  full  benefit  of  the  space  gained 
by  its  extraction. 

The  following  case  will  serve  to  illus- 
trate the  means  employed  for  remedying 
this  description  of  deformity.  The  sub- 
ject was  a  young  lady  fifteen  years  of 
age.  Her  teeth  presented  the  arrange- 
ment as  seen  in  Fig.  170. 

The  second  molars  of  the  upper  jaw 
occupied  their   proper   position   in   the 

alveolar  arch,  or,  in  other  words,  they  were  a  little  more  than  an  inch 
and  a  quarter  apart ;  the  first  molars  were  hardly  an  inch  apart,  and 
the  first  bicuspids  were  still  nearer  to  each  other.  The  cuspids,  except 
that  they  were  pushed  a  little  too  far  forward,  occupied,  very  nearly, 
their  proper  position.  The  right  central  and  left  lateral  incisors  pro- 
jected fully  a  quarter  of  an  inch,  lifting  and  otherwise  annoying  and 
disfiguring  the  upper  lip ;  the  left  central  was  thrown  behind  and 
partly  between  the  right  central  and  left  lateral,  while  the  right  lateral 
occupied  a  position  in  a  line  with  it. 

Without  going  into  a  minute  detail  of  the  method  adopted  for  pre- 
paring the  appliance  used,  it  will  be  suffi- 
cient to  refer  the  reader  to  Fig.  171.  This 
represents  a  plaster  model  of  the  teeth, 
alveolar  border,  palatine  arch,  and  the  ap- 
paratus for  remedying  the  deformity.  The 
second  bicuspids  were  first  extracted,  then, 
by  means  of  ligatures  applied  to  the  sec- 
ond molars  and  first  bicuspids,  and  made 
fast  to  a  band  of  gold  passing  on  the  out- 
side of  the  arch,  which  were  renewed  every 
day,  these  teeth  were  brought  out  to  their 
proper  position  in  eleven  weeks ;  this  done, 


442 


IRREGULARITY    OF    THE    TEETH. 


Fio.  i: 


there  was  a  space  of  nearly  an  eighth  of  an  inch  between  the  cuspids 
and  first  bicuspids;  this  was  filled  up  by  bringing  back  the  cuspids 
with  ligatures.  A  ligature  was  next  applied  to  the  right  lateral,  passed 
througii  a  hole  in  the  gold  band  in  front,  and  made  fast.  In  ten  days 
this  tooth  was  brought  to  its  proper  place.  A  ligature  was  now  attached 
to  a  knob  soldered  on  the  gold  plate  which  had  been  fitted  to  the  inside 
of  the  teeth  and  palatine  arch  for  this  purpose,  and  tied  tiglitly  in  front 
of  the  projecting  right  central  incisor.  In  about  three  weeks  this  was 
brought  to  a  position  alongside  the  lateral  incisor  of  the  same  side. 
The  left  central  was  then,  in  like  manner,  brought  forward,  and  the 
left  lateral  carried  backward  to  its  proper  place. 

After  the  deformity  was  corrected,  the  teeth  presented  the  arrange- 
ment represented  in  Fig.  172,  taken  from  a  plaster  model  made  from 
an  impression  of  the  regulated  teeth.  To 
correct  the  irregularity  in  this  case,  it  re- 
quired, in  all,  twenty-one  weeks.  If  all  the 
teeth  could  have  been  acted  upon  at  the 
same  time,  the  operation  might  have  been 
accomplished  in  a  shorter  period.  It  was 
found  necessary,  too,  in  consequence  of  the 
diseased  action  of  the  gums,  occasioned  by 
the  apparatus,  to  remove  it  every  eight  or 
ten  days,  and  let  it  remain  oflT  each  time 
twenty-four  hours.  It  may  be  proper  also 
to  observe  that  every  time  the  ligatures 
•were  removed,  it  was  taken  from  the  mouth,  and  the  teeth  thoroughly 
cleansed. 

For  moving  a  projecting  incisor  or  cuspid  backward,  a  gold  spiral 
spring  was  formerly  employed.  It  was  found  to  be  more  efficient  than 
a  ligature  of  silk,  inasmuch  as  it  kept  up  a  constant  traction  upon  the 
deviating  tooth.  But  it  is  objectionable  on  account  of  the  annoyance 
it  causes  the  patient.  A  ligature  of  rubber  is  far  preferable,  and  this 
material  is  now  very  generally  employed  in  the  treatment  of  every 
description  of  irregularity  in  which  agencies  of  this  sort  are  required. 
The  difficulty  of  tying  India-rubber  ligatures  is  obviated  by  the  use  of 
several  sizes  of  delicate  elastic  tubing  (French  manufacture),  from 
which  sections  may  be  cut,  more  or  less  thick,  according  to  the  required 
length  and  power  of  the  ligature.  Each  strip  becomes  thus  an  endless 
band  which  may  be  readily  passed  from  one  tooth  to  another  or  to  a 
hook  on  the  plate. 

There  are  other  kinds  of  irregularity  of  the  upper  incisors ;  but  we 
shall  only  notice  one,  which,  from  its  peculiar  character,  is  sometimes 
exceedingly  difficult  to  remedy.    It  is  when  one  or  more  of  these  teetJ^ 


lEEEGULAEITY    OF    THE    TEETH. 


443 


are  placed  so  far  back  in  the  jaw  that  the  under  teeth  come  before  it 
or  them  at  each  occlusion  of  the  mouth. 

Of  this  kind,  Mr.  Fox  enumerates  four  varieties :  The  first  is,  when 
one  of  the  central  incisors  is  situated  so  far  back  that  the  lower  teeth 
shut  over  it,  while  the  other  central  remains  in  its  proper  place,  as 
represented  in  Fig.  173,  which  is  copied  from  his  work,  as  are  also 
those  which  follow. 


Fig.  173. 


Fig.  174. 


The  second  is,  when  both  of  the  centrals  have  come  out  behind  the 
circle  of  the  other  teeth,  and  the  laterals  occupy  their  own  projDer 
position,  as  represented  in  Fig.  174. 

The  third  is,  when  the  lateral  incisors  are  thrown  so  far  back  that 
the  under  teeth  shut  before  them,  while  the  centrals  are  well  arranged, 
as  exhibited  in  Fig.  175. 


Fig.  175. 


Fig.  176. 


The  fourth  is,  when  all  the  incisors  are  placed  so  far  behind  the  arch 
that  the  lower  teeth  shut  before  them,  as  in  Fig.  176. 

He  might  also  have  added  to  these  a  fifth  variety ;  for  it  sometimes 
happens  that  the  cuspids  of  the  u]3per  jaw  are  thrown  so  far  back  as 
to  fall  on  the  inside  of  the  lower  teeth.  The  author  has  met  with 
several  such  cases. 

Two  things  are  necessary  in  the  treatment  of  the  kind  of  irregularity 
just  described  :  first,  to  prevent  the  upper  and  lower  teeth  from  coming 
entirely  together,  by  placing  between  them  some  hard  substance,  so 
that  the  overlapping  incisors  may  not  interfere  with  the  necessary  out- 
ward movement.  The  second  is,  the  application  of  some  fixture  that 
will  exert  a  constant  and  steady  pressure  upon  the  deviating  teeth, 
until  they  pass  those  of  the  lower  jaw. 


444 


IREEGULARITY    OF    THE    TEETH, 


For  the  accomplishment  of  this,  various  plans  have  been  proposed. 
Duval  recommended  the  application  of  a  grooved  or  guttered  plate, 
and  Catalan  invented  an  instrument,  based,  we  believe,  upon  the  same 
principle,  but  much  better  adapted  to  the  purpose.  We  doubted  the 
utility  of  the  inclined  plane  of  Catalan  until  we  had  employed  it,  and 
found  it  an  effectual  and  speedy  method  of  moving  deviating  front 
teeth  in  the  upper  jaw  from  behind  the  dental  circle  to  their  proper 
places.  It  acts  with  great  force,  and  in  the  proper  manner  for  the  ac- 
complishment of  the  object.  But  this  very  force,  and  the  difficulty  of 
controlling  it,  make  it  necessary  to  be  careful  in  its  use,  especially 
upon  partially  erupted  teeth.  The  roots  of  such  teeth  are  in  process 
of  formation,  and  of  course  highly  vitalized,  and  are  very  susceptible 
to  injury  from  the  shock  of  repeatedly  striking  upon  the  inclined 
plane. 

In  the  application  of  this  principle  for  the  correction  of  irregularity, 
the  author  has  been  in  the  habit  of  constructing  the  apparatus  some- 
what differently.  With  a  metallic  die  and  counter-dies,  he  has  a  plate 
of  gold  struck  up  over  all  the  teeth,  when  practicable,  as  far  back  as 
the  first  or  second  molar,  completely  encasing  them  and  the  alveolar 


Fia.  177. 


Fig.  178. 


Fig.  179. 


ridge.  An  encasement  of 
this  sort  (Fig.  177)  pos- 
sesses greater  stability  than 
can  be  obtained  for  an  ap- 
pliance like  the  one  invent- 
ed by  Catalan,  which  con- 
sisted of  a  simple  circular 
bar  or  plate  of  gold  run- 
ning round  in  front  of  the 
teeth,  from  the  first  molar 
on  one  side  to  the  first  molar 
on  the  other,  to  which  the 
inclined  plane  was  soldered. 
In  Fig.  177  is  seen  a  rep- 


IRREGULARITY    OF    THE    TEETH. 


445 


resentation  of  an  inclined  plane  for  bringing  forward  a  central  incisor 
"which  had  come  out  about  a  quarter  of  an  inch  behind  the  circle  of 
the  other  teeth.  The  manner  of  the  action  of  this  instrument  upon 
the  deviating  tooth  is  shown  in  Fig.  178. 

The  plan  proposed  by  Delabarre,  as  shown  in  Fig.  179,  taken  from 
his  treatise  on  second  dentition,  is  to  pass  silk  ligatures  (a)  around  the 
teeth,  in  such  a  way  that  a  properly  directed  and  steady  pressure  will 
be  exerted  on  such  of  the  teeth  as  are  situated  behind  the  arch.  To 
keep  the  jaws  from  coming  in  contact,  he  recommeuds  the  application 
of  a  metallic  grate  (b)  fitted  to  two  of  the  inferior  molars.  A  cap  of 
"vulcanized  rubber  is  preferable  to  the  metallic  grate. 

This  plan  possesses  the  merit  of  simplicity,  and  occasions  little  or  no 
inconvenience  to  the  patient.  It  "will,  however,  sometimes  be  found  not 
only  inefficient,  but  also  injurious  in  its  action  upon  the  teeth  adjacent 
to  those  to  be  brought  forward.  The  force  on  the  irregular  teeth,  and 
those  against  which  the  ligatures  act,  being  equal,  and  in  opposite 
directions,  the  latter  will  be  drawn  back,  while  the  former  are  brought 
forward;  thus  the  means  used  for  the  correction  of  one  evil  will  some- 
times occasion  another.  The  author  has  tried  it,  how'ever,  in  some 
cases  with  the  most  satisfactory  results. 

Mr.  Fox  recommended  a  gold  bar  about  the  sixteenth  part  of  an 
inch  in  width,  and  of  proportionate 
thickness,  bent  to  suit  the  curvature 
of  the  mouth,  and  fastened  with  liga- 
tures to  the  temporary  molars  of  each 
side.  It  is  pierced  opposite  each  ir- 
regular tooth  with  two  holes.  The 
teeth  of  the  upper  and  lower  jaw  are 
prevented  from  coming  entirely  to- 
gether by  means   of  thin  blocks   of 

ivory,  attached  to  each  end  of  the  bar  by  small  pieces  of  gold,  and 
resting  upon  the  grinding  surfaces  of  the  temporary  molars.  (Fig.  180.) 

After  the  instrument  has  been  thus  fastened  to  the  teeth,  silk  liga- 
tures are  passed  round  such  as  are  within  the  arch,  and  through  the 
holes  opposite  them,  and  then  tied  in  a  firm  knot  on  the  outside  of 
the  bar. 

The  ligatures  must  be  renewed  every  three  or  four  days,  until  the 
teeth  shall  have  come  forward  far  enough  to  strike  in  front  of  those 
that  formerly  shut  before  them,  and  until  they  shall  have  acquired  a 
sufficient  degree  -of  firmness  to  prevent  them  from  returning  to  their 
former  position.  As  soon  as  the  teeth  shut  perpendicularly  upon  each 
other,  the  blocks  may  be  removed,  and  the  bar  alone  retained. 

Since  1830,  many  practitioners,  both  in  England  and  the  United 


Fig.  180, 


446         IRREGULARITY  OF  THE  TEETH. 

States,  have  substituted  c{ii)s  of  gold,  or,  what  is  better,  of  v^ulcanized 
rubber,  for  the  bloclvs  of  ivory  reeoin mended  by  JMr.  Fox,  and  in- 
stead of  simply  bending  the  bar,  they  now  swage  it  between  metallic 
casts,  so  that  all  its  parts,  except  those  immediately  opposite  the  irreg- 
ular teeth,  may  be  perfectly  adapted  to  the  dental  circle.  The  a])pa- 
ratus,  with  these  modifications,  is  more  comfortable,  and  less  liable  to 
move  upon  the  teeth. 

Mr.  Fox  directs  that  the  blocks  of  ivory  be  placed  upon  the  tem- 
porary molars  ;  but  the  caps  of  gold  or  rubber  now  substituted  are 
entirely  disconnected  from  the  bar,  and  are  often  used  after  the  moult- 
ing of  these  teeth  ;  they  are  then  placed  upon  the  first  permanent 
molars.  As  the  caps  prevent  the  teeth  from  coming  together,  masti- 
cation, during  the  time  they  are  worn,  is,  necessarily,  perfi)rmed  on 
them.  They  should,  thex-efore,  be  placed  upon  the  largest  and  strongest 
teeth ;  and  for  this  reason  they  should  be  applied  to  the  molars. 

The  curved  bar  should  be  washed,  and  the  teeth  cleansed  every  time 
the  ligatures  are  renewed.  If  this  be  neglected,  the  particles  of  food 
that  collect  between  it  and  the  teeth  will  soon  become  putrid  and  offen- 
sive, constituting  a  source  of  disease  both  to  the  gums  and  teeth.  Be- 
fore the  bar  is  applied,  it  should  be  ascertained  whether  there  is  suffi- 
cient space  for  the  deviating  teeth,  and  if  there  is  not,  room  should  be 
made  in  the  manner  before  described. 

Some  diversity  of  opinion  exists  as  to  the  most  suitable  age  for  the 
correction  of  this  description  of  irregularity.  Mr.  Fox,  it  would  seem, 
preferred  the  period  immediately  previous  to  the  shedding  of  the  tem- 
porary molars  —  probably  the  tenth  or  eleventh  year  after  birth. 
Others  think  that  the  anterior  part  of  the  dental  arch  continues  to  ex- 
pand until  the  second  denture  is  completed,  and  that  the  bicuspids  afford 
a  better  support  for  the  ends  of  the  bar  than  any  other  teeth,  and  are 
content  to  wait  until  the  fifteenth  or  even  sixteenth  year.  But,  though 
the  arch  does  sometimes  expand  a  little,  yet  even  when  the  expansion 
occurs,  it  is  generally  so  inconsiderable,  that  little  advantage  can  be 
derived  from  it.  Moreover,  the  arch,  instead  of  expanding,  is  much 
more  liable  to  contract  whenever  a  vacancy  occurs  in  the  dental  circle, 
either  by  the  extraction,  or  from  the  improper  growth  of  one  or  more 
of  the  teeth  ;  hence,  the  difficulty  is  apt  to  be  increased  by  delay.  The 
evil,  it  is  true,  may  be  remedied  at  the  fifteenth,  seventeenth,  or  even 
eighteenth  year ;  but  it  is  rarely  advisable  to  defer  it  to  so  late  a  period. 
The  most  that  is  required  in  the  treatment  of  irregularity  of  the 
lower  incisors  is  to  remove  a  tooth,  and  to  apply  frequent  pressure  to 
the  deviating  organs.  The  lower  incisors  are  less  conspicuous  than 
those  of  the  upper  jaw,  and  the  loss  of  one,  if  the  others  are  well  arranged, 
is  scarcely  perceptible. 


lEEEGULARITY  OF  THE  TEETH.         447 

The  use  of  vulcanite  or  hardened  India-rubber  promises  to  be  of 
great  value  in  the  correction  of  irregularities.  The  peculiar  manipula- 
tions it  requires  will  be  found  in  another  portion  of  this  work ;  it  is 
only  necessary,  therefore,  in  concluding  this  cha^Dter,  to  briefly  mention, 
the  properties  which  fit  it  for  this  important  branch  of  dental  practice. 

It  admits  of  absolutely  perfect  adaptation  to  the  teeth.  If  only  a  part 
of  the  crowns  of  the  teeth  require  fitting,  a  wax  impression  will  be  suffi- 
ciently accui'ate.  But  if  the  gum  and  undercut  surfaces  of  the  teeth 
are  to  be  fitted,  a  plaster  impression  is  necessary.  Prof.  Austen's 
method  of  taking  plaster  impressions  in  gutta-percha  cups  will  enable 
a  skilful  operator  to  take  an  accurate  impression  of  any  mouth,  how- 
ever irregularly  the  teeth  may  be  arranged. 

A  closely  fitting  vulcanite  plate  "can  be  worn  with  comfort ;  hence 
the  patient  is  not  tempted  to  remove  it.  It  has  no  motion  ;  hence  does 
not  wear  the  teeth  or  irritate  the  gums.  Its  firmness  of  adaptation 
makes  it  an  excellent  "fixed  point,"  from  which  to  make  pressure  or 
traction  in  any  required  direction  upon  the  irregular  teeth  t  the  coun- 
ter pressure,  being  distributed  over  all  the  regular  teeth,  is  not  felt. 
When  it  is  necessary  to  cap  the  molars,  a  layer  of  varying  thickness 
should  be  carried  over  them  all,  to  prevent  the  soreness  caused  by  mas- 
tication upon  any  one  tooth. 

Any  variety  of  appliance  may  be  used  in  connection  with  the  plate, 
that  the  judgment  of  the  operator  suggests,  as  best-  adapted  to  bring 
about  the  required  change.  The  plastic  nature  of  the  crude  material 
permits  enlargement  or  extension  in  any  direction,  without  the  neces- 
sity of  soldering,  as  in  metallic  plates,  and  with  an  exactness  which 
cannot  be  had  in  carving  ivory  blocks. 

Thus,  prominences  may  be  left  behind  teeth  which  are  to  be  moved 
outward  ;  in  which  may  be  made  dovetails  for  the  insertion  of  com- 
pressed wood  ;  slits  or  holes  for  India-rubber,  which  makes  more  rapid 
pressure  than  the  wood  ;  or  holes  for  the  insertion  of  small  screws. 
These  screws  may  bear  directly  against  the  tooth,  and  be  turned 
slightly  each  day  or  two.  Or  the  portion  of  the  plate  next  the  tooth 
or  teeth  to  be  moved  may  be  separated  with  a  delicate  saw  from  the 
plate  ;  the  ends  of  the  screw  or  screws  playing  into  this  move  the  tooth 
or  teeth  by  a  broad  bearing,  which  will,  in  certain  cases,  be  better  than 
the  point  of  the  screw. 

Or  a  small  piece  of  vulcanized  rubber  may  be  taken  ;  one  end  fitting 
against  a  molar  or  bicuspid,  and  into  the  other  ep.d  a  screw  thread  cut 
to  receive  a  delicate  screw ;  on  the  head  of  this  screw  a  second  piece 
of  rubber  may  be  fitted  against  the  tooth,  to  be  moved  so  as  to  allow 
the  screw  to  be  turned  without  changing  its  position  on  the  tooth.  This 
combination   forms  a  miniature  jack-screw,  similar  to  those   recom- 


448 


IRREGULARITY    OF    THE    TEETH. 


Fig.  181. 


mended  some  years  since  by  Dr.  Dwindle,  and  will  often  be  found  use- 
ful. It  may  be  used  in  combination  with  the  rubber  plate  by  attaching 
one  end  to  the  plate  instead  of  resting  it  against  a  tooth. 

If  it  is  desired  to  move  a  tooth  by  the  elasticity  of  a  spring,  this  can 
be  made  of  vulcanite ;  one  end  of  it  fitting  tightly  into  a  groove  cut  in 
the  plate,  so  that  the  free  end  shall  bear  with  the  recjuisito  force  against 
the  tooth.  The  clastic  slip  or  spring  can  readily  be  bent  by  means  of 
a  warm  burnisher,  so  as  to  press  with  greater  or  less  force,  as  the  case 
may  demand.     Fig.  181,  taken  from  Mr.  Tomes'  work,  will  illustrate 

one  variety  of  the  application  of  springs; 
in  this  case  pressing  outward  and  later- 
ally the  left  central  and  right  lateral 
incisors.  This  mode  of  making  press- 
ure will  be  found  very  useful.  It  acts 
steadily,  is  under  control,  and  does  not 
need  renewal  so  often  as  the  wedges  of 
wood  or  rubber. 

Where  ligatui-es  are  required,  the 
vulcanite  plate  affords  an  easy  means 
of  attaching  them  in  any  desired  posi- 
tion ;  passing  them  through  holes  and 
tying;  looping  them  over  projecting 
knobs  of  vulcanite,  or  over  small  metal 
hooks  set  in  the  plate ;  or  stretching  them  through  slits  sawn  in  the 
plate. 

If  a  band  is  to  be  carried  for  any  purpose  in  front  of  the  arch,  it 
may  be  connected  with  the  plate  on  the  inside  of  the  arch,  through 
any  spaces  occurring  between  the  bicuspids  or  molars  ;  if  there  are  no 
such  spaces,  or  if  they  are  to  be  closed  up  in  the  process  of  regulation, 
the  cap  which  is  often  required  to  pass  over  the  molars  will  connect 
the  two.  But  the  outside  band  is  not  often  necessary.  The  inside 
plate  is  less  awkward  to  the  patient;  it  is  out' of  sight;  and  almost,  if 
not  quite,  every  required  movement  can  be  obtained  from  it,  even  to 
the  exclusion  of  the  inclined  plane  of  Catalan. 

The  case  described  on  page  439,  Fig.  170,  could  have  been  advan- 
tageously treated  by  the  use  of  a  vulcanite  plate;  the  various  stages 
progressing  nearly  at  the  same  time.  The  impression  in  this  case  to  be 
taken  in  plaster;  the  plate  capping  the  second  molars  ;  first  molars  and 
first  bicuspids  carried  outward  by  wooden  or  elastic  wedges,  or  by  a 
double  spring  of  vulcanite  fastened  to  the  plate  opposite  each  space  of 
the  extracted  second  bicuspids  ;  the  left  central  and  right  lateral  car- 
ried out  by  wedges  or  screws  ;  the  right  central  and  left  lateral  brought 
in  by  ligatures  looped  over  hooks  in  the  plate.     At  the  completion  of 


lEEEGULAEITY  OF  THE  TEETH.         449 

the  work  a  new  impression  to  be  taken,  and  the  plate  worn  until  the 
teeth  become  firmly  set,  passing  a  ligature  around  the  two  outstanding 
teeth,  to  prevent  their  tendency  to  return  to  their  old  positions ;  the 
plate  itself  would  keep  the  others  in  place. 

A  text-book  can  only  give  general  principles  and  illustrate  them  by 
a  few  examples ;  for  the  varieties  of  irregularity  are  almost  endless. 
Their  successful  treatment  demands  a  correct  knowledge  of  physiologi- 
cal and  pathological  action  to  know  when  and  where  to  act ;  a  skilful 
hand  and  an  inventive  wit  to  know  just  what  to  do  and  how  to  do  it. 

In  conclusion,  to  sum  up  briefly,  do  not  interfere  where  by  simple 
extraction  the  case  will  correct  itself:  when  teeth  must  be  moved,  dc 
it  decidedly,  to  avoid  tedious  delay ;  but  take  care  not  to  be  so  rapid 
as  to  excite  inflammation :  do  not  move  teeth  with  deformed  or  defec- 
tive roots ;  do  not  sacrifice  sound  and  regular  bicuspids  to  bring  into 
the  arch  teeth  which  will  require  to  be  moved  through  a  great  space, 
for  this  movement  materially  impairs  their  durability;  lastly,  do  not 
attemj)t  to  bring  teeth  to  a  position  where  you  cannot  keep  them  until 
firm  ossific  deposit  makes  them  permanent  in  their  new  positions. 

Where  the  superior  central  incisors  project  beyond  the  inferior  so 
much  as  to  give  a  pointed  appearance  to  the  lij),  Dr.  Kingsley  recom- 
mends the  following  regulating  appliance :  A  rubber  plate  fitting  the 
roof  of  the  mouth  is  constructed  oil  a  plaster  model,  taken  from  a  plas- 
ter impression,  in  the  same  manner  as  any  other  vulcanized  rubber 
plate  would  be  made.  This  plate,  which  is  made  as  delicate  as  strength 
and  durability  will  permit,  is  cut  away  opposite  the  irregular  incisors, 
so  that  there  may  be  room  for  these  to  be  pressed  in.  The  pressure, 
which  is  brought  to  bear  in  such  a  manner  as  not  only  to  move  these 
incisors,  but  to  act  more  or  less  upon  the  whole  arch,  is  made  by  means 
of  a  very  simple  contrivance,  such  as  a  piece  of  gold,  formed  in  the 
shape  of  a  T,  about  a  quarter  of  an  inch  in  length,  and  with  a  staple 
or  ring  at  the  bottom  of  the  upright  portion  of  the  T,  through  which 
a  ligature  may  be  passed.  This  ligature  is  a  rubber  ring,  cut  from  a 
piece  of  small  rubber  tubing,  and  is  passed  through  the  eyelet  in  the 
T  and  then  attached  to  the  plate,  reaching  directly  to  the  second 
molars  on  either  side. 

The  plate  being  introduced  into  the  mouth,  the  T  is  brought  forward 
and  passed  between  the  central  incisors,  so  that  the  cross-bar  of  the  T 
is  brought  to  bear  upon  their  labial  surfaces.  If  the  incisors  are  in 
close  contact,  space  is  made  for  the  gold  bar  forming  the  part  of  the  T 
which  projects  into  the  mouth,  by  wedging.  The  effect  of  this  appli- 
ance will  be  to  draw  the  central  incisors  inward,  and  at  the  same  time 
to  force  the  side  teeth  outward.  To  prevent  the  incisors  from  return- 
ing to  their  abnormal  position,  delicate  rubber  rings  may  be  used,  being 
29 


450 


IRREGULARITY    OF    THE    TEETH. 


Fig.  182. 


slipped  over  the  incisors  and  attached  to  a  close-fitting  retaining  plate 
of  rubber  covering  the  roof  of  the  mouth. 

An  appliance  for  correcting  irregularity,  invented  by  Dr.  Redman, 
consists  of  a  vulcanized  rubber  plate  fitting  the  roof  of  the  mouth,  and 
covering  the  exterior  surfaces  of  the  teeth  which  give  it  support. 

This  plate  is  cut  away  in  the  direction  in  which  any  tooth  is  to  be 
moved,  and  wedges  of  wood  inserted  in  holes  made  in  the  plate,  bear- 
ing upon  the  deviating  teeth,  either  from  the  outside  or  inside,  as  the 
case  may  require.  The  wedges  of  wood  are  changed  from  time  to  time 
as  the  moving  of  the  teeth  may  require.  The  appliance  is  easily 
removed  by  the  patient  for  the  purpose  of  cleansing  it. 

Deformity  from  Excessive  Development  of  the  Teeth  and  Alveolar  Ridge 
of  Lower  Jaw.  —  When  the  teeth  of  the  lower  jaw  form  a  larger  arch 

than  those  of  the  upper,  the  incisors 
and  cuspids  of  the  former  shut  in  front 
of  those  of  the  latter,  causing  the  chin 
to  project,  and  otherwise  impairing  the 
symmetry  of  the  face.  Figs.  182  and 
183  present  a  front  and  a  side  view  of 
this  deformity.  It  may  result  from  a 
want  of  correspondence  in  the  devel- 
opment of  the  teeth  and  alveoli  of  the 
two  maxilla,  the  upper  jaw  being  defec- 
tive in  size,  while  the  lower  jaw  is  natural ;  or  the  former  being  natu- 
ral, the  latter  may  be  in  excess.     It  may  also  arise  from  a  simple 

eversion  of  the  lower  teeth  or 
inversion  of  the  upper. 

Treatment — The  remedial 
indications  of  the  deformity 
in  question  consist  in  dimin- 
ishing the  size  of  the  dental 
arch,  which  is  always  a  te- 
dious and  diflBcult  operation, 
requiring  great  patience  and 
perseverance  on  the  part  of 
the  patient,  and  much  me- 
chanical ingenuity  and  skill 
on  the  part  of  the  dentist. 
The  apjiliances  to  be  em- 
ployed have,  of  necessity,  to  be  more  or  less  complicated,  requiring 
the  most  perfect  accuracy  of  adaptation  and  neatness  of  execution; 
they  must  also  be  worn  for  a  long  time,  and,  as  a  natural  consequence, 
are  a  source  of  considerable  annoyance.     The  first  thing  to  be  done 


Fig.  183. 


lEREGULARITY    OF    THE    TEETH. 


451 


Fig.  184. 


is  to  extract  the  fii'st  inferior  bicuspids.  Sufficient  room  will  tlius  be 
obtained  for  the  contraction  which  it  will  be  necessary  to  effect  in  the 
dental  arch  for  the  accomplishment  of  the  object.  An  accurate  im- 
pression of  the  teeth  and  alveolar  ridge  should  be  taken  with  wax, 
softened  in  warm  water,  and  from  this  impression  a  plaster  model  is 
procured,  and  afterward  a  metallic  die  and  counter-die,  in  the  manner 
to  be  described  in  a  subsequent  chapter. 

This  done,  a  gold  plate  of  the  ordinary  thickness  should  be  swaged 
to  fit  the  first  and  second  molars,  (if  the  second  has  made  its  appear- 
ance, and  if  not,  the  second  bicus- 
pid and  first  molar  on  each  side,) 
so  as  completely  to  encase  these 
teeth.  If  these  caps  are  not  thick 
enough  to  prevent  the  front  teeth 
from  coming  together,  a  piece  of 
gold  plate  may  be  soldered  on 
that  part  of  each  which  covers 
the  grinding  surfaces  of  the  teeth. 
Having  proceeded  thus  far,  a 
small  gold  knob  is  soldered  to 
the  inner  and  outer  front  corners 
of  both  caps,  and  to  each  of  these  a  ligature  of  silk  or  rubber  is 
attached.  These  ligatures  are  to  be  brought  forward  and  tied  tightly 
around  the  cuspids.  When  thus  adjusted,  the  lower  arch  will  present 
the  appearance  exhibited  in  Fig.  184.  By  this  means  the  cuspids 
may,  in  fifteen  or  twenty  days,  be  taken  back  to  the  bicuspids.  If  in 
their  progress  they  are  not  carried  toward  the  inner  part  of  the  alveo- 
lar ridge,  the  oiiter  ligatures  may  be  left  off  after  a  few  days,  and  the 
inner  ones  alone  employed  to  complete  the  remainder  of  the  operation. 

After  the  positions  of  the  cuspids  have  been  thus  changed,  a  circular 
bar  of  gold  should  be  made,  extending  from  one  cap  to  the  other,  so 
as  to  j)ass  about  a  quarter  of  an  inch  behind  the  incisors,  and  be  sol- 
dered to  the  inner  side  of  each  cap.  A  hole  is  to  be  made  through 
this  band  behind  each  of  the  incisors,  through  which  a  ligature  of  silk 
may  be  passed  and  brought  forward  and  tied  tightly  in  front  of  each 
tooth.  These  ligatures  should  be  renewed  every  day  until  the  teeth 
are  carried  far  enough  back  to  strike  on  the  inside  of  the  correspond- 
ing teeth  in  the  upper  jaw. 

Fig.  185  represents  the  appearance  which  the  lower  jaw  presents 
with  the  last-named-  apparatus  upon  it,  and  will  better  convey  an  idea 
of  its  construction,  the  manner  of  its  application,  and  its  mode  of 
action,  than  any  description  which  can  be  given. 

An  appliance  of  this  sort  may  be  made  to  act  with  great  efficiency 


452 


IRREGULARITY    OP    THE    TEETH. 


in  remedying  the  deformity  in  question ;  but,  in  its  application,  it  13 
necessary  that  the  caps  be  fitted  with  the  greatest  accuracy  to  the 

teeth,  and  they  should  be  re- 
moved every  day  and  thoroughly 
cleansed,  as  well  as  the  teeth  they 
cover.  If  this  precaution  is  neg- 
lected, the  secretions  of  the  mouth, 
which  collect  between  the  gold 
caps  and  teeth,  will  soon  become 
acid,  and  corrode  the  latter. 

The  remarks  made  in  the  pre- 
vious chapter  upon  the  use  of  the 
vulcanite  are  applicable  here. 
Such  a  plate,  for  this  class  of  cases,  is  readily  made,  and  inflicts  no 
injury  upon  teeth  or  gums.  Elastic,  instead  of  silk,  ligatures  might  be 
used,  and  the  retraction  of  the  incisors  carried  on  simultaueously  Avith 
that  of  the  cuspids.  The  use  of  vulcanized  rubber  instead  of  gold  is 
of  great  value  in  correcting  irregularities  of  this  nature,  the  form  of 
the  appliances  being  the  same. 

Protrusion  of  the  Lower  Jaw. — This  deformity,  although  produced 
by  a  different  cause  from  the  one  last  described,  is  similar  to  it,  and 
gives  to  the  lower  part  of  the  face  an  unnatural  and  sometimes  disa- 
greeable appearance.  It  also  interferes  with  mastication,  and  often 
with  prehension  and  distinct  utterance.  It  wholly  changes  the  rela- 
tionship which  the  teeth  should  sustain  to  each  other  when  the  mouth 
is  closed.  The  cusps  or  protuberances  of  the  bicuspids  and  molars  of 
one  jaw,  instead  of  fitting  into  the  depressions  of  the  corresponding 
teeth  of  the  other,  often  strike  their  most  prominent  points;  at  other 
times,  the  outer  protuberances  of  the  lower  molars  and  bicuspids,  instead 
of  fitting  into  the  depressions  of  the  same  class  of  teeth  in  the  upper 
jaw,  shut  on  the  outside  of  these  teeth.  The  trituration  of  aliments  ia 
consequently  rendered  more  or  less  imperfect. 

This  protrusion  of  the  lower  jaw  is  supposed  by  some  to  be  the  result 
of  a  "natural  partial  luxation."  In  fact,  its  causes  are  by  no  means 
clearly  understood.  It  is  often  hereditary,  and  would  seem  to  be  caused 
by  that  mysterious  agency  which  impresses  peculiarities  of  growth  and 
shape  not  only  upon  the  lower  maxilla,  but  upon  every  bone  in  the 
body.  This  agency  is  so  constant  and  over-ruling,  that  we  must  be 
prepared  to  find  the  jaw  returning  to  its  position  after  the  discontinu- 
ance of  treatment ;  unless,  by  the  interlocking  of  the  cusps  of  the  upper 
teeth  and  the  overlapping  of  the  upper  incisors,  we  can  restrain  the 
tendency.  It  is  of  more  frequent  occurrence  than  the  one  which  results 
from  excessive  development  of  the  teeth  and  alveolar  ridge,  and  requires. 


lEEEGULAEITY    OF    THE    TEETH, 


453 


Fig.  186. 


as  before  stated,  an  entirely  different  plan,  of  treatment.     It  jarely 
occurs  previously  to  second  dentition. 

Treatment. — The  plan  of  treatment  usually  adopted  consists  in  fast- 
ening on  each  side  a  small  block  of  ivory  or  a  cap  of  vulcanite  on  one 
of  the  lower  molars,  thick  enough  to  keep  the  front  teeth  about  a 
quarter  of  an  inch  apart  when  the  jaws  are  closed.  Fox's  bandage 
must  now  be  applied.  This  is  buckled  as  tightly  as  the  patient  can 
bear  with  convenience,  pressing  the  chin  upward  and  backward.  A 
piece  of  tough  wood,  slightly  hollowed  so  as  to  fit  the  arch  of  the  lower 
teeth,  made  narrow  at  the  upper  end,  is  introduced  between  the  teeth 
several  times  a  day,  the  concave  portion  resting  upon  the  outside  of 
the  lower,  and  against  the  inside  of  the  upper,  employing  at  each  time 
as  much  pressure  as  can  be  safely  applied.  By  continuing  this  opera- 
tion from  day  to  day,  for  several  weeks,  the  natural  relationship  of  the 
jaws  will,  in  most  cases,  be  restored.* 

The  description  of  bandage  here  alluded  to,  and  the  manner  of  its 
application,  is  represented  in  Fig.  186. 
When  the  protrusion  of  the  lower  jaw 
is  accompanied  by  irregularity,  means 
should,  at  the  same  time,  be  employed 
for  remedying  it.  The  earlier  the  treat- 
ment is  instituted,  the  more  easily  will 
the  deformity  be  overcome.  It  may, 
however,  be  successfully  remedied  at 
any  time  previously  to  the  twentieth 
year  of  age,  and  sometimes  at  a  much 
later  period;  but  after  this  time  the 
(operation  becomes  more  difficult. 

In  cases  where  the  lower  front  teeth 
close  over  the  upper,  and  thus  cause  a 
leformity  of  the  face,  it  is  important  to  discriminate  correctly  between 
those  which  result  from  malformation,  and  a  protrusion  of  the  jaw 
occasioned  by  partial  luxation,  as  the  remedial  indications  in  the 
two  are  entirely  different.  Those  which  would  prove  successful  in  the 
one  would  prove  unsuccessful  in  the  other.  But,  fortunately,  deformity 
arising  from  the  last  mentioned  cause  is,  comparatively,  of  rare  occur- 
rence ;  hence,  the  dentist  is  seldom  called  upon  to  exercise  his  inge- 
nuity and  skill  in  its  treatment. 

*  An  interesting  article  by  Dr.  J.  S.  Gunnell,  on  the  treatment  of  deformities 
of  this  kind,  is  contained  in  one  of  the  early  volumes  of  the  American  Journal  of 
Dental  Science. 


454      DISLOCATION    AND    FRACTUEE    OF    THE    JAW. 


CHAPTER  IX. 

DISLOCATION   AND   FRACTURE   OF   THE   JAW. 

FROM  the  peculiar  manner  iu  which  the  inferior  maxilla  is  articu- 
lated to  the  temporal  bones,  it  is  not  very  liable  to  dislocation. 
When  it  occurs  iu  one  or  both  of  the  condyles,  the  luxatiou  is  always 
forward,  the  conformation  of  the  parts  preventing  it  from  taking  place 
in  any  other  direction.  The  oblong,  rounded  head  of  each  condyle  is 
received  into  the  fore  part  of  a  deep  fossa  in  the  temporal  bone,  situ- 
ated just  before  the  meatus  auditorius  externus,  and  under  the  begin- 
ning of  the  zygomatic  arch.  The  articular  surface  of  each  is  covered 
with  a  smooth  cartilage,  and  between  them  there  is  a  movable  carti- 
lage. This  latter  is  connected  with  the  articulating  surfaces  of  the 
condyle  and  glenoid  cavity,  externally  by  the  external  lateral  liga- 
ment, internally  by  the  capsular  ligament,  and  in  front  by  the  tendon 
of  the  external  pterygoid.  This  cartilage  is  sometimes  called  the 
meniscus,  from  its  shape,  being  thickest  around  its  circumference, 
especially  at  the  back  part.  The  temporo-maxillary  articulation  is 
strengthened  by  an  internal,  an  external,  and  a  capsular  ligament, 
also  by  the  tendinous  and  muscular  insertions  of  the  masseter,  tempo- 
ral, and  pterygoid  muscles.  The  intervening  movable  cartilage,  being 
more  closely  connected  Avith  the  head  of  the  condyle  than  with  the 
glenoid  cavity,  escapes  with  the  former,  whenever  dislocation  of  the 
jaw  takes  place. 

Dislocation  of  the  lower  jaw  is  rarely  caused  by  a  blow,  unless  given 
when  the  mouth  is  open ;  it  is  more  frequently  occasioned  by  yawning 
or  laughing.  It  has  been  known  to  occur  in  the  extraction  of  teeth, 
and  in  attempting  to  bite  a  very  large  substance.  Sir  Astley  Cooper 
mentions  the  case  of  a  boy  who  had  his  jaw  dislocated  by  suddenly 
putting  an  apple  into  his  mouth  to  keep  it  from  a  playfellow. 

After  the  jaw  has  been  dislocated  once,  it  is  always  more  liable  to 
this  accident;  consequently,  Mr.  Fox  very  properly  recommends  to 
those  with  whom  it  has  once  happened,  the  precaution  of  supporting 
the  jaw  whenever  the  mouth  is  opened  very  widely  in  gaping,  or  for 
the  purpose  of  having  a  tooth  extracted.  None  of  these  causes  would 
be  sufficient  to  produce  the  accident,  unless  the  ligaments  of  the  tem- 
poro-maxillary articulation  are  very  loose,  and  the  muscles  of  the  jaw 
much  relaxed. 

The  author  witnessed  a  case  of  dislocation  of  the  lower  jaw  in  which 


DISLOCATION    AND    FRACTURE    OF    THE    JAW.      455 


Fig.  187. 


the  displacement  occurred  duriug  an  attempt  to  extract  the  first  right 
infei'ior  molar.  The  patient  was  a  young  lady  from  Virginia,  about 
seventeen  years  of  age.  Both  condyles  were  luxated,  but  so  com- 
pletely were  the  muscles  of  the  jaw  relaxed,  that  he  immediately  re- 
duced it  without  the  least  difficulty,  and  afterward,  by  supporting  the 
jaw  with  his  left  hand,  succeeded  in  removing  the  tooth. 

When  the  lower  jaw  is  dislocated,  the  mouth  remains  wide  open,  as 
seen  in  Fig.  187,  and  a  great  deal 
of  pain  is  experienced ;  this,  accord- 
ing to  Boyer,  is  caused  by  the  press- 
ure of  the  condyles  on  the  deep- 
seated  temporal  nerves  and  those 
which  go  to  the  masseter  muscles, 
situated  at  the  root  of  the  zygo- 
matic process.  The  condyles,  hav- 
ing left  their  place  of  articulation, 
are  advanced  before  the  articular 
eminences  and  lodged  under  the 
zygomatic  arches.  The  jaw  cannot 
be  closed ;  the  coronoid  processes 
may  be  felt  under  the  malar  bones ; 
the  temporal,  m'asseter,  and  bucci- 
nator muscles  are  extended;  the 
articular  cavities  being  empty,  a  hollow  may  be  felt  there ;  the  saliva 
flows  uninterruptedly  from  the  mouth,  and  deglutition  and  speech  are 
either  wholly  prevented  or  very  greatly  impaired.  Boyer  says  that 
during  the  first  five  days  after  the  accident  the  patient  can  neither 
speak  nor  swallow.  The  jaw,  when  only  one  condyle  is  displaced,  is 
forced,  more  or  less,  to  one  side. 

If  the  dislocation  continues  for  several  days  or  weeks,  the  chin 
gradually  approaches  the  upper  jaw,  and  the  patient  slowly  recovers 
the  functions  of  speech  and  deglutition.  We  are  told  by  Mr.  Samuel 
Cooper  that  it  may  prove  fatal  if  it  remain  unreduced ;  *  but  Sir 
Astley  Cooper  says  he  has  never  known  any  dangerous  effects  to  result 
from  this  accident ;  on  the  contrary,  after  it  has  continued  for  a  con- 
siderable length  of  time,  the  jaw  partially  recovers  its  motion.f 

In  the  reduction  of  dislocation  of  the  lower  jaw,  the  older  surgeons 
employed  two  pieces  of  wood,  which  were  introduced  on  each  side  of 
the  mouth,  between  the  molar  teeth ;  while  these  were  made  to  act  as 
levers  for  depressing  the  back  part  of  the  bone,  the  chin  was  raised  by 
means  of  a  bandage. 

The  method  usually  adopted  by  modern  surgeons  for  reducing  a 

*  Surgical  Dictionary,  p.  306.  f  A.  Cooper  on  Dislocations,  p.  389. 


456       DISLOCATION    AND    FRACTURE    OF    THE    JAW. 

dislocation  of  this  bone,  consists  in  introducing  tlie  thumbs,  wrapped 
in  a  napkin  or  cloth  (to  prevent  them  from  being  hurt  by  the  teeth), 
as  far  back  upon  the  molars  as  possible;  then  depressing  the  back 
part  of  the  jaw,  and  at  the  same  time  raising  the  chin  with  the  fingers. 
In  this  way  the  condyles  are  disengaged  from  under  the  zygomatic 
arches,  and  made  to  glide  back  into  their  articular  cavities.  But  the 
moment  the  condyles  are  disengaged,  the  thumbs  of  the  operator 
should  be  slipped  outward  between  the  teeth  and  the  cheeks ;  as  the 
action  of  the  muscles,  at  this  instant,  in  drawing  the  jaw  back,  causes 
it  to  close  very  suddenly,  and  with  considerable  force.  This  precau- 
tion is  necessary  to  avoid  being  hurt,  unless  a  piece  of  cork  or  soft 
wood  has  been  previously  placed  between  the  teeth. 

By  the  foregoing  simple  method  the  dislocation  may,  in  almost  every 
case,  be  readily  reduced  ;  but  Mr.  Fox  mentions  a  case  in  Avhich  it 
failed.  The  subject  was  a  lady  whose  lower  jaw  had  been  luxated 
several  times  before;  this  time  the  accident  was  occasioned  by  an 
attempt  which  he  made  to  extract  one  of  the  inferior  dentes  sapi- 
entite.  After  having  failed  to  reduce  the  luxated  bone  by  the  usual 
method,  he  "happened  to  recollect  a  statement  made  to  him  by  M.  de 
Chemant,  who,  having  been  frequently  applied  to  by  a  person  in  Paris 
who  was  subject  to  this  accident,  had  always  succeeded  in  immediately 
reducing  the  luxation  by  means  of  a  lever  of  wood,  as  recommended 
by  Dr.  Monroe."  Profiting  by  this  statement,  Mr.  Fox  procurad  a 
piece  of  wood  about  an  inch  square,  and  ten  or  twelve  inches  long. 
He  placed  one  end  of  this  upon  the  lower  molars,  and  then  raised  the 
other,  so  that  the  upper  teeth  acted  as  a  fulcrum.  As  soon  as  the  jaw 
was  depressed,  the  condyle  of  the  side  upon  which  the  wood  was 
applied  immediately  slipped  back  into  its  articular  cavity.  The  wood 
was  then  applied  to  the  opposite  side  of  the  jaw,  and  the  other  condyle 
reduced  in  the  same  manner.  * 

The  method  produced  by  Sir  Astley  Cooper  consists,  when  both 
condyles  are  displaced,  iu  introducing  two  corks  behind  the  molars, 
and  then  elevating  the  chin.  He,  however,  first  places  his  patient  in 
a  recumbent  posture  ;|  but  this  is  seldom  necessary.  The  reduction 
of  the  dislocation  can  be  as  conveniently  effected  with  the  patient  in  a 
sitting  as  in  a  recumbent  posture. 

After  the  reduction  of  the  dislocation,  the  patient  is  recommended 
to  abstain  for  several  days  from  the  use  of  solid  aliments,  and  to  wear 
a  four-tailed  bandage  ;|  or,  what  is  still  better,  the  bandage  contrived 
by  Mr.  Fox  (Fig.  186),  to  prevent  its  recurrence  in  the  extraction  of 

■*  American  edition  of  Fox  on  the  Human  Teeth,  p.  330. 
f  A.  Cooper  on  Dislocations,  p.  391. 
J  Cooper's  Surgical  Dictionary,  p.  306. 


DISLOCATIOlSr    AND    FEACTUEE    OF    THE    JAW.      457 

teeth.  When  this  bandage  is  used  for  the  latter  purpose,  the  mouth 
is  first  opened  to  the  proper  extent,  with  the  condyles  in  their  articu- 
lar cavities  ;  it  is  then  applied,  and  the  straps  tightly  buckled.  This 
done,  it  is  impossible  to  advance  the  jaw  sufficiently  to  produce  a  dis- 
location. 

FRACTURES   OF   THE   JAWS. 

Fractures  of  the  jaws  rarely  occur,  except  from  direct  violence.  In 
the  upper  jaw  this  violence  is  usually  of  a  character  that  complicates 
the  fracture  with  severe  injury  to  adjacent  parts.  Gun-shot  wounds 
are  by  far  the  most  frequent  source  of  fractures  in  this  locality;  and  it 
is  wonderful  what  an  amount  of  injury  to  the  bones  of  the  face  may 
be  recovered  from  without  ill  result.  The  bones  of  the  face  are  of 
softer  character  than  those  found  elsewhere,  and  consequently  the  whole 
injury  is  at  the  place  of  impact  and  along  the  course  of  the  ball,  no 
long  fractures  or  extensive  contusions  are  found,  or  very  rarely  so,  and 
the  parts  are  abundantly  supplied  with  blood,  hence  the  restorative 
process  proceeds  very  rapidly ;  but  this  abundant  sanguineous  supply, 
so  useful  in  the  restoration  of  parts,  is  also  the  chief  source  of  danger. 
Hemorrhage  is  generally  excessive  and  difficult  to  control,  and  to  sec- 
ondary hemorrhage  is  due  the  greatest  fatality  in  injuries  of  this  kind ; 
ligature  of  the  carotid  artery,  which  has  been  frequently  practised, 
usually  serving  but  to  postpone  the  fatal  termination.  Owing  to  the 
liberal  supply  of  blood,  necrosis  seldom  occurs,  and  it  is  seldom  necessary 
to  remove  fragments  of  bone,  even  after  the  most  extensive  comminu- 
tion ;  they  should  be  left,  except  for  some  peculiar  reason,  until  death 
is  manifest  in  them,  when  they  may  be  abstracted  without  additional 
trouble.  Loosened  teeth  should  always  be  left  to  contract  adhesions, 
which  they  will  generally  readily  do.  Indeed,  but  little  surgical  inter- 
ference is  required  in  cases  of  this  kind,  and  should  usually  be  limited 
to  efforts  to  secure  the  proper  apposition  of  the  teeth.  Numerous  cases 
of  the  most  extraordinary  injuries  to  the  face  are  to  be  found  in  the 
surgical  reports  of  the  late  war  in  the  States,  and  in  those  of  the  French 
and  English  surgeons  during  the  wars  of  the  first  Napoleon  and  the 
Crimea.  Fractures  of  the  superior  maxilla  may,  however,  occur  from 
other  violence  than  gun-shot  wounds.  Mr.  Salter  reports  a  case  result- 
ing from  the  collision  of  the  face  and  head  of  two  "  cricketers."  The 
kick  of  a  horse,  as  in  the  well-known  Wiseman  case,  has  occasioned 
frightful  injury  of  this  character.     In  this  case,  the  "face  was  driven 

in,  the  lower  jaw  projecting  forward The  bones  of  the  palate 

were  driven  so  far  back,  it  was  impossible  to  pass  my  finger  behind 
them."  The  patient  made  a  good  recovery.  Mr.  Heath  records  a  case 
reported  by  Dr.  Tyffe,  in  which,  "  on  watching  the  patient's  profile  while 


458      DISLOCATION    AND    FRACTURE    OF    THE    JAW. 

iu  the  act  of  swallowing  food,  the  whole  of  the  bones  of  the  face  were 
observed  to  move  up  and  down  upon  the  fixed  part  of  the  skull  as  the 
different  parts  were  brouglit  into  motion.  It  appeared  as  if  the  integu- 
ments only  retained  them  in  their  position.  It  was  a  curious  feature 
in  the  case,  that,  notwithstanding  the  very  extensive  injury  done,  and 
the  violent  character  of  the  force  which  caused  them  (the  upsetting  of 
a  cab),  not  a  single  tooth  was  fractured  or  misplaced."  Fractures  in 
the  dentist's  chair,  from  ill-directed  efforts  to  remove  teeth,  not  uncom- 
mon when  "keys"  were  in  general  use,  are  now  so  infreq^uent  as  to  be 
undeserving  of  special  mention. 

Among  the  comjjlications  of  fracture  of  the  upper  jaw  may  be 
mentioned  breaking  and  displacement  of  teeth,  closure  of  the  nasal 
duct  with  consequent  epiphora,  secondary  hemorrhage,  and  paralysis 
of  the  infra-orbital  nerve  as  the  most  common. 

Diagnosis  of  fractures  of  the  upper  jaw  is  usually  attended  with  but 
little  difficulty.  It  is  determined  by  pain,  crepitation,  irregularity  in 
the  line  of  the  teeth,  and  excessive  secretion  of  saliva.  The  treatment 
consists  in  the  nice  adaptation  of  the  teeth  and  their  permanent  secu- 
rity in  proper  position.  This  is  generally  effected  with  but  little  diffi- 
culty, by  a  single  finger  passed  into  the  mouth  to  press  the  fragments 
into  position,  Avhere  they  may  be  secured  by  wires  or,  in  cases  of  great 
displacement,  by  the  interdental  splint.  The  hemorrhage  should  be 
controlled  by  styptics,  of  which  the  persulphate  of  iron  is  the  best,  by 
the  actual  cautery,  and,  when  not  otherwise  manageable,  by  ligation 
of  the  carotid  artery. 

Fractures  of  the  lower  jaw  are  much  more  common  than  those  of  the 
upper.  They  give  comparatively  little  trouble,  are  readily  diagnosed, 
and  are  occasioned  by  direct  violence,  as  in  the  upj^er  jaw.  The  most 
common  seat  of  fracture  is  the  middle  of  the  horizontal  ramus.  Before 
the  use  of  interdental  splints,  fractures  of  the  lower  jaw  were  difficult 
of  adjustment,  and  were  frequently  attended  with  bad  results,  and  in 
rare  cases  they  still  are  so.  A  good  many  forms  of  apparatus  have 
been  devised,  of  which  the  simplest  is  the  four-tailed  bandage,  which 
consist  of  a  slip  of  muslin,  of  suitable  dimensions,  torn  from  each  ex- 
tremity toward  the  centre,  leaving  enough  space  to  receive  the  chin. 
It  is  secured  by  passing  the  tails  over  the  top  of  the  head  and  around 
the  back  of  the  neck,  and  tying  them  in  this  position.  This  apparatus 
may  be  supplemented  by  a  pasteboard  splint  moulded  to  the  form  of 
the  jaw.  Sometimes  the  bones  are  secured  in  position  by  passing  wires 
around  the  firm  teeth  and  binding  them  together.  They  may  also  be 
secured  by  sutures,  the  bones  having  been  drilled  to  permit  their  pass- 
age. Mr.  Wheelhouse,  of  Leeds,  recommends  that,  after  drilling  through 
the  bones  on  either  side  of  the  fracture,  silver  pins  "  with  flat,  circular 


DISLOCATIOlSr    AND    FEACTUEE    OF    THE    JAW.      459 

and  perforated  heads"  be  passed  through  the  opening  from  -svithin  out- 
ward, and  their  points  bent  in  opposite  directions  so  as  to  form  hooks, 
and  the  fragments  secured  by  passing  silver  or  gold  wire  in  a  figure 
of  eight  over  the  pins.  The  perforations  in  the  head  of  the  wires  are 
for  silk  sutures,  by  which  they  may  be  readily  removed  when  necessary. 
It  is  also  recommended  that  not  only  should  the  fragments  be  secured 
together  in  this  way,  but  that  they  also  be  bound  to  the  upper  jaw. 
Wedges  of  cork  cut  into  suitable  shapes ;  of  gutta-percha,  introduced 
and  moulded  to  the  teeth  ;  Mutter's  silver  clamps,  or  their  modification 
by  Mr.  Tomes ;  Hay  ward's  silver  caps,  and  other  more  complicated 
apparatuses  may,  in  our  judgment,  be  all  superseded  by  the  vulcanite 
interdental  splint  contrived  about  the  same  time,  and  independently 
of  each  other,  by  Dr.  Bean,  of  Atlanta,  Ga.,  and  Dr.  Gunning,  of  New 
York,  except  in  cases  of  obstinate  vertical  displacement.  An  impres- 
sion in  wax  is  first  taken  of  both  jaws,  from  which  a  plaster  cast  is 
taken,  and  upon  this  the  vulcanite  plate  is  accurately  moulded  with 
indentations  corresponding  exactly  to  the  adjusted  teeth,  and  with 
an  interspace  at  the  most  convenient  point  for  administering  food. 
The  splints  are  now  introduced  into  the  mouth,  the  teeth  arranged  in 
their  appropriate  indentations,  and  the  whole  fixed  in  position  by  a 
mental  compress  and  occipito-frontal  bandage,  thus  securing  the  jaws 
from  motion  and  the  splint  from  displacement.  The  compress  consists 
of  a  light  piece  of  wood,  on  which  is  fixed  a  metallic  cup  of  form  and 
size   adapted  to  the  patient's   chin,  to   each   extremity  of  which  is 

Fig.  188. 


460  DISEASES    OF    THE    MAXILLARY    SINUS. 

affixed  a  metallic  side-piece  four  or  five  inches  in  length,  and  from  tjiree 
quarters  to  one  inch  in  width.  Encasing  these  side-pieces  are  the  tem- 
poral straps  made  of  stout  cloth,  and  secured  by  a  strong  cord  at  the 
base  of  each  piece.  The  occipito-frontal  bandage  is  composed  of  a 
band  passing  around  the  head,  from  the  forehead  to  the  occipital 
protuberance  behind,  and  secured  by  a  buckle  one  inch  to  the  right 
of  the  median  line  behind ;  of  another  straji  secured  to  the  band  in 
front  and  behind ;  and  a  third  strap  extending  from  the  temporal 
buckles  on  either  side  and  secured  to  the  middle  strap  at  the  point  of 
crossing.    See  Fig.  188. 


CHAPTER  X. 

DISEASES   OF  THE   MAXILLARY  SINUS. 

PRELIMINARY  REMARKS.  — It  was  not  until  the  knowledge 
of  anatomy  had  made  considerable  progress  that  the  existence  of 
this  cavity  was  known.  Casserius,  an  anatomist  of  Padua,  is  supposed 
to  have  been  the  first  to  discover  it.  He  flourished  during  the  latter 
part  of  the  sixteenth  and  early  part  of  the  seventeenth  centuries ;  but 
no  correct  description  of  it  was  given  until  about  the  middle  of  the  lat- 
ter ;  the  credit  therefore  of  this  discovery  is  given  to  Nathaniel  High- 
more,  author  of  a  treatise  on  anatomy,  published,  in  1651.  Hence  its 
name,  "  antrum  Highmoriantim." 

This  cavity  is  subject  to  some  of  the  most  formidable  and  dangerous 
diseases  the  medical  or  surgical  practitioner  is  ever  called  upon  to  treat ; 
and  yet  there  are  few  diseases  incident  to  the  human  body  that  have 
received  less  attention  from  writers  on  pathology  and  therapeutics  than 
these.  There  are  diseases  here  met  with  over  which  neither  the  sur- 
geon nor  physician  can  exercise  any  control,  the  progress  of  which 
ceases  only  with  the  life  of  the  unfortunate  sufferer. 

All  of  the  diseases  to  which  the  maxillary  antrum  is  subject,  however, 
are  not  of  so  dangerous  a  character,  for  some  are  very  simple  and  easily 
cured ;  but  even  those  which  are  regarded  as  the  least  dangerous,  and 
■which  yield  most  readily  to  treatment,  when  instituted  during  their 
incipient  or  earlier  stages,  may  assume,  if  neglected,  or  improperly 
treated,  a  form  so  aggravated  as  to  bid  defiance  to  the  skill  both  of  the 
physician  and  surgeon.  While  thus,  on  the  one  hand,  the  most  simple 
affections  of  this  cavity  may,  by  neglect  or  improper  treatment,  become 
ultimately  incurable,  many  of  those,  on  the  other  hand,  which  are 


DISEASES    OF    THE    MAXILLARY    SINUS.  461 

considered  the  most  malignant  and  dangerous,  might,  we  have  no 
doubt,  by  timely  and  judicious  treatment,  be  effectually  and  radically 
removed. 

The  form  which  the  disease  puts  on  is  determined  by  the  state  of  the 
constitutional  health  or  some  specific  tendency  of  the  general  system  ; 
and  we  can  readily  imagine  that  a  cause  which,  in  one  person,  would 
give  rise  to  simple  inflammation  of  the  lining  membrane,  or  mucous 
engorgement  of  the  sinus,  would,  in  another,  produce  an  ill-conditioned 
ulcer,  fungus  hsematodes,  or  osteo-sarcoma.  Simple  inflammation  and 
mucous  engorgement  not  unfrequently  cause  caries  and  exfoliation  of 
the  surrounding  osseous  tissues,  and,  in  some  instances,  even  the  destruc- 
tion of  the  life  of  the  patient. 

The  importance  of  early  attention  to  the  diseases  of  this  cavity  is, 
therefore,  very  apparent ;  and  this  is  the  more  necessary  as  it  is  often 
difficult,  and  sometimes  impossible,  to  determine  the  character  of  the 
malady  until  it  has  progressed  so  far  as  to  involve,  to  a  greater  or  less 
extent,  the  neighboring  parts  ;  when,  if  it  has  not  become  incurable, 
its  removal  is,  to  say  the  least,  rendered  less  easy  of  accomplishment. 
It  may  be  safely  assumed,  therefore,  that  in  a  very  large  majority  of 
the  cases  of  disease  of  the  maxillary  sinus,  the  danger  to  be  apprehended 
arises  more  from  neglect  than  from  any  necessarily  fatal  character  of 
the  malady,  so  that,  in  forming  a  prognosis,  the  circumstances  to  be 
considered  are  the  state  of  the  constitutional  health,  the  progress  made 
by  the  affection,  and  the  nature  of  the  injury  inflicted  by  it  upon  the 
surrounding  tissues.  If  the  general  health  is- not  so  much  impaired  as 
to  prevent  its  restoration  by  the  employment  of  proper  remedies,  and 
the  neighboring  structures  have  not  become  implicated,  the  prognosis 
will  be  favorable ;  but  if  the  functional  operations  of  the  body  have 
become  very  much  deranged,  and  the  bones  of  the  face  and  nose  seri- 
ously affected,  the  combined  resources  both  of  medicine  and  surgery 
will  prove  unavailing. 

In  young  and  middle-aged  subjects  of  good  constitution,  a  morbid 
action  may  exist  in  the  antrum  for  years  without  giving  rise  to  any 
alarming  symptoms,  while  the  same  affection  in  another  less  healthy 
might  rapidly  extend  and  degenerate  into  a  form  of  disease  so  malig- 
nant as  to  threaten  the  speedy  destruction  of  the  life  of  the  patient. 
Medical  history  abounds  with  examples  of  this  kind,  and  conclusively 
establishes  the  fact  that  the  state  of  the  general  health  and  habit  of 
body,  whatever  may  have  been  the  primitive  characteristics  of  the  mal- 
ady, ultimately  determines  its  malignancy  ;  in  the  treatment  of  affec- 
tions of  this  cavity,  therefore,  as  well  as  of  other  local  diseases  of  the 
body,  the  condition  of  the  system  should  not  be  overlooked. 

Independently  of  the  danger  arising  from  the  local  affection,  diseases 


462  DISEASES    OF    THE    MAXILLARY    SINUS. 

of  the  antrum  are,  for  the  most  part,  very  loathsome,  and  suhject  the 
patient  to  great  annoyance.  They  change  the  quality  of  its  secretions, 
and  cause  them  to  exhale  a  fetid,  nauseating  odor.  This,  in  many 
instances,  is  almost  insufferable  to  the  patipnt,  and  when  they  are  pre- 
vented from  escaping  through  the  natural  ojjcning  into  the  nose,  they 
pass  through  one  artificially  formed  by  the  surgeon,  or  made  by  the 
disease  through  the  cheek,  alveolar  border,  or  palatine  arch,  always 
causing  the  patient  great  inconvenience. 

The  progress  of  disease  in  this  cavity  is  often  very  insidious.  It  not 
unfrequeutly  happens  that  it  exists  for  weeks  and  even  months  before 
its  existence  is  suspected.  The  slight  uneasiness  felt  is  attributed  to 
some  morbid  condition  of  the  teeth  or  gums,  and  the  symptoms  attend- 
ant upon  one  description  of  affection  are  often  so  similar  to  those  that 
accompany  another,  that  it  is  impossible  to  determine  its  true  character 
until  it  has  made  considerable  progress. 

The  morbid  aflfections  of  the  maxillary  sinus  are,  for  the  most  part, 
similar  to  those  of  the  nasal  fossse.  There  is,  however,  one  form  of 
disease  which  seems  to  be  peculiar  to  this  cavity,  viz. :.  mucous  engorge- 
ment. Deschamps  mentions  two  kinds  of  accumulations,  dropsical 
and  purulent ;  but  the  first  of  these  is,  properly  speaking,  a  disease  of 
serous  membranes,  and  is  never  met  with  in  this  cavity ;  and  authors, 
who  have  enumerated  it  among  its  diseases,  have  evidently  mistaken 
mucous  engorgement  for  it.  The  fluids  that  accumulate  here  are  of  a 
mucous  or  muco-jDurulent  character,  except  when  they  are  the  result 
of  the  disorganization  of  some  of  the  surrounding  parts ;  then  they 
are  sanious. 

The  most  simple  form  of  disease  that  occurs  here  is  inflammation  of 
the  lining  membrane,  and  this  in  most  instances  may  be  said  to  precede 
all  others.  It  often  subsides  spontaneously ;  but  when  it  continues  for 
a  long  time,  is  apt  to  become  chronic,  and  may  then  give  rise  to  other 
and  more  formidable  kinds  of  disease.  When  unattended  by  any  other 
morbid  affection,  either  local  or  constitutional,  it  is  easily  cured. 

A  purulent  condition  of  the  fluids  of  the  antrum  is  a  common  affec- 
tion, but  is  seldom  met  with  in  persons  of  good  constitution.  It 
seems  to  be  dependent  upon  a  bad  habit  of  body;  also  upon  inflamma- 
tion of  the  mucous  membrane  of  the  sinus,  which  arises  more  frequently 
from  dental  irritation  than  any  other  cause.  This  condition  of  the 
secretions  sometimes  gives  rise  to  caries  and  exfoliation  of  portions  of 
the  surrounding  bone,  and  to  fistulous  ulcers ;  but  when  dependent  upon 
no  other  local  cause  than  simple  inflammation  of  the  mucous  membrane, 
it  is  seldom  that  such  effects  result  from  it.  When  complicated  with 
other  morbid  conditions  of  the  cavity,  they  are  not  unfrequent. 

All  purulent  secretions  of  this  membrane  are  by  some  denominated 


DISEASES    OF    THE    MAXILLARY    SIXUS.  463 

abscess.  The  name,  however,  as  is  justly  remarked  by  Mr.  Thomas 
Bell,  is  improper.  The  term  abscess  is  more  correctly  applied  to  puru- 
lent collections  in  the  areolar  tissue  —  either  submucous,  subserous, 
subcutaneous,  intermuscular,  or  parenchymatous.  It  seldom  originates 
in  the  submucous  tissue  of  the  antrum,  but  proceeds  occasionally  from 
disease  in  the  cancellated  structure  of  the  surrounding  bones.  Instances 
of  it  have  been  met  with  at  the  extremities  of  the  roots  of  teeth  which 
had  perforated  the  sinus  ;  and  it  sometimes  happens  that  when  an  ab- 
scess is  seated  in  the  alveolus  of  a  superior  molar,  the  matter,  instead 
of  making  for  itself  a  passage  through  the  socket  of  the  tooth  on  either 
side,  escapes  into  this  cavity,  and  thence  with  the  antral  secretions 
through  the  nasal  opening.  Mr.  Bell  describes  a  case  of  abscess  seated 
in  the  upper  part  of  the  anti'um  ;  but  this,  and  one  other,  are  the  only 
examples  of  the  kind  on  record. 

Ulceration  of  the  lining  membrane  is  an  affection  less  frequently 
met  with.  It  is  rarely,  if  ever,  idiopathic,  but  seems  rather  to  be  de- 
pendent upon  some  other  local  malady  or  some  specific  constitutional 
vice.  Scorbutic  and  scrofulous  diatheses,  and  those  afiected  with  a 
venereal  taint,  are  more  liable  to  ulceration  of  this  membrane  than 
persons  of  sound  constitution.  Consequently,  it  is  seldom  cured  by 
local  remedies  alone.  It  is  almost  always  complicated  with  fungus  of 
the  membrane  and  caries  of  the  walls  of  the  sinus,  and  may,  if 
neglected,  take  on  a  cancerous  form  and  become  incurable. 

The  next  form  of  disease  is  caries  of  the  antral  parietes.  This,  though, 
always  complicated  with  other  forms  of  diseased  action,  seems,  never- 
theless, to  be  worthy  of  separate  consideration.  Like  ulceration  of  the 
lining  membrane,  it  is  the  result  of  some  other  affection.  It  may  result 
from  accumulation  of  the  secretions  of  the  sinus,  from  ulceration,  or 
from  tumors. 

The  occurrence  of  fungus  and  of  various  kinds  of  tumor  is  less  fre- 
quent than  any  of  the  preceding  affections ;  yet  this  cavity  is  not  exempt 
from  them,  and  they  constitute  the  most  dangerous  form  of  disease  to 
which  the  superior  maxilla  is  subject.  Although  it  is  'probable  that, 
in  their  incipient  stage,  they  might  in  nearly  every  instance  be  radi- 
cally removed,  it  is  seldom  they  are  cured  after  they  have  attained  a 
very  large  size,  and  have  implicated,  to  considerable  extent,  the  sur- 
rounding tissues.  They  have,  however,  been  successfully  extirpated 
even  after  they  had  required  great  volume,  and  implicated  to  such  an 
extent  the  surrounding  parts,  as  to  render  necessary  the  removal  of 
the  whole  of  the  superior  maxillary  bone.  They  usually  grow  with 
great  rapidity,  and,  if  not  completely  removed,  are  soon  reproduced. 

Besides  these,  other  varieties  of  disease  are  occasionally  met  with 
here.     The  antrum  is  liable  to  injuries  from  blows  and  other  kinds  of 


46-4  DISEASES    OF    THE    MAXILLARY    SINUS. 

mechanical  violence,  and  from  the  introduction  of  insects  and  foreign 
bodies.  The  diseases  of  the  maxillary  sinus  are  sujiposed  to  be  de- 
pendent upon  certain  specific  constitutional  vices ;  upon  the  oblitera- 
tion of  the  opening  of  this  cavity  into  the  uose,  and  upon  dental  irrita- 
tion. That  all  of  these  may,  at  times,  be  concerned  in  their  production, 
is  more  than  probable.  But  actual  disease  rarely  develops  itself 
spontaneously  as  a  consequence  merely  of  a  bad  habit  of  body  or 
constitutional  vice.  This  does  not  of  itself  originate  disease,  but  only 
occasions  an  increase  of  susceptibility  of  the  tissues  to  morbid  im- 
pressions ;  so  that  when  an  unhealthy  action  is  once  induced  here,  a 
more  aargravated  or  a  different  form  of  disease  occurs  than  that  which 
would  otherwise  have  been  produced. 

Thus  it  may  be  seen  that  disease  of  the  maxillary  sinus  is  dependent 
upon  some  exciting  cause,  favored  by  some  constitutional  vice;  for 
without  this  no  serious  morbid  effects  would  be  jDroduced,  or,  if  pro- 
duced, they  would  be  of  a  different  and  less  aggravated  character.  Any 
disposition  or  vice  of  body  which  weakens  the  vital  energies  of  the 
system,  increases  the  susceptibility,  or  rather  excitability,  of  all  its  parts 
—  those  of  this  cavity  equally  with  the  rest.  There  are  various  kinds 
which  have  this  effect;  as,  for  example,  the  scorbutic,  scrofulous,  ven- 
ereal, mercurial,  etc.,  each  of  which  may  influence  the  character  of  the 
morbid  action  in  a  manner  peculiar  to  itself;  or  it  may  be  similar  to 
that  which  might  be  exercised  by  another,  only  causing  it  to  assume  a 
greater  or  less  degree  of  malignancy,  accordingly  as  the  functional 
operations  of  the  body  generally  are  more  or  less  enervated  by  it. 

This  seems  to  be  the  way  in  which  a  bad  habit  of  body  is  capable  of 
affecting  the  maxillary  sinus.  It  is  a  predisposing,  but  not  an  exciting 
cause  of  disease;  and  it  is  important  that  this  distinction  should  be 
borne  in  mind.  The  one  should  never  be  confounded  w^ith  the  other, 
because  an  error  of  this  sort  might,  in  many  instances,  lead  to  the  adop- 
tion of  incorrect  views  concerning  the  therapeutical  indications  of  the 
disease.  This  part  of  the  subject  we  shall  have  occasion  to  advert  to 
hereafter. 

Inflammation  and  idceration  of  the  nasal  j^ituitary  membrane  some- 
times extend  themselves  to  the  maxillary  sinus;  but  disease  is  not  so 
frequently  propagated  from  the  nasal  fossse  to  this  cavity  as  the  inti- 
mate relationship  between  the  two  might  lead  one  to  suppose.  It  is 
seldom  that  both  are  affected  at  the  same  time.  Hence  we  infer,  that, 
although  lined  by  one  common  membrane,  the  propagation  of  disease 
from  one  to  the  other  is  a  rare  occurrence. 

The  obliteration  of  the  nasal  opening  of  this  cavity  is  sometimes 
caused  by  disease  in  the  nose,  and  is  followed  by  mucous  engorgement 
of  the  sinus,  inflammation  of  the  lining  membrane,  distention  of  the 


DISEASES    OF    THE    MAXILLARY    SINUS.  465 

osseous  walls,  aud  not  unfrequently  by  other  and  moi-e  complicated 
forms  of  disease.  But  the  closing  of  this  opening  is  oftener  an  effect 
than  a  cause  of  disease  in  this  cavity,  and  it  generally  re-establishes 
itself  without  any  assistance  of  art  after  the  cure  of  the  affection  which 
caused  it. 

If  all  the  circumstances  connected  wdth  the  history  of  the  diseases 
under  consideration  could  be  ascertained,  we  think  it  would  be  found 
that  these  affections  are  more  frequently  induced  by  a  morbid  condi- 
tion of  the  teeth,  gums,  and  alveolar  processes  than  any  other  cause. 
There  are,  in  fact,  no  sources  of  irritation  to  which  this  cavity  is  so 
much  and  so  often  exposed  as  those  arising  from  the  dental  organism. 
It  is  sejDarated  from  the  apices  of  the  roots  of  the  superior  molars  and 
bicuspids  by  only  a  very  thin  plate  of  bone,  and  is  sometimes  even 
penetrated  by  them  ;  so  that  it  could  scarcely  be  otherwise  than  that 
aggravated  and  protracted  disease  in  the  teeth  and  alveoli  should  exert 
an  unhealthy  influence  upon  it.  The  pain  occasioned  by  diseased 
teeth  is  often  very  severe,  sometimes  almost  excruciating,  and  inflam- 
mation in  the  alveoli-dental  periosteum  and  gums  frequently  extends 
itself  to  the  whole  of  one  side  of  the  face.  It  could  hardly  be  possi- 
ble, therefore,  for  this  cavity  to  escape.  Alveolar  abscess,  and  some- 
times necrosis  and  exfoliation  of  the  socket  of  the  affected  tooth,  arise 
from  the  inflammation  thus  lighted  up.  It  often  happens  that  the 
gums  and  alveolar  periosteum  are  affected  for  years  with  chronic 
inflammation  and  other  morbid  affections. 

If,  in  addition  to  these  facts,  other  proofs  be  necessary  to  establish 
the  agency  of  dental  and  alveolar  irritation  in  the  production  of  dis- 
ease in  the  maxillary  sinus,  they  may  be  found.  Many  of  the  affec- 
tions here  met  with  are  often  cured  by  the  removal  of  diseased  teeth 
after  other  remedies  have  been  employed  in  vain,  and  that  without 
even  perforating  the  antrum.  This  would  not  be  the  case  if  the  irri- 
tation did  not  arise  as  a  consequence  of  the  dental  malady. 

Most  writers  on  diseases  of  the  sinus  agree  in  ascribing  them  to  a 
morbid  condition  of  the  teeth  and  alveoli.  There  are  some,  however, 
who,  though  they  admit  that  dental  irritation  may,  perhaps,  occasion- 
ally give  rise  to  them,  seem,  nevertheless,  to  attribute  their  occurrence, 
in  the  majority  of  instances,  to  other  causes,  such  as  irregular  exposure 
to  cold,  blows  upon  the  face,  and  certain  constitutional  diseases.  We 
shall  now  proceed  to  the  consideration  of  some  of  the  more  common 
affections  of  this  cavity,  under  their  respective  and  appropriate  heads. 

Inflammation   of  the  Lining  Membrane  of  the  Maxillary  Sinus.  — 

Inflammation,  when  not  complicated  with  any  other  morbid  affection, 

is  the  most  simple  form  of  disease  to  which  the  pituitary  membrane 

of  the  antrum  is  subject.     As  it  precedes  and  accompanies  all  others,, 

30 


466  DISEASES    OF    THE    MAXILLARY    SINUS. 

it  will  be  proper  to  offer  a  few  remarks  upon  it  before  entering  upon 
the  consideration  of  those  of  a  more  aggravated  nature. 

Inucce!?sible  as  it  is  here  to  most  of  the  acrid  and  irritating  agents 
to  which  it  is  exposed  in  the  nasal  fossae  and  some  other  cavities  of  the 
body,  it  would  rarely  become  the  seat  of  inflammation  were  it  not  for 
its  proximity  to  the  teeth  and  alveolar  border  ;  and  simple  inflamma- 
tion rarely  gives  rise  to  any  other  form  of  diseased  action,  unless 
favored  by  some  general  morbid  tendency,  but  usually  subsides  spon- 
taneously on  the  removal  of  the  exciting  cause.  In  good  constitutions 
it  is  less  subject  to  inflammation,  and,  consequently,  to  any  other 
description  of  morbid  action,  than  those  in  whom  there  exists  some 
vice  of  body  or  constitutional  predisposition.  Febrile  and  gastric 
affections;  eruptive  diseases,  such  as  measles,  small-pox,  etc. ;  syphilis, 
and  excessive  and  protracted  use  of  mercurial  medicines  ;  a  scorbutic 
or  scrofulous  diathesis  of  the  general  system  —  in  short,  everything 
that  has  a  tendency  to  enervate  the  vital  powers  of  the  body  increases 
its  irritability. 

When  in  a  healthy  condition,  it  secretes  a  slightly  viscid,  transpa- 
rent and  inodorous  fluid,  by  which  it  is  constantly  lubricated ;  but 
inflammation  changes  the  character  of  the  secretion.  It  causes  it  to 
become  vitiated ;  at  first  less  abundant,  it  is  afterward  secreted  in 
larger  quantities  than  usual,  becomes  more  serous,  and  so  acrid  as 
sometimes  to  irritate  the  membrane  of  the  nose,  over  which  it  passes 
after  having  escaped  from  the  antrum.  It  also  exhales  an  odor  more 
or  less  offensive,  accordingly  as  the  inflammation  is  mild  or  severe.  It 
moreover  gives  rise  to  a  thickening  of  the  membrane,  and  sometimes 
to  obliteration  of  the  nasal  opening. .  This  last  rarely  occurs ;  but 
when  it  does  happen,  an  accumulation  of  the  secretion  and  other  mor- 
bid phenomena,  of  which  Ave  shall  hereafter  treat,  result  as  a  necessary 
consequence. 

If  at  any  time  during  the  continuance  of  the  inflammation,  the  pa- 
tient is  attacked  with  severe  constitutional  disease,  the  local  affection 
will  be  aggravated,  and  sometimes  assume  a  different  character. 

The  inflammation,  when  long  continued,  degenerates  into  a  chronic 
form,  and  is  sometimes  kept  up  for  several  years,  without  giving  rise 
to  any  other  unpleasant  symptoms  than  occasional  paroxysms  of  .dull 
and  seemingly  deep-seated  pain  in  the  face,  and  a  vitiated  condition 
of  the  fluids  of  this  cavity.  The  slightly  fetid  odor  which  they  exhale 
ceases  to  be  annoying  or  even  perceptible  to  the  patient,  when  he  be- 
comes accustomed  to  it. 

Symptoms.  —  The  symptoms  of  inflammation  here,  though  not 
always  precisely  the  same  as  elsewhere,  are,  for  the  most  part,  very 
similar.     They  are  severe,  fixed,  and   deep-seated  pain   under  the 


DISEASES    OF    THE    MAXILLARY    SINUS.  467 

cheek,  extending  from  the  alveolar  border  to  the  lower  part  of  the 
orbit ;  local  heat,  pulsation,  and  sometimes  fever.  Boyer  says  these 
symptoms  are  not  always  jDresent,  and  that  inflammation  may  exist 
when  it  is  not  suspected.  Other  affections  of  the  face  and  superior 
maxilla  may  be  mistaken  for  this,  and  this  for  others;  but  that  inflam- 
mation should  exist,  without  being  attended  with  pain  or  any  other 
signs  indicative  of  its  presence,  is  scarcely  probable. 

Deschamps  distinguishes  the  symptoms  of  this  from  those  of  other 
affections  of  this  cavity  by  a  dull,  heav}^  pain  in  the  region  of  the 
sinus,  which,  he  says,  becomes  sharp  and  lancinating,  and  extends 
from  the  alveolar  arch  to  the  frontal  sinus.  The  disease  goes  on 
without  interruj)tion,  increasing  until  the  superior  maxilla  of  the 
affected  side  is  more  or  less  involved.  This  malady,  he  says,  cannot  be 
confounded  with  any  other,  even  where  there  is  no  external  visible 
cause ;  differing  from  a  simple  retention  of  mucus,  by  being  painful  at 
the  commencement,  and  not  by  being  accompanied  with  swelling  of  the 
bones  ;  from  polypus,  by  the  continuance  of  pain ;  and  from  cancer, 
by  the  character  of  the  pain.  "  Suppuration  and  ulcers  have  peculiar 
signs  which  cannot  be  confounded  with  those  of  inflammation."  Pain 
in  the  molar  and  bicuspid  teeth,  accompanied  by  a  sense  of  fluctuation 
in  the  parts,  he  seems  to  regard  as  a  very  certain  indication  of  inflam- 
mation, and  especially  when  joined  to  the  other  symptoms.  "If  an 
external  cause  is  discovered,  it  will  furnish  a  certain  diagnosis : "  he 
also  mentions  fever  and  headache  as  almost  invariable  accompani- 
ments. 

The  inflammation,  if  not  subdued  by  appropriate  remedies,  after 
having  continued  for  a  length  of  time,  gradually  assumes  a  chronic 
form;  the  pain  then  begins  to  diminish,  and  is  less  constant ;  it  becomes 
duller,  and  is  principally  confined  to  the  region  of  the  antrum.  The 
teeth  of  the  affected  side  cease  to  ache,  or  ache  only  at  times,  but  still 
remain  sensitive  to  the  touch.  The  mucous  membrane  of  the  nostril 
next  the  diseased  sinus  is  often  tender  and  slightly  inflamed ;  and  if 
in  the  morning,  or  after  two  or  three  hours'  sleep,  the  other  nostril  be 
closed  by  pressing  upon  it  with  the  thumb  or  one  of  the  fingers,  and  a 
violent  expiration  be  made,  a  thin  watery  fluid,  of  a  slightly  fetid  odor, 
will  be  discharged,  and  pain  will  be  experienced  in  the  region  of  this 
cavity. 

Causes.  —  All  morbid  conditions  of  the  teeth  and  gums,  causing  irri- 
tation in  the  alveolar  periosteal  tissue,  may  be  regarded  as  among  the 
most  frequent  of  its  exciting  causes,  especially  caries,  necrosis,  and 
exostosis ;  also,  loose  teeth,  and  the  roots  of  such  as  have  been  either  frac- 
tured in  an  attempt  at  extraction,  or  by  a  blow  or  fall,  and  left  in  their 
sockets,  or  that  have  remained  after  the  destruction  of  their  crowns  by 


468  DISEASES    OF    THE    MAXILLARY    SINUS. 

decay.  It  sometimes  happens,  too,  that  inflammation  is  excited  in  this 
membrane  by  fractured  ulveoli ;  but  Avhen  an  accident  of  this  sort  occurs, 
the  detached  portions  of  bone  are  generally  soon  thrown  off  by  the 
economy,  and  the  cause  being  removed,  the  inflammation  immediately 
subsides.  Not  so  with  the  roots  of  the  teeth.  They  often  remain  con- 
cealed in  their  sockets  for  years,  unless  removed  by  art.  Nature,  it  is 
true,  makes  an  effort  to  expel  them  from  the  jaw,  but  this  is  accom- 
plished only  by  a  slow  and  very  tedious  process,  and  not,  in  many  in- 
stances, until  they  have  given  rise  to  some  serious  affection.  But  of 
the  deleterious  effects  that  result  from  necrosed  roots  of  teeth  in  the 
alveoli,  it  is  not  necessary  now  to  speak ;  as  extraneous  bodies,  they 
are  always  productive  of  more  or  less  irritation.  We  might  also  men- 
tion exposure  to  sudden  transitions  of  temperature,  and  certain  con- 
stitutional diseases,  as  among  the  causes  which  occasionally  give  rise  to 
inflammation  of  tliis  membrane. 

Treatment.  —  The  curative  indications  of  inflammation  of  the  lining 
membrane  of  the  antrum  are  simple,  and,  for  the  most  part,  similar 
to  those  of  inflammation  in  other  parts  of  the  body.  In  many  cases, 
great  benefit  will  be  derived  from  the  application  of  leeches  to  the 
cheek,  as  recommended  by  Mr.  Thomas  Bell.  When  the  disease  is 
dependent,  as  in  most  cases  it  is,  upon  an  unhealthy  condition  of  the 
alveolar  processes,  the  first  thing  to  be  done  is  to  remove  all  such  teeth, 
or  roots  of  teeth,  as  ai'e  productive  of  the  least  irritation ;  for  while 
any  local  sources  of  irritation  are  permitted  to  remain,  neither  topical 
nor  general  bleeding,  or  indeed  any  other  treatment,  will  be  of  perma- 
nent advantage. 

Simple  inflammation  of  the  lining  membrane  of  the  antrum  would 
be  of  little  consequence,  were  it  not  that  it  is  liable  to  give  rise 
to  other  and  more  dangerous  forms  of  disease,  such,  for  instance,  as 
engorgement  or  a  purulent  condition  of  its  secretions.  It  should 
never,  thei'efore,  be  permitted  to  continue,  but  be  as  speedily  arrested  as 
possible;  and  for  the  accomplishment  of  this,  the  means  here  joointed 
out  will,  if  timely  and  properly  applied,  be  found  fully  adequate. 

Purulent  Condition  of  the  Secretions  and  Engorgement  of  the  Maxillary 
Sinus. — A  purulent  condition  of  the  secretions  of  the  maxillary  sinus 
and  mucous  engorgement  are,  indiscriminately,  though  very  improperly, 
denominated  by  many  writers  on  the  aflfections  of  this  cavity,  abscess. 
To  this,  neither  bears  the  slightest  resemblance.  Deschamps  treats  of 
the  former  under  the  name  of  suppuration,  and  the  latter,  dropsy.  Of 
the  first,  he  says,  "  If,  by  the  time  the  inflammation  has  passed,  the 
surrounding  parts  cease  to  be  painful,  while  the  affection  still  continues 
to  cause  pain  in  the  antrum,  and  the  fever,  though  diminished,  occurs 
at  irregular  intervals,  and  if  the  inflammation  is  followed  by  pulsating 


DISEASES    OF    THE    MAXILLARY    SINUS.  469 

pain,  we  have  reason  to  suppose  that  an  abscess  has  formed  in  the  sinus ; 
and  all  doubt  will  be  removed,  if,  on  the  patient's  inclining  his  head 
CO  the  opposite  side,  matter  is  discharged  into  the  nostrils,  or  if  some 
tubercles  are  formed  near  the  outer  angle  of  the  eye,  or  alveolar  border, 
which  last  happens  more  frequently ;  and,  finally,  if  the  purulent 
matter,  not  finding  any  opening  through  which  to  discharge  itself, 
distends  the  sinus  to  such  an  extent  as  to  form  a  tumor  outwardly 
upon  the  cheek,"  In  short,  all  the  symptoms  which  he  mentions  as 
belonging  to  the  disease  are  those  accompanying  the  one  under  con- 
sideration.    The  matter,  he  says,  is  of  a  "  putrid  serous  consistence." 

Bordenave  has  fallen  into  a  similar  error.  He  terms  an  altered 
state  of  these  secretions  suppuration  of  the  membrane,  and  says  that 
inflammation  is  not  necessary  to  it.  He  seems  to  have  confounded 
with  abscess  of  the  antrum  those  cases  of  alveolar  abscess  where  the 
matter,  instead  of  discharging  itself,  as  it  ordinarily  does,  by  an  open- 
ing through  the  alveolus  and  gum  into  the  mouth,  passes  into  that 
cavity.  Again  he  asserts  that  the  disease  (suppuration,  as  he  calls  it) 
may  be  independent  of  the  surrounding  parts ;  and  although  ordina- 
rily implicated  with  an  altered  condition  of  them,  he  afiirms,  it  is 
sometimes  the  effect  of  disease  primarily  seated  in  the  cavity. 

There  is  no  doubt  that  a  purulent  condition  of  the  fluids  of  this  cavity 
is  often  complicated  with  ulceration  of  the  lining  membrane  ;  but  that 
the  affection  is  different  from  abscess,  its  very  nature  and  situation  are 
sufficient  to  show.  "  A  reference  to  the  structure  of  the  antrum,"  says 
Mr.  Bell,  "  would  appear  to  be  sufficient  to  point  out  the  improbability, 
to  say  the  least,  of  the  occurrence  of  abscess  in  such  a  situation.  That 
a  mucous  membrane  covering,  in  a  thin  layer,  the  whole  internal  sur- 
face of  such  a  cavity,  should  become  the  seat  of  all  the  consecutive 
steps  of  true  abscess,  is  a  statement  bearing  on  the  face  of  it  an  obvious 
absurdity."  Notwithstanding  the  seedling  improbability  of  such  an 
'occurrence,  —  and  it  is  certainly  one  that  very  rarely  happens, — 
abscess  does  sometimes  develop  itself  in  this  cavity  ;  but  it  is  a  diflTerent 
affection  altogether  from  that  usually  treated  of  under  that  name. 

When  complicated  with  ulceration  of  the  mucous  membrane  —  and 
it  is  probable  that  a  purulent  condition  of  its  secretions,  in  most  in- 
stances, is  thus  complicated — the  affection  is  analogous  to  ozsena,  and  • 
many  of  the  older  writers  designate  it  by  that  name.  Mr.  Bell  describes 
it,  and  very  properly  too,  as  being  similar  to  gonorrhoea  ;  both  diseases 
alike  consist  in  an  alteration  of  seciietion  ;  in  the  one  case  of  the  pitui- 
tary membrane,  and  in  the  other  of  the  mucous  lining  of  the  urethra ; 
])ut  in  neither  instance  does  it  possess  any  of  the  characteristics  of 
abscess,  though  the  matter  in  both  is  purulent. 

It  has  been  before  stated  that  the  obliteration  of  the  nasal  opening 


470  DISEASES    OF    THE    MAXILLAliY    SINUS. 

was  more  frequently  an  effect  than  a  cause  of  disease  in  the  maxillary 
sinus ;  it  docs,  however,  sometimes  become  closed  from  other  causes 
than  an  unhealthy  condition  of  this  cavity;  when  this  happens,  en- 
gorgement of  the  sinus  is  the  inevitable  consequence.  The  fluids  thus 
accumulated  are  not  always  at  first  purulent,  although  they  may  sub- 
sequently become  so:  when  the  closing  of  the  opening  is  the  result  of 
previous  disease  in  the  antrum,  the  secretions  are  more  or  less  altered 
from  the  very  first. 

Accumulation  of  any  secretion  within  the  antrum,  whether  of  mucus 
or  pus,  is  a  source  of  irritation  to  the  lining  mond)rane,  and  the  press- 
ure which  it  ultimately  exerts  upon  the  surrounding  walls  causes  a 
new  form  of  diseased  action,  which  not  unfrequently  involves  in  disease 
all  the  bones  of  the  face  as  well  as  those  of  the  base  of  the  cranium. 
When  prevented  from  escaping  through  the  nasal  opening,  the  secre- 
tion eventually  makes  for  itself  a  way  of  escape  —  sometimes  through 
the  cheek  ;  at  other  times  beneath  it,  just  above  the  alveolar  ridge ;  or 
through  the  palatine  arch  or  alveoli  by  the  sides  of  the  roots  of  one  or 
more  of  the  teeth  ;  and  from  a  fistula  thus  established  fetid  matter  will 
be  almost  constantly  discharged.  From  openings  of  this  sort  the  mutter 
is  sometimes  discharged  for  years,  while  the  disease  in  the  antrum, 
very  frequently,  docs  not  seem  to  undergo  any  apparent  change.  At 
other  times  the  membrane  ulcerates  and  the  bony  walls  become  carious. 

A  purulent  secretion  from  the  mucous  membrane  of  this  cavity,  inde- 
pendently of  caries  of  the  bone,  or  even  of  simple  fistulous  openings, 
is  an  exceedingly  troublesome  and  unpleasant  aflfection.  The  odor 
from  the  matter  is  often  very  annoying  even  to  the  patient,  and  when 
the  secretions  are  retained  for  some  days  in  the  sinus  before  they  escape, 
the  fetor  is  almost  insufllerable. 

In  good  constitutions,  the  secretions  of  the  antrum  are  not  so  liable 
to  become  purulent,  though  they  be  confined  for  a  long  time  in  the 
cavity,  and  thus  become  more  or  less  oflfensive.  Inflammation  of  the 
lining  membrane  (the  immediate  or  proximate  cause)  may  exist  for 
years  without  giving  rise  to  it.  It  is  only  in  scrofulous,  scorbutic,  or 
debilitated  habits  that  they  are  liable  to  become  thus  altered.  The 
difference  in  the  effects  produced  upon  them  and  the  surrounding  parts, 
by  inflammation,  is  owing  to  the  difference  in  the  state  of  the  constitu- 
tional health  of  those  aflTected  with  it. 

Where  a  puriform  state  of  the  secretions  is  complicated  with  ulcera- 
tion of  the  membrane,  the  matter  w'ill  have  mixed  with  it  a  greater  or 
less  quantity  of  flocculi,  sometimes  of  so  firm  a  consistence  as  to  block 
up  the  nasal  opening  and  prevent  its  exit.  Mr.  Thomas  Bell  says  he 
has  seen  more  than  one  case  in  which  a  considerable  accumulation  had 
taken  place  in  the  antrum,  accompanied  by  the  usual  indications  of 


DISEASES    OF    THE    MAXILLARY    SINUS.  471 

this  affection,  (muco-purulent  engorgement  of  the  sinus,)  when  a  sudden 
discharge  of  the  contents  into  the  nose  took  place,  "  in  consequence  of 
the  pressure  having  overcome  the  resistance  which  had  thus  been  ofiered 
to  its  escape."  Cases  of  a  very  similar  nature  have  fallen  under  our 
observation,  the  history  of  one  of  which  will  be  given  in  the  course  of 
this  chapter.  The  formation  of  these  flocculi  rarely  ceases,  except  with 
the  cure  of  the  ulcers  on  the  membrane.  They  give  rise  to  considerable 
irritation,  and  their  presence  always  constitutes  an  obstacle  to  the  cure. 
They  are  usua-lly  easily  removed  by  injections. 

The  pituitary  membrane  of  the  antrum,  when  in  a  healthy  state, 
secretes,  as  we  have  before  stated,  a  transparent,  slightly  viscid  and 
inodorous  fluid,  poured  out  only  in  sufficient  quantity  to  lubricate  the 
cavity.  But  when  inflammation  is  excited  in  the  membrane,  its  secre- 
tions soon  become  more  abundant,  and  are  at  first  thinner,  afterward 
thicker  and  more  glutinous.  Their  color  and  consistence  are  not  always 
the  same.  Instead  of  being  transparent,  they  sometimes  have  a  dirty, 
opaque  appearance ;  at  other  times  they  assume  a  greenish,  whitish,  or 
yellowish  color,  and  in  some  instances  they  bear  a  considerable  resem- 
blance to  pus,  which,  it  has  been  conjectured,  might  be  owing  to  sup- 
puration of  some  of  the  mucous  follicles  and  a  mixture  of  pus  with  its 
secretions.  Mr.  Thomas  Bell,  however,  inclines  to  the  opinion  that  it 
is  attributable  to  an  "alteration  simply"  of  the  secretions  of  the  cavity. 
Their  color  and  consistence  are  determined  by — the  degree  of  inflam- 
mation ;  the  length  of  time  it  has  existed ;  the  state  of  the  health  of 
the  lining  membrane,  and  that  of  the  surrounding  osseous  walls;  the 
egress  which  the  matter  has  from  the  sinus ;  and  the  general  habit  of 
the  body. 

Affections  of  this  sort  are  more  common  to  young  subjects  than  to 
middle-aged  or  persons  in  advanced  life.  An  eminent  French  writer 
says  that  of  three  individuals  afiected  with  dropsy  (mucous  engorge- 
ment), the  oldest  was  not  twenty  years  of  age. 

Symptoms.  —  The  diagnoses  of  the  several  affections  of  the  antrum 
are  so  much  alike,  that  it  is  often  difficult  to  distinguish  those  that 
belong  to  one  from  those  attendant  upon  another.  The  symptoms  of 
mucous  engorgement  and  purulent  accumulation,  however,  are  gener- 
ally such  as  will  enable  the  practitioner  to  distinguish,  with  considerable 
certainty,  these  from  other  affections.  They  are  always  preceded  by 
inflammation  of  the  lining  membrane ;  a  description  of  the  symptoms 
of  which,  having  already  been  given,  need  not  be  repeated.  Omitting 
these,  we  at  once  proceed  to  mention  those  by  which  they  are  accom- 
panied. 

In  speaking  of  the  symptoms  more  particularly  belonging  to  a  puru- 
lent condition  of  the  secretions  of  the  antrum,  Deschamps  says  the 


472  DISEASES    OF    THE    MAXILLARY    SINUS. 

afTt'ctioii  nuvy  be  distinguished  by  dull,  heavy  pain  extending  along  the 
alveolar  border.  Upon  this  symi)tom  alone,  little  reliance  can  be 
placed,  as  it  is  always  present  in  chronic  inflammation.  In  addition 
to  this,  he  mentions — the  presence  of  decayed  teeth  ;  soreness  in  those 
that  are  sound ;  and,  on  the  patient's  inclining  his  head  to  the  side 
opposite  to  the  one  affected,  the  discharge  of  fetid  matter  from  the  nose. 
These  are  very  conclusive  indications  of  purulent  effusions  in  this  cavity. 
Bordenave,  after  enumerating  the  symptoms  indicative  of  inflammation, 
mentions  the  following  as  belonging  to  the  affection  of  which  we  are 
now  speaking:  dull  and  constant  pain  in  the  sinus,  extending  from 
the  maxillary  fossaj  to  the  orbit ;  a  discharge  of  fetid  matter  from  the 
nose,  when  the  patient  inclines  his  head  to  the  opposite  side,  or  when 
the  nose  is  blown  from  the  nostril  of  the  affected  side.  These  symp- 
toms are  mentioned  by  almost  every  writer  upon  the  subject,  as  indica- 
tive of  a  purulent  condition  of  the  secretions  of  the  maxillary  sinus. 

The  symptoms  of  engorgement  differ  materially  from  those  which 
denote  simply  a  purulent  condition  of  the  mucous  secretions.  The 
pain,  in^;tead  of  being  dull  and  heavy,  as  just  described,  becomes  acute, 
and  a  distressing  sense  of  fulness  and  weight  is  felt  in  the  cheek,  accom- 
panied by  redness  and  tumefaction  of  the  integument  covering  the 
antrum.  The  nasal  opening  having  become  closed,  the  fluids  of  the 
cavity  gradually  accumulate  until  they  fill  it ;  when,  finding  no  egress, 
they  press  upon  and  distend  the  surrounding  osseous  w'alls,  causing 
those  parts  which  are  the  thinnest  ultimately  to  give  way.  The  effects 
are  generally  first  observable  anteriorly  beneath  the  malar  prominence, 
where  a  smooth,  hard  tumor  presents  itself,  covered  with  the  mucous 
membrane  of  the  mouth.  But  this  is  not  always  the  point  which  first 
gives  Avay;  the  sinus  sometimes  bursts  into  the  orbit,  at  other  times 
outwardly  through  the  cheek,  or  through  the  palatine  arch.  The  long- 
continued  pressure  thus  exerted  upon  the  bony  walls  often  causes  the 
breaking  down  or  softening  of  their  tissues. 

The  tumor,  which  is  at  first  hard,  becomes  in  a  short  time  so  soft  as 
readily  to  yield  to  pressure.  A  distention,  Deschamps  says,  may  be 
distinguished  from  other  diseases  that  affect  the  skin  or  subcutaneous 
tissues  by  the  uniformity  or  regularity  of  the  tumor,  its  firmness  at 
the  commencement,  the  slowness  with  which  it  progresses,  and,  above 
all,  by  the  natural  appearance  of  the  skin,  and  the  absence  of  pain 
when  pressure  is  made  upon  the  tumor.  Obliteration  of  the  nasal 
opening,  he  says,  may  be  suspected  by  the  dryness  of  the  nostril  of  the 
affected  side,  the  mucous  membrane  of  which  becomes  thickened  and 
the  cavity  contracted,  inflammation  and  sponginess  of  the  gums,  loosen- 
ing and,  sometimes,  in  consequence  of  the  destruction  of  their  sockets, 


DISEASES    OF    THE    MAXILLARY    SINUS.  473 

displacement  of  the  teeth,  may  also  be  mentioned  as  occasional  accom- 
paniments of  engorgement. 

Causes. —  Inflammation  of  the  mucous  membrane  is  the  cause  of 
a  purulent  condition  of  the  secretions  of  the  maxillary  sinus,  and  this 
arises  more  frequently  from  alveolo-dental  irritation  than  from  any 
particular  habit  of  body  or  constitutional  disturbance.  Engorgement 
results  from  the  obliteration  of  the  nasal  opening,  which,  in  the  case  of 
altered  secretion,  is  usually  caused  by  inflammation  and  thickening 
of  the  lining  membrane. 

Treatment.  —  The  curative  indications  of  muco-purulent  secretion 
and  engorgement  of  the  maxillary  sinus  are,  firstly,  if  the  nasal  open- 
ing be  closed,  the  evacuation  of  the  retained  matter ;  secondly,  the  re- 
moval of  all  local  and  exciting  causes  of  irritation ;  thirdly,  and  lastly, 
the  restoration  of  the  lining  membrane  to  its  normal  function. 

For  the  fulfilment  of  the  first,  an  opening  must  be  made  into  the 
antrum,  and  this  should  be  effected  in  that  part  which  will  afford  the 
most  easy  exit  to  the  retained  mattei*.  Several  ways  have  been  pro- 
posed for  the  accomplishment  of  this  object ;  and  before  we  proceed 
further,  it  may  not  be  amiss  to  notice  some  of  the  various  methods 
that  have  been  adopted  by  different  practitioners. 

With  regard  to  the  tooth  most  proper  to  be  extracted  authors  differ. 
Cheselden  preferred  the  first  or  second  molar.  Junker  recommends 
the  extraction  of  the  first  or  second  bicuspid,  and  if  a  fistula  had 
formed,  to  enlarge  it  instead  of  perforating  the  floor  of  the  antrum. 
But  the  second  molar,  being  directly  beneath  the  most  dependent  part 
of  the  cavity,  is  the  most  suitable  tooth  to  be  removed.  If  this  be 
sound,  the  first  or  third  molar  or  either  of  the  bicuspids,  if  carious, 
may  be  extracted  in  its  stead,  and,  in  fact,  no  tooth  beneath  the  antrum, 
in  an  unhealthy  condition,  should  be  permitted  to  remain.  Heath 
recommends  the  extraction  of  the  first  molar  on  account  of  the  depth 
of  its  socket,  and  because  it  is  more  liable  to  decay  than  any  of  the 
other  teeth. 

An  opening  having  been  effected  through  the  alveolus  of  a  tooth 
into  the  antrum,  it  should  be  kept  open  until  the  health  of  the  cavity 
is  restored.  For  this  purpose,  sounds  and  bougies  adapted  to  the  pur- 
pose have  been  introduced. 

When  the  natural  opening  is  closed,  the  first  indication,  as  has  been 
stated,  is  the  evacuation  of  the  matter ;  and  for  this  purpose,  a  per- 
foration should  be  made  into  the  sinus,  and  the  most  proper  place  for 
effecting  this,  it  has  been  shown,  is  through  the  alveolar  cavity  of  the 
second  molar.  It  may,  however,  be  penetrated  from  that  of  either  of 
the  other  molars  or  bicuspids. 

The  perforation,  after  the  extraction  of  the  tooth,  is  made  with  a 


474  DISEASES    OF    THE    MAXILLARY    SINUS. 

straight  trocar,  which  will  be  found  more  convenient  than  those  usu- 
ally emploved  for  the  purpose.  The  point  of  the  instrument,  having 
been  introduced  into  the  alveolus  through  which  it  is  intended  to  make 
the  opening,  should  be  pressed  against  the  bottom  of  the  cavity  in  the 
direction  toward  the  centre  of  the  antrum.  A  few  rotary  motions  of 
the  instrument  will  suffice  to  i)iercc  the  intervening  plate  of  bone.* 
If  the  first  opening  be  not  sufficiently  large,  its  dimensions  maybe 
increased  to  the  necessary  size  by  means  of  a  spear-pointed  instrument. 
The  entrance  is  usually  attended  with  a  momentary  severe  pain,  and 
the  withdrawal  of  the  instrument  followed  by  a  sudden  gush  of  fetid 
mucus.  In  introducing  the  trocar,  care  should  be  taken  to  prevent 
a  too  sudden  entrance  of  the  instrument  into  the  cavity.  AVithout  this 
precaution,  it  might  be  suddenly  forced  against  the  opposite  wall.  It 
is  not  always  necessary  to  perforate  the  floor  of  the  antrum  after  the 
extraction  of  the  tooth ;  it  occasionally  happens,  as  has  already  been 
remarked,  that  some  of  the  alveolar  cavities  communicate  with  it. 

An  opening  having  thus  been  effected,  it  should  be  prevented  from 
closing  until  a  healthy  action  is  established  in  the  lining  membrane, 
and  for  this  purpose  a  bougie,  or  leaden  or  silver  canula,  may  be  in- 
serted into  the  opening  and  secured  to  one  of  the  adjacent  teeth.  It 
should,  however,  be  removed  for  the  evacuation,  of  the  secretions  at 
least  twice  a  day.  The  formation  of  an  opening  at  the  base  or  most 
dependent  part  of  the  sinus  will,  in  those  cases  where  a  fistula  has 
been  previously  formed,  be  followed,  in  most  instances,  by  its  speedy 
restoration.  Having  proceeded  thus  fiir,  the  cure  will  be  aided  by  the 
employment  of  such  general  remedies  as  may  be  indicated  by  the  state 
of  the  general  health  ;  and  for  the  dispersion  of  the  local  inflammation, 
leeches  to  the  gums  and  cheeks  will  be  found  serviceable.  The  antrum 
may,  in  the  mean  time,  be  injected  with,  at  first,  some  mild  or  bland 
fluid,  and  aiterward  with  gently  stimulating  liquids.  Diluted  port 
wine,  weak  solutions  of  the  sulphate  of  zinc  and  rose-water,  copper 
and  rose-water,  or  permanganate  of  potash,  answer  admirably,  es- 
pecially the  latter.  Diluted  tincture  of  myrrh  may  sometimes  be 
advantageously  employed,  and  when  the  membrane  is  ulcerated,  a 
solution  of  nitrate  of  silver  will  be  highly  serviceable.  The  author 
has  used  a  solution  of  iodide  of  potassium  with  advantage,  also  a 
weak  alcoholic  solution  of  tannic  acid.  For  correcting  the  fetor  of 
the  secretions,  a  weak  solution  of  the  chlorinated  soda  or  lime  may  be 
occasionally  injected  into  the  antrum. 

In  casdfe  of  simple  muco-purulent  secretion,  a  weak  decoction  of 

*  In  a  collection  of  nearly  one  hundred  superior  maxillce,  presented  to  tLe 
museum  of  the  Baltimore  Dental  College  by  Dr.  Maynard,  the  floor  of  the  antrum 
varies  in  thickness  from  that  of  tissue  paper  to  half  an  inch. 


DISEASES    OF    THE    MAXILLARY    SIXUS.  475 

galls  may  be  injected  into  the  sinus  with  advantage.  Injections  of  a 
too  stimulating  nature  are  sometimes  employed.  This  should  be  care- 
fully guarded  against,  by  making  them  at  first  weak,  and  afterward 
increasing  their  strength  as  occasion  may  require ;  and  if  symptoms 
of  a  violent  character  are  by  this  means  produced,  they  should  be 
combated  by  applying  leeches  to  the  gums  and  fomentations  to  the 
cheek. 

Dependent  as  these  affections  in  most  instances  are  upon  local  irri- 
tants, greater  reliance  is  to  be  placed  on  their  removal  and  giving 
vent  to  the  acrid  puriform  fluids,  than  on  any  therapeutical  effects 
exerted  upon  the  cavity  by  injections.  As  adjuvants,  they  are  ser- 
viceable, but  cure  cannot  be  effected  while  the  exciting  cause  remains 
unremoved. 

The  following  cases  may  serve  to  illustrate  the  treatment  usually 
pursued  in  this  disease. 

Case  1.  Mrs.  T.,  a  married  lady,  about  forty  years  of  age,  of  a  bil- 
ious  temperament,  applied  to  the   author  for   advice  in  1853.     She 
had  suffered  from  neuralgic  pains  in  her  face  and  temples,  at  intervals, 
for  nearly  twenty  years,  and  as  all  of  her  teeth,  especially  of  the  upper 
jaw,  were  so  much  decayed  as  to  preclude  the  possibility  of  restora- 
tion, he  urged  their  immediate  removal.     She  submitted  to  the  opera- 
tion, hoping  that  it  would  relieve  her  from  the  pain  to  which  she  had 
so  long  been  a  martyr,  and  intending  to  have  the  lost  organs  replaced 
with  an  artificial  set.    -She  called  again  in  a  few  months,  partly  for 
this"  purj^ose  and  partly  to  obtain  relief  from  pain  which  she  still  ex- 
perienced.   It  was  not  now  so  much  diffused  as  formerly,  but  was  almost 
wholly  confined  to  the  left  side  of  the  face.     On  inquiry,  it  was  ascer- 
tained that  fetid  matter  was  occasionally  discharged  from  the  nostril 
of  the  affected  side.     This  led  him  to  suspect  that  the  antrum  was 
diseased.     An  opening  was  accordingly  made  through   the  alveolar 
border,  at  the  point  originally  occupied  by  the  second  molar.     The 
withdrawal  of  the  instrument  was  followed  by  the  discharge  of  a  small 
quantity  of  purulent  matter.     The  antrum  was  now  forcibly  injected 
with  water.     This  caused  the  discharge  of  more  than  two  table-spoon- 
fuls of  hardened  flocculi  from  the  left  nostril,  which,  from  long  con- 
finement, was  insufferably  offensive.     The  injection  was  repeated  until 
the  antrum  was  completely  freed  from  this  accumulation.     A  solution 
of  sulphate  of  zinc,  in  the  proportion  of  six  grains  to  the  ounce  of 
water,  was  now  substituted.     The  sinus  was  injected  daily  with  this 
for  a  little   more  than  a  week,  and  without  any  other  treatment  a 
complete  cure  was  effected. 

The  particulars  of  the  following  case  are  obtained  from  "Observa- 


476  DISEASES    OF    THE    MAXILLARY    SIXUS.     - 

tions  of  Bordenave  on  the  Diseases  of  the  Maxillary  Sinus,"  a  paper 
embodying  reports  of  forty  highly  interesting  cases. 

Case  2.  "In  1756,"  says  our  author,  "I  was  consulted  by  a  lady 
whose  right  cheek  was  tumefied.  About  a  month  previously  she  had 
experienced  acute  pain  under  the  orbit  of  the  affected  side ;  and  she 
felt  a  pulsation  and  heat  in  the  interior  of  the  sinus,  and  the  maxillary 
bone  w-as  slightly  elevated.  These  signs  determined  me  to  propose  the 
extraction  of  the  first  molar  tooth  and  the  perforation  of  the  antrum 
through  the  alveolus.  The  operation  was  followed  by  a  discharge  of 
purulent  matter,  the  sinus  was  afterward  injected,  the  maxilla  gradu- 
ally reduced  itself,  and  a  cure  was  effected  in  about  two  months." 

Although  injections  were  employed  in  the  above  case,  it  Avas  no 
doubt  the  escape  of  the  matter  contained  in  the  antrum  to  which  the 
"  cure  was  attributable.  As  regards  the  cause  that  gave  rise  to  the  affec- 
tion in  the  first  instance,  not  a  single  word  is  said.  It  may  have  re- 
sulted from  inflammation,  lighted  up  in  the  sockets  of  one  or  more 
teeth,  and  propagated  from  thence  to  the  mucous  membrane  of  this 
cavity,  or  from  inflammation  produced  by  some  other  cause,  and  a 
consequent  obliteration  of  the  nasal  opening. 

The  following  brief  statement  is  taken  from  the  history  of  a  case 
narrated  by  Fauchard : 

Case  3.  The  child  of  M.  Galois,  aged  twelve  years,  whose  first  right 
superior  molar  was  decayed,  had  a  tumor  situated  anteriorly  upon  the 
upper  jaw  of  the  same  side,  extending  up  to  the  orbit.  M.  Fauchard, 
supposing  this  tumor,  which  was  about  the  size  of  a  small  egg,  had 
been  caused  by  the  carious  tooth  in  question,  determined  on  its  extrac- 
tion as  the  only  means  of  effecting  a  speedy  and  certain  cure,  and  the 
result  proved  his  opinion  correct.  The  removal  of  the  tooth  was  fol- 
lowed by  a  large  quantity  of  yellow  serous  matter,  which,  on  examina- 
tion, was  found  to  have  escaped  from  the  antrum.  The  tumor  disap- 
peared soon  after  the  discharge  of  the  matter,  and  a  complete  cure  was 
effected. 

Bordenave,  in  noticing  the  foregoing  case,  does  not  believe  that  the 
tumor  communicated  with  the  maxillary  sinus,  for  the  reason  that  the 
matter  escaped  through  the  alveolus  of  the  first  molar  immediately 
after  its  extraction.  He,  however,  admits  that  the  acumen  and  knowl- 
edge of  Fauchard  are  such  as  to  have  prevented  deception  in  the  case. 
Admitting,  then,  the  statement  to  be  correct  —  and  surely  the  circum- 
stance mentioned  by  Bordenave  does  not  in  the  least  tend  to  invalidate 
it,  for  it  is  of  frequent  occurrence  —  a  cure  was  effected  simply  by  the 
removal  of  a  decayed  tooth,  to  the  irritation  produced  by  which  the 
disease  was   undeniably  attributable.     The   two   following  cases  are 


,    DISEASES    OF    THE    MAXILLARY    SINUS.  477 

described  at  length  by  the  last-named  author  in  the  "Memoires  de 
.  FAcademie  Royale  de  Chirurgie." 

Case  4.  A  Avoman,  in  1731,  had  the  first  superior  molar,  the  crown 
of  which  had  been  destroyed  by  caries,  extracted.  Not  many  days  after 
the  operation,  she  was  attacked  with  pain  in  the  upper  jaw,  which  ex- 
tended from  the  maxillary  fossa  to  the  orbit.  The  pain  was  so  great 
as  to  deprive  her  of  rest ;  but  there  was  no  tumefaction  of  the  cheek  or 
gums.  An  opening  through  the  alveolus  into  the  sinus  was  discovered, 
into  which  a  probe  was  introduced  by  a  surgeon.  The  withdrawal  of 
this  was  followed  by  a  discharge  of  yellow  fetid  matter.  M.  Lamourier, 
who  was  afterward  consulted,  removed  from  the  opening  a  tooth  that 
had  been  thrust  into  the  antrum  and  prevented  the  egress  of  the  mat- 
ter, which,  by  its  retention,  had  become  purulent.  Injections  were 
employed,  a  part  of  which,  at  the  expiration  of  thirty  days,  escaped 
from  the  nasal  opening.     A  perfect  cure  was  soon  after  effected. 

In  this  case,  the  affection  of  the  sinus  was  evidently  the  result  of 
the  injury  inflicted  upon  the  socket  of  the  first  superior  molar  in  an 
attempt  at  the  extraction  of  the  tooth.  The  inflammation  excited  by 
this,  and  by  the  presence  of  the  tooth  that  had  been  thrust  into  the 
antrum,  extended  itself  to  the  lining  membrane  of  this  cavity,  and 
caused  a  temporary  obliteration  of  the  nasal  opening,  so  that  to  effect 
a  cure  it  was  necessary  to  obtain  free  vent  for  the  retained  matter.  In 
restoring  to  a  heg-lthy  action  the  mucous  membrane  of  the  cavity,  the 
injections  may  have  been  serviceable. 

Case  5.  A  girl,  aged  twenty-six  years,  had  a  very  much  decayed  and 
painful  superior  dens  sapientise  on  the  right  side  extracted  ;  the  tooth 
was  broken,  and  all  the  roots  but  one  were  left  in  their  sockets.  These 
caused  an  abscess  to  form;  and  this  was  followed,  for  a  short  time,  by  a 
subsidence  of  the  pain,  which,  however,  soon  returned,  and  a  dull, 
heavy  sensation  was  felt  in  the  antrum  of  the  affected  side.  From 
thence  the  pain  extended  to  the  eye  and  ear.  The  gums  at  length 
became  tumefied  and  the  pain  less  constant ;  the  patient  remained  in 
this  condition  for  five  years,  during  which  time  five  teeth  were  extracted. 
At  this  time  (1756),  M.  Beaupreau,  who  was  consulted,  found,  on 
examination,  that  the  gums,  where  the  first  tooth  had  been  extracted, 
had  not  entirely  united,  and  a  small  tubercle  had  formed,  from  which 
a  fluid  of  a  bad  smell  and  reddish  color  was  discharging  itself  He 
introduced  a  probe  into  the  fistulous  hole  of  the  tubercle,  which,  after 
having  overcome  some  obstacle  that  at  first  impeded  its  passage,  pene- 
trated the  antrum.  The  opening  was  enlarged  and  mercurial  water 
applied  to  the  carious  bone ;  but  it  soon  closed,  and  the  pain,  which 
had  ceased,  returned.  Injections  then  were  resorted  to,  which  dis- 
charged themselves  in  part  through  the  nasal  opening,  and  the  patient 


478  DISEASES    OF    THE    MAXILLARY    SINUS.   ^ 

contiiuuHl  in  this  way  until  an  exfoliation  of  the  bone  took  place,  ,vhen 
a  cure  wad  eti'ected. 

The  cause  of  the  disease  in  this,  as  in  the  preceding  cases,  was  alve- 
olo-dental  irritation,  and  a  cure  would  at  once  have  been  accomplished 
by  the  removal  of  the  roots  of  the  tooth  that  had  been  left  in  their 
sockets ;  this  was  proven  by  the  fact  that  it  was  not  until  they  were 
thrown  off  with  their  exfoliated  alveoli  that  the  disease  was  subdued. 

In  alluding  to  these  and  similar  cases,  Bordenave  concludes  there 
are  not  nuiny  cases  where  the  extraction  of  teeth  simply  will  suffice  to 
effect  a  cure.  This  inference,  to  say  the  least  of  it,  is  unfair ;  for  in  the 
case  last  given,  the  disease  was  attributable  to  the  i^resence  of  the  roots 
of  a  tooth  that  had  been  fractured  in  an  attempt  to  extract  it,  and  left 
in  their  sockets,  and  we  have  good  reason  to  believe  that  the  cure  was 
wholly  owing  to  their  removal. 

The  history  of  the  following  exceedingly  interesting  case,  which  was 
communicated  to  the  Faculty  of  Medicine  by  Prof  Dubois,  is  contained 
in  the  eighth  number  of  their  bulletin  for  the  year  1813,  and  also  in 
Beyer's  work  on  Surgical  Diseases. 

Case  6.  Upon  a  child  between  seven  and  eight  years  old,  at  the  base 
of  the  ascending  apophysis  of  the  superior  maxillary  bone,  a  small, 
hard,  round  tumor  of  the  size  of  a  walnut  was  perceived  by  its  parents. 
About  a  year  after,  the  child  fell  upon  its  face,  and  caused  a  consider- 
able discharge  of  matter  from  its  nose,  at  the  same  .time  bruising  the 
tumor.  N^o  other  injury  was  received,  and  the  tumor  did  not  increase 
perceptibly  in  size  from  the  eighth  to  the  fifteenth  year.  During  the 
next  year,  however,  it  sensibly  augmented,  and  from  the  sixteenth  to 
the  eighteenth  year  it  attained  so  great  a  volume  that  the  floor  of  the 
orbit  was  elevated,  which  caused  a  diminution  in  the  size  of  the  eye, 
and  restricted  the  motions  of  the  eyelids.  The  arch  of  the  palate  was 
depressed,  and  the  nasal  fossa  almost  closed.  The  nose  was  forced  to 
the  right  side  of  the  upper  part  of  the  tumor,  and  there  was  a  consider- 
able elevation  beneath  the  sub-orbital  fossa.  The  skin  below  the  infe- 
rior eyelid  was  of  a  violet  red  color,  and  very  tense.  The  upper  lid 
was  elevated,  and  the  gums  on  the  left  side  protruded  beyond  those  on 
the  other  side  of  the  arch.  Kespiration  was  painful,  and  the  patient 
spoke  -with  difficulty.  Sleep  was  laborious,  and  mastication  was  attended 
wdth  pain.  "  In  this  state,"  says  M.  Boyer,  "  he  was  seen  by  M.  Dubois, 
September  1st,  1802  ;  but  as  he  was  not  able  to  determine  on  the  proper 
operation,  M.  Sabatier,  M.  Pelletan,  and  himself  were  called  in.  It 
was  the  opinion  of  all  that  there  was  a  fungous  tumor  of  the  antrum, 
and  for  the  removal  of  this,  M.  Dubois  was  requested  to  make  choice 
of  his  own  method  of  operating." 

A  fluctuation  was  felt  behind  the  upper  lip,  and  this  determined  M. 


DISEASES    OF    THE    MAXILLARY    SINUS.  479 

Dubois  to  commence  the  operation  by  making  an  incision  there,  ^vhich 
was  followed  by  the  discharge  of  a  large  quantity  of  glairy,  lymphatic 
substance.  Through  this  opening  a  sound  was  introduced  into  the 
antrum,  and,  to  M.  Dubois'  surprise,  this  cavity  contained  no  tumor ; 
but  upon  moving  the  sound  about,  it  struck  upon  a  hard  substance,  in 
the  most  elevated  part  of  the  sinus,  which,  on  being  removed,  proved 
to  be  a  canine  tooth.  Preparatory,  however,  to  its  extraction,  two 
incisors  and  one  molar  were  removed  and  their  alveoli  cut  away. 
Injections  were  afterward  employed,  and  the  patient  was  soon  restored 
to  health. 

It  is  not  necessary  to  stop  to  inquire  how  this  tooth  got  into  the 
antrum ;  aberrations  of  this  sort  in  the  growth  of  the  teeth  are  fre- 
quently met  with,  and  some  precisely  similar  instances  have  already 
been  referred  to. 

In  all  the  cases  which  have  as  yet  been  noticed,  the  affection  was 
traceable  to  local  irritation,  and  in  all,  except  the  last,  it  originated  in 
the  alveolar  ridge.  The  following  case  of  muco-purulent  engorgement 
may  be  thought  by  some  to  have  been  occasioned  by  a  different  cause. 
Yet  there  are  circumstances  connected  with  the  history  of  even  this 
case  that  go  to  justify  the  belief  that  if  the  teeth  had  been  in  a  healthy 
condition  the  affection  would  not  have  existed. 

-    Case  7.  Mr,  G ,  a  laborer,  about  thirty  years  old,  of  a  decidedly 

scorbutic  habit,  applied,  in  the  spring  of  1834,  to  an  eminent  physician 
of  Baltimore,  to  obtain  his  advice  concerning  an  affection  of  the  left 
side  of  his  face,  under  which  he  had  been  laboring  for  several  months. 
The  physician,  after  having  examined  the  case,  came  to  the  conclusion 
that  it  was  mucous  engorgement  of  the  maxillary  sinus,  and  requested 
him  to  call  upon  us,  and  have  one  of  his  molar  teeth  extracted  and 
the  floor  of  the  antrum  pierced  through  its  alveolus.  He  at  the  same 
time  desired,  that  if  his  opinion  in  regard  to  the  nature  of  the  disease 
proved  to  be  correct,  we  should  take  charge  of  the  case  altogether. 
On  examining  his  mouth,  we  discovered  that  nearly  all  the  teeth  of 
both  jaws,  the  gums  and  alveoli,  were  extensively  diseased ;  and,  on 
inquiry,  obtained  from  him  the  following  statement  with  regard  to  the 
commencement  and  progress  of  the  affection. 

About  six  months  before  this  time,  having  been  exposed,  while  pur- 
suing his  ordinary  avocations,  to  very  inclement  and  changeable 
weather,  he  conti^acted  a  severe  cold ;  in  consequence  of  this  he  was 
confined  to  his  bed  for  several  days,  during  which  time  he  was  twice 
bled,  took  two  cathartics,  and  other  medicines. 

The  disease  at  first  settled  in  his  head,  face,  and  jaws,  but  at  the 
expiration  of  eight  or  ten  days  was  subdued  by  the  above  treatment, 
with  the  exception  of  the  pain  in  his  left  cheek,  and  soreness  in  the 


480  DISEASES    OF    THE    MAXILLARY    SINUS. 

upper  teeth  of  the  same  side.  The  pain  in  his  cheek,  although  not 
constant,  still  continued  ;  the  nasal  cavity  of  that  side  ceased  to  be  sup- 
plied with  its  usual  secretion,  the  teeth  became  more  sensitive  to  the 
touch  ;  finally,  at  the  end  of  four  months,  a  slight  protuberance  of  the 
cheek  was  observable,  accompanied  by  a  tumor  upon  the  left  side  of 
the  palatine  arch,  which,  when  we  first  saw  him,  had  attained  to  half 
the  size  of  a  black  walnut ;  and  it  was  by  tlie  fluctuation  felt  here  that 
the  physician  whom  he  first  consulted  was  induced  to  suspect  the  true 
nature  of  the  disease. 

Acting  in  consultation  with  the  medical  gentleman  in  whose  care 
the  patient  had  placed  himself,  we  extracted  the  second  left  superior 
molar;  then,  through  its  alveolus,  penetrated  the  antrum  by  means  of 
a  straight  trocar,  after  the  withdrawal  of  which  a  large  quantity  of 
glairy,  fetid,  mucous  fluid  was  discharged.  The  perforation  was  kept 
open  by  means  of  a  bougie,  secured  with  a  slight  ligature  to  an  adjoin- 
ing tooth,  as  recommended  by  Deschamps,  and  the  antrum  injected 
three  times  a  day,  at  first  simply  with  rose-water,  to  which  a  small 
quantity  of  sulphate  of  zinc  w^as  afterward  added.  By  this  treatment 
the  lining  membrane  of  the  antrum,  at  the  expiration  of  five  weeks, 
was  restored  to  health,  and  the  secretions  that  escaped  through  the 
perforation  no  longer  exhaled  a  fetid  odor. 

The  patient,  not  exjDerienciug  any  inconvenience,  withdrew  the 
bougie,  and  allowed  the  aperture  to  close.  In  about  two  months,  he 
again  presented  himself  to  the  author  similarly  aflected  as  when  we 
first  saw  him.  He  now  extracted  the  first  superior  left  molar  and  per- 
forated the  antrum  through  the  alveolus,  and  a  quantity  of  fetid 
mucous  fluid  was  again  discharged ;  the  dens  sapientise  and  the  fii'st 
and  second  bicuspids  of  the  affected  side,  being  carious,  were  also 
extracted.  Injections  of  sulphate  of  zinc  and  rose-water,  diluted  tinc- 
ture of  myrrh,  diluted  port  wine,  and  a  decoction  of  nutgalls,  w'ere 
alternately  employed  for  three  months ;  at  the  expiration  of  this  time, 
the  nasal  opening,  which  had  been  previously  closed,  was  re-established, 
and  a  perfect  cure  effected. 

The  condition  of  the  teeth,  in  the  case  just  narrated,  may  not  be 
thought  to  have  exerted  any  agency  in  the  production  of  the  affection 
of  the  antrum,  but  the  following  considerations  would  seem  to  justify 
a  different  conclusion.  The  presence  of  decayed  teeth  beneath  the 
sinus  may  not  only  have  contributed  to  aggravate  the  morbid  action 
lighted  up  by  the  cold  which  he  had  taken,  but  may  also  have  caused 
it  to  locate  itself  in  this  cavity;  and  the  fact  that  the  inflammation  of 
the  lining  membrane  and  the  obliteration  of  the  nasal  opening  con- 
tinued until  they  were  removed,  would,  at  least,  seem  to  warrant  such 
an  inference.     That  the  injections  were  beneficial,  we  do  not  doubt, 


DISEASES    OF    THE    MAXILLARY    SINUS.  481 

but  that  the  cure  was  eftected  by  them,  no  one,  we  think,  will  dare  to 
affirm.  We  are  far  from  believing  that  the  presence  of  the  decayed 
teeth  Avas  the  sole  cause  of  the  disease  of  the  antrum ;  that  they  con- 
tributed to,  and  protracted  it,  we  cannot  hesitate  to  believe ;  still,  but  for 
the  increased  excitability,  and,  perhaps,  actual  inflammation,  induced 
in  the  mucous  membrane  by  the  exposure  of  the  patient  to  inclement 
and  sudden  transitions  of  weather,  it  is  j)robable  the  sinus  would  never 
have  become  afiected.  But,  on  the  other  hand,  we  think  it  not  un- 
likely that,  although  the  disturbance  may  have  originated  from  this 
cause,  no  very  serious  or  lasting  morbid  efiect  would  have  been  pro- 
duced if  the  teeth  and  alveoli  had  been  in  a  perfectly  healthy  con- 
dition. 

The  particulars. of  the  following  highly  interesting  case  were  com- 
municated to  the  author  by  Dr.  L.  Roper,  of  Philadelphia,  in  a  con- 
versation which  he  had  with  him  in  1845. 

Case  8.  Miss  M ,  a  young  lady  from  the  West  Indies,  about 

fourteen  years  of  age,  had  a  fistulous  opening  beneath  the  right  orbit, 
communicating  with  the  maxillary  sinus.  By  means  of  a  probe  intro- 
duced through  the  opening  into  this  cavity,  the  apices  of  the  roots  of 
the  first  superior  molar  could  be  distinctly  felt. 

Medical  aid  was  sought  at  an  early  stage  of  the  disease,  but  as  no 
permanent  benefit  resulted  from  the  treatment  adopted,  the  young  lady, 
at  the  expiration  of  nine  months,  was  brought  by  her  father  to  Phila- 
delphia, and,  in  the  spring  of  1831,  placed  under  the  care  of  the  late 
Dr.  Physick.  He,  suspecting  that  the  afiection  of  the  antrum  had 
resulted  from  and  was  still  kept  up  by  irritation,  produced  by  the  first 
superior  molar  of  the  affected  side,  which  was  considerably  decayed, 
directed  her  to  be  taken  to  Dr.  Roper,  who,  concurring  with  him  in 
opinion,  at  once  extracted  the  carious  tooth.  The  operation  was  fol- 
lowed by  the  immediate  discharge  of  a  large  quantity  of  thick,  muddy, 
and  greenish  matter.  The  fistula  under  the  oi'bit  soon  closed,  and, 
without  any  further  treatment,  a  perfect  cure  was  accomplished  in  the 
course  of  a  few  weeks. 

The  foregoing  are  all  the  particulars  which  we  could  obtain  concern- 
ing this  interesting  case.  We  have  no  doubt  that,  if  all  the  circum- 
stances connected  with  its  early  history  were  known,  it  would  be  found 
to  have  resulted  from  inflammation  of  the  lining  membrane  of  the 
antrum,  caused  by  irritation  in  the  socket  of  the  tooth  which  was  ex- 
tracted. This  opinion  is  sustained  by  the  facts  that  this  tooth  was 
affected  with  caries,  and  that  its  removal  was  followed  by  the  immedi- 
ate cure  of  the  disease. 

In  Bordenave's  collection  of  cases  of  disease  of  the  maxillary  sinus, 
published  in  the  Memoirs  of  the  Royal  Academy  of  Surgery,  there  are 
31 


482  DISEASES    OF    THE    MAXILLARY    SINUS. 

several  examples  similar  to  the  one  just  narrated.     We  subjoin  a  des- 
cription of  the  two  following : 

Case  9.  A  servant  of  the  Count  dc  Maurepas  had  been  afflicted  for 
six  mouths  with  a  fistula  upon  the  left  cheek,  a  little  below  the  orbit, 
penetrating  to  the  maxillary  sinus,  and  caused  by  the  spontaneous 
opening  of  an  abscess.  The  first  and  second  molars,  both  of  which  were 
considerably  decayed,  were  extracted  by  M.  Hevin.  As  there  were  no 
openings  through  the  alveoli,  he  perforated  one  with  a  trocar ;  this 
opening  gave  vent  to  a  great  quantity  of  putrid  sanies,  and  did  not 
close  for  more  than  a  year  after  it  was  made.  The  fistula  of  the  cheek 
healed  in  about  ten  days. 

Case  10.  In  1717,  a  soldier  of  the  regiment  of  Bassigny,  who  had 
for  a  long  time  a  fistula  in  his  cheek  penetrating  into  the  maxillary 
sinus,  was  treated  for  it  at  the  Hotel  Dieu,  of  Montpellier.  The  matter  - 
settling  near  the  orifice  of  the  fistula  prevented  it  from  closing.  M. 
Laraourier,  on  examining  the  mouth  of  the  soldier,  perceived  that  the 
second  superior  molar  was  decayed  ;  this  he  extracted,  and  profited  by 
the  alveolar  cavity  to  make  an  opening  into  the  base  of  the  sinus.  The 
fistula  of  the  cheek  was  by  this  means  cured  in  a  few  days,  but  the  coun- 
ter opening  was  not  immediately  permitted  to  close. 

In  cases  of  fistula  resulting  simply  from  engorgement  of  the  sinus, 
the  treatment  should  consist,  as  in  the  foregoing  cases,  in  the  formation 
of  a  counter  openinp-,  which  should  always  be  effected  at  the  most  de- 
pendent part  of  the  cavity ;  and  next  in  the  removal  of  all  sources  of 
local  irritation  ;  lastly,  in  the  employment  of  suitable  injections. 

In  the  cases  thus  far  presented,  we  have  selected  such  as  were  not 
complicated  with  abscess,  ulceration  of  the  lining  membrane,  or  caries 
of  the  surrounding  osseous  walls  ;  but  to  the  existence  of  the  two  last, 
the  aiiections  of  which  we  have  been  treating,  often  give  rise.  For 
tumors,  etc.,  of  the  antrum,  the  reader  is  referred  to  tumors  of  the 
gums. 


PART    FOURTH, 


MECHANICS. 


483 


MECHANICS. 


THIS  branch  of  dental  science  teaches  the  art  of  replacing  lost 
organs  of  the  Mouth,  or  any  lost  parts  thereof.  It  is  sometimes 
called  dental  Prosthesis  (replacement).  Mechanical  detail  is  its  pre- 
vailing feature;  substitution,  or  replacement,  is  its  distinctive  pecu- 
liarity. 

Mechanical  detail  also  distinguishes  the  Surgery  of  dentistry  as 
compared  with  general  surgery ;  but  as  a  branch  of  dentistry,  thera- 
peusis,  or  the  arrest  of  disease,  is  its  distinctive  peculiarity. 

The  one  treats  disease,  or  irregularity  of  the  natural  organs ;  the 
other  substitutes  their  loss  by  artificial  ones.  Both  demand  a  skilful 
training  of  the  hands,  and  equally  require,  for  their  fullest  develop- 
ment, all  the  knowledge  comprehended  under  the  term  Dental  Science. 

Dental  Mechanics  includes  the  laws  and  principles  which  determine 
and  regulate  the  processes  employed  in  the  construction  of  all  forms 
of  dental  mechanism ;  also,  the  properties  and  relations  of  all  materials 
used  in  these  processes.     It  gives  rules  for  the  replacement  of 

1.  Lost  teeth. 

2.  Lost  alveoli,  or  parts  thereof. 

3.  Lost  palate,  hard  and  soft,  or  parts  thereof. 

The  first  division  is  the  most  important  because  the  most  universally 
.demanded. 

Prof  Austen  gives  the  following  order  of  operations  in  the  Re- 
placement OF  Lost  Teeth,  and  classification  of  the  various  styles 
of  work. 

1.  Preparation  of  the  mouth  ;  including 

(a)  Treatment  of  the  mucous  membrane. 

(b)  Extraction,  or  treatment  of  teeth  and  roots. 

2.  Impression  of  the  mouth;  including 

(a)  Form  and  material  of  impression  cups. 
(6)  Description  of  impression  materials, 
(e)  Selection  and  manipulation  of  the  same, 
(d)  Preparation  for  the  model. 

485 


486  MECHANICS. 

3.  The  plaster  model ;  including 

(a)  General  directions  for  making  model. 

(b)  Special  forms  adapted  to  subsequent  uses. 

(c)  Removal  from  impression. 

(fZ)  Preparation  for  the  operation  of  making  the  plate. 

4.  The  base-plate ;  which  is  either 

(a)  Permanent,  in  swaged  work,  or 

(b)  Temporary,  in  plastic  work. 

The  subsequent  operations  differ  in  their  order   and  character  so 
widely  as  to  require  a  separate  classification  in 
(A)  Swaged  work: 

(1)  Metallic  die  and  counter-die,  made  by 

(a)  Sand  moulding ; 

(b)  Dipping,  or  pouring ; 

(c)  Fusible  metal  process,  or  by 

(d)  Pouring  directly  into  the  impression. 

(2)  Refining  and  rolling  plate. 

(3)  Swaging  plate  (gold,  silver,  platinum,  or  aluminum). 

(4)  Articulating  impressions. 

(5)  Adjustment  on  articulator. 

(6)  Selection  and  fitting  of  teeth,  and 

(7)  Attaching  them  to  base-plate,  by 

(a)  Soldering ; 

(b)  Vulcanite; 

(c)  Porcelain  continuous  gum. 

(8)  Finishing  process. 
(B)  Plastic  work : 

(1)  Temporary  plate  of 

(a)  Wax,  or  gutta-percha  ; 

(b)  Thick  tin,  or  lead,  foil. 

(2)  Articulating  impressions. 

(3)  Adjustment  on  articulator. 

(4)  Selection  and  fitting  of  teeth.  ' 

(5)  Preparation  of  the  matrix. 

(6)  Moulding  and  hardening  of  the  base-plate,  made  of 

(a)  Vulcanite  compounds  which  harden  by  heat; 

(b)  Molten  tin  alloys  which  harden  on  cooling ; 

(c)  Molten  aluminum ; 

(7)  "Which  process  at  the  same  time  attaches  the  teeth. 

(8)  Finishing  process. 

The  details  of  Swaged  work  vary  according  to  the  mode  of  making 
dies,  the  metal  chosen  for  the  plate,  and  the  manner  of  attaching 
the  teeth;  but  the  order  of  operations  is  the  same.     The  details  of 


MECHANICS.  487 

Plastic  work  vary  also  according  to  the  material  composing  the  plate; 
but  the  order  of  operations  is  the  same  —  differing  from  the  former 
mainly  because  articulation  follows  the  formation  of  the  base-plate  in 
one  case,  while  in  the  other  it  precedes  it. 

These  differences  in  the  material  of  the  base-plate  give  rise  to  a 
classification  of  Swaged  work  into 

1.  Gold  plate ; 

2.  Aluminum  plate; 

3.  Platinum  plate. 

The  first  (and  third)  allows  attachment  of  the  teeth  by  soldering ; 
the  second  demands  a  vulcanite  attachment ;  the  third  alone  permits, 
by  virtue  of  its  resistance  to  furnace  heat,  the  addition  of  a  continuous 
porcelain  giim. 

Plastic  work  is  divided  into 

1.  Vulcano-plastic ; 

2.  Metallo-plastic ; 

3.  Ceramo-plastic. 

The  first  is  known  as  rubber  work  ;  the  second  includes  cheoplastic 
work,  the  old-fashioned  block  tin-base,  all  tin  alloys  and  cast  aluminum ; 
the.third  is  known  as  the  porcelain  base. 

In  Prosthetic  dentistry,  swaged  work  is  the  patrician  element ;  plastic 
work,  the  plebeian.  When  the  latter  runs  riot,  without  the  conservative 
influence  of  the  former,  the  power  of  the  people  becomes  a  power  for 
evil.  This  is  precisely  the  danger  which  now  threatens  dentistry,  in 
the  abuse  of  certain  most  valuable  processes  and  materials. 

Facility  of  construction  and  cheapness  of  material  have  encouraged 
a  style  of  practice  in  the  highest  degree  detrimental  to  the  profession. 
If  such  practice  is  inseparable  from  plastic  work,  it  should  be  unhesi- 
tatingly abandoned  by  every  one  who  holds  the  honor  of  dentistry 
dear  to  him.  It  becomes  also  a  grave  question  how  far  the  present 
mania  for  patents  (another  abuse  of  a  valuable  privilege)  is  beneficial 
to  the  reputation  of  a  liberal  profession. 


488  DENTAL    PROSTHESIS. 

CHAPTER  I. 

DENTAL  PEOSTHESIS. 

CONTRIBUTING,  as  the  teeth  do,  to  the  beauty  and  expression  of 
the  countenance,  to  correct  enunciation,  and,  through  improved 
facility  of  mastication,  to  the  health  of  the  whole  organism,  it  is  not 
surprising  that  their  loss  should  be  considered  a  serious  affliction,  and 
that  art  should  be  called  u})on  to  replace  such  loss  with  artificial  sub- 
stitutes. So  great,  indeed,  is  the  liability  of  the  human  teeth  to  decay, 
and  so  much  neglected  are  the  means  of  their  preservation,  that  few 
persons,  at  the  present  day,  reach  even  adult  age  without  losing  one  or 
more  of  these  invaluable  organs.  Happily  lor  suffering  humanity, 
they  can  now  be  replaced  with  artificial  substitutes  so  closely  resembling 
the  natural  organs  as  to  be  readily  mistaken  for  them,  even  by  critical 
and  practised  observers.  Although  there  is  a  perfection  in  the  work 
of  nature  that  can  never  be  equalled  by  art,  artificial  teeth  are  now  so 
constructed  as  to  subserve,  at  least  to  a  great  extent,  the  purposes  of 
the  natural  organs.  When  properly  adjusted,  they  are  worn  Avithout 
the  slightest  discomfort ;  so  much  so,  in  many  cases,  that  the  patient, 
after  they  have  been  in  the  mouth  a  few  weeks,  is  scarcely  conscious  of 
their  presence. 

The  construction  of  artificial  teeth  is  an  operation  which,  though 
acknowledged  to  be  of  great  importance,  and  performed  by  every  one 
having  any  pretension  to  a  knowledge  of  dentistry,  is,  unfortunately, 
but  little  understood  by  the  majority  of  practitioners.  The  mouth  is 
often  irreparably  injured  by  their  improper  application.  A  single  arti- 
ficial tooth,  badly  inserted,  may  cause  the  destruction  of  the  two  adja- 
cent natural  teeth,  or  those  to  which  the  artificial  appliance  is  secured  ; 
and  if  the  deficiency  thus  occasioned  be  unskilfully  supplied,  it  may 
cause  the  loss  of  others;  in  this  way  all  the  teeth  of  the  upper  jaw^  are 
sometimes  destroyed. 

The  utility  of  artificial  teeth  depends  upon  their  proper  construction 
and  correct  application.  There  is  no  branch  of  dental  practice  that 
requires  more  skill  and  judgment,  or  more  extensive  and  varied  scien- 
tific information.  A  knowledge  of  the  anatomy  and  physiology  of  the 
mouth,  of  its  vai-ious  pathological  conditions,  and  their  therapeutical 
indications,  is  as  essential  to  the  mechanical  as  to  the  surgical  dentist. 
To  correct  information  upon  these  subjects  must  be  added  the  ability 
to  execute,  with  the  nicest  skill  and  most  perfect  accuracy,  all  the 
mechanism  required  in  dental  prosthesis. 


DENTAL    PEOSTHESIS.  489 

There  are  difficulties  connected  with  the  insertion  of  artificial  teeth 
of  which  none  but  an  experienced  dentist  has  any  idea.  They  must  be 
constructed  and  applied  in  such  a  manner  that  they  may  be  easily  re- 
moved and  replaced  by  the  patient ;  at  the  same  time  they  must  be 
securely  fixed  in  the  mouth,  and  be  productive  of  no  injury  to  the  parts 
with  which  they  are  in  relation. 

But  perfect  mechanism  is  not  the  sole  element  of  success  :  often  it  is 
not  the  most  essential  one.  To  know  when  to  extract  and  when  to  re- 
tain a  root  or  a  tooth  ;  when  to  secure  a  piece  by  clasps  and  when  by 
simple  adaptation ;  when  to  use  gold  and  when  some  other  material; 
to  determine  the  best  form  of  a  plate  and  the  proper  time  for  its 
insertion ;  finally,  to  determine  when  and  what  prosthetic  skill  can  do, 
when  and  why  it  will  fail  —  are  a  few  of  the  problems  in  dental  me- 
chanics which  demand  for  their  correct  solution  a  fulness  and  extent 
of  information  which  are  not  always  brought  to  bear ;  perhaps  because, 
unfortunately,  the  necessity  is  not  recognized  as  it  should  be. 

Notwithstanding  the  triumphs  of  prosthetic  dentistry,  and  the  high 
state  of  excellence  to  which  it  has  arrived,  at  no  previous  time  was 
there  ever  so  much  injury  inflicted,  and  suffering  occasioned  by  arti- 
ficial teeth,  as  at  present, — resulting  solely  from  their  bad  construc- 
tion and  incorrect  application.  That  such  should  be  the  case,  when 
thei'e  are  so  many  scientific  and  skilful  dentists  in  every  city  and  in 
many  of  the  villages  of  the  country,  may  seem  strange,  but  the  fact  is 
nevertheless  undeniable.  We  may  explain  it  in  part  by  the  very  rapidly 
increasing  demand  for  dental  services,  which  has  not  allowed  time  for 
the  development  of  intelligent  and  skilled  labor  either  of  head  or  hand  ; 
in  part  also  by  the  universal  experience  that  all  new  professions  are 
full  of  immature  and  crude  material.  Bat  these  explanations  cannot 
]ong  be  received  in  excuse  for  a  state  of  things  which  ought  to  be  rapidly 
disappearing ;  which  is  in  fact  giving  way  under  the  combined  influ- 
ence of  our  colleges,  our  periodicals  and  text-books,  the  teachings  and 
example  of  our  eminent  practitioners,  and  the  more  appreciative  judg- 
ment of  the  public. 

These  remarks  apply  alike  to  the  surgery  and  mechanism  of  dentis- 
try. The  latter  has  an  additional  barrier  to  progress  in  the  common 
practice  of  delegating  the  greater  part  of  its  details  to  inexperienced, 
uninformed  and  irresponsible  assistants.  Perfect  dentistry  demands 
equal  skill  and  education  in  both  departments.  Each  requires  that 
its  complete  series  of  operations  shall  be  the  work  of  one  person.  If 
therefore  the  work  of  the  two  are  so  far  incompatible  that  they  cannot 
be  combined,  the  separation  should  be  complete.  The  semi-mechanism 
of  the  surgeon  is  like  the  semi-surgery  of  the  mechanician.     Each 


490  DENTAL    PROSTHESIS. 

injures  an  otherwise  perfect  rei^utatian ;  both  do  harm  to  the  profession 
they  seek  to  honor. 

The  information  obtainable  from  works  on  mechanical  dentistry  was 
until  recently  exceedingly  limited;  and  it  fs  surprising,  that  from  the 
number  who  have  written  on  the  diseases  and  loss  of  the  teeth,  this 
sul)ject  should  have  received  so  little  attention.  Fauchard,  Bourdet, 
Angermann,  Maury,  Delabarre,  Koecker,  Lefoulon,  Brown,  and  a  few 
others,  are  all  who,  until  within  a  few  years  past,  have  given  it  any- 
thing more  than  a  passing  notice ;  and  the  works  of  these  writers  con- 
tain few  explicit  directions  upon  the  subject.  Delabarre's  Mechanical 
Dentistry  was,  at  the  time  of  its  publication,  a  work  of  much  merit. 
The  various  methods  adopted  at  that  period  for  the  construction  and 
application  of  artificial  teeth  are  accurately  and  minutely  described, 
together  with  the  advantages  and  disadvantages  of  each.  But,  how- 
ever perfect  the  work  may  then  have  been,  it  does  not  furnish  the  in- 
formation required  upon  the  subject  at  the  present  day.  Still  more 
deficient  in  correct  information  are  nearly  all  other  French  works. 

Among  the  English  writers,  Koecker  is  almost  the  only  one,  except 
Robinson,  a  more  recent  author,  who  has  described  correctly  the  prin- 
ciples upon  which  artificial  teeth  should  be  applied.  His  "Essay  on 
Artificial  Teeth,  Obturators  and  Palates,"  contains  much  useful  and 
valuable  information.  It  does  not,  however,  contain  a  description  of 
the  manner  of  constructing  a  dental  substitute,  preparatory  to  its  appli- 
cation; yet,  to  one  ca^Dable  of  executing  the  various  manipulations  re- 
quired in  this  department  of  practice,  it  is  very  serviceable.  Dv. 
Koecker,  perhaps,  thought  that,  as  this  ability  can  only  be  acquired  by 
a  regular  apprenticeship,  a  moi'e  minute  description  was  unnecessary. 
There  are  many  practitioners,  however,  who,  although  in  other  respects 
competent,  have  not,  in  the  mechanical  department,  enjoyed  this  advan- 
tage, and,  consequently,  it  is  to  be  regretted  that  he  has  not  entered 
more  into  detail  upon  the  subject.  Most  of  the  deficiencies  that  exist 
in  the  last-named  work  wei-e  supplied,  up  to  1844,  by  Dr.  Solyman 
Brown,  in  his  series  of  papers  on  Mechanical  Dentistry,  published  in 
the  American  Journal  of  Dental  Science.  These  papers  were  illustra- 
ted with  numerous  cuts,  and  constituted,  up  to  the  time  of  their  publi- 
cation, the  best  treatise  upon  the  subject.  But  numerous  and  important 
impi-ovements  have  subsequently  been  made  in  this  department  of 
practice,  all  of  which  we  propose  to  give  a  brief  description  of  in  their 
proper  place. 

The  only  treatises  upon  Mechanical  Dentistry,  published  in  book 
form,  in  this  country,  since  the  papers  of  Dr.  Brown,  have  been  this 
division  of  our  own  work  and  the  treatise  of  Prof.  Joseph  Richardson. 
In  the  dental  periodicals  of  the  past  eighteen  years  will  be  found  many 


SUBSTANCES    EMPLOYED    AS    SUBSTITUTES.        491 

carefully  prepared  papers  from  the  pen  of  Prof.  Austen,  and  others, 
which  present  a  great  amount  of  information,  very  valuable  to  the 
practitioner.  They  give  also  an  insti'uctive  view  of  the  rapid  progress 
made  in  the  dental  art,  and  teach  the  necessity  of  being  constantly 
alive  to  the  improvements,  real  or  fancied,  which  are  almost  daily  pro- 
posed. 

We  shall  enumerate  some  of  the  different  kinds  of  dental  substitutes 
that  have  been  employed  since  the  commencement  of  the  present  cen- 
tury. We  shall  also  notice,  briefly,  the  principal  methods  that  have 
been  adopted  in  their  application,  before  entering  upon  a  minute 
description  of  those  practised  at  the  present  time.  Great  improvements 
have  been  made  in  dental  prosthesis  since  the  publication  of  the  first 
edition  of  this  work.  In  fact  no  science  or  art,  except  Chemistry,  has 
been  so  eminently  progressive  during  the  last  twenty  years  as  Mechan- 
ical Dentistry. 


CHAPTER  II. 

SUBSTANCES  EMPLOYED    AS   DENTAL  SUBSTITUTES. 

THERE  are  two  qualities  which  it  is  highly  important  that  dental 
substitutes  should  possess.  They  should  be  durable  in  their  nature; 
and  in  their  appearance  should  resemble  the  natural  organs  which  they 
replace  or  with  which  they  are  associated. 

The  kinds  of  teeth  that  have  been  employed,  since  1820,  are : 

1.  Human  teeth. 

2.  Teeth  of  neat  cattle,  sheep,  etc. 

3.  Teeth  carved  from  the  ivory  of  the  elephant's  tusk,  and  from  the; 
tooth  of  the  hippopotamus. 

4.  Porcelain  teeth. 

HUMAN    TEETH. 

As  regards  appearance,  which  in  a  dental  substitute  is  an  important 
consideration,  human  teeth  are  preferable  to  any  other,  except,  perhaps, 
the  almost  perfect  recent  productions  of  the  dento-ceramic  art.  When 
used  for  this  purpose,  they  should  be  of  the  same  class  as  those  the 
loss  of  which  they  are  to  replace.  The  crowns  only  are  employed,  and 
if  well  selected  and  skilfully  adjusted,  the  artificial  connection  with 
the  alveolar  ridge  cannot  easily  be  detected. 

The  durability  of  these  teeth  when  thus  employed  depends  upon  the 
density  of  their  texture,  the  soundness  of  their  enamel,  and  the  condi- 
tion of  the  mouth  in  which  they  are  placed..    If  they  are  of  a  dense 


492       SUBSTANCES    EMPLOYED    AS    SUBSTITUTES. 

texture,  with  sound  ami  perfect  enamel,  and  are  placed  in  a  healthy 
mouth,  they  will  last  from  eight  to  twelve  years,  or  even  longer.  The 
difficulty,  however,  of  procuring  these  teeth  is  generally  so  great  that 
it  is  sehK)ni  that  such  as  we  have  described  can  be  obtained  ;  and  even 
when  tliey  can,  the  mouth,  in  half  the  cases  in  which  artificial  teeth 
are  placed,  is  not  in  a  healthy  condition  ;  its  secretions  are  often  so 
vitiated  and  of  so  corrosive  a  nature,  that  they  destroy  them  in  less 
than  four  years.  We  have  even  known  them  to  be  destroyed  in  two, 
and  in  one  case  in  fifteen  mouths. 

A  human  tooth,  artificially  applied,  is  more  liable  to  decay  than  one 
of  equal  density  having  a  vital  connection  with  the  general  system,  for 
the  reason  that  its  dentinal  structure  is  more  exposed  to  the  actimi  of 
deleterious  chemical  agents.  Yet  of  all  the  animal  substances  em- 
ployed for  this  purpose,  human  teeth  are  unquestionably  the  best. 
They  are  harder  than  bone,  and  being  more  perfectly  protected  by 
enamel,  are  consequently  more  capable  of  resisting  the  action  of  cor- 
rosive agents. 

Many  object  to  having  human  teeth  placed  in  the  mouth,  under 
the  belief  that  infectious  diseases  may  be  communicated  by  them.  But 
the  purifying  process,  to  which  they  are  previously  submitted,  greatly 
diminishes  this  danger.  When  the  practice  of  transplanting  teeth 
was  in  vogue,  occurrences  of  this  sort  were  not  unfrequent ;  but  since 
that  has  been  discontinued,  these  have  seldom  if  ever  happened.  Still, 
the  prejudice  against  human  teeth  is  so  strong  that  it  is  impossible,  in 
most  cases,  to  overcome  them.  This  feeling,  the  difficulty  of  procuring 
them,  the  high  price  they  command,  and  their  want  of  durability, 
have  gradually  led  to  their  entire  disuse,  w'hich  is  scarcely  to  be  re- 
gretted, now  that  art  can  produce  in  porcelain  such  accurate  imitations 
of  nature.  The  only  case  in  which  we  might  feel  called  upon  to  insert 
natural  teeth  is  where  any  of  the  twelve  front  teeth  become  loosened 
by  periosteal  disease,  and  drop  from  their  sockets  while  yet  perfectly 
free  from  caries.  These  teeth  may  often  be  adjusted  to  a  plate  so  as  to 
present  an  exceedingly  natural  appearance. 

TEETH   OF    CATTLE. 

Of  the  various  kinds  of  natural  teeth'  employed  for  dental  substi- 
tutes those  of  neat  cattle  are,  perhaps,  after  human  teeth,  the  best.  By 
slightly  altering  their  shape  they  may  be  made  to  resemble  the  incisors 
of  some  persons ;  but  a  configuration  similar  to  the  cuspids  cannot  be 
given  to  them,  and  in  most  cases  they  are  too  >vhite  and  glossy.  The  con- 
trast, therefore,  which  they  form  with  the  natural  organs  should  consti- 
tute, were  they  in  all  other  respects  suitable,  a  very  serious  objection 
to  their  use.     Imitation  of  nature  has  been  too  much  disregarded,  both 


SUBSTANCES    EMPLOYED    AS    SUBSTITUTES.        493 

by  dentists  and  patients.  Indeed,  many  of  those  who  need  artificial 
teeth  wish  to  have  them  as  white  and  brilliant  as  possible,  and  some 
practitioners  lack  either  the  decision  or  the  judgment  to  refuse  com- 
pliance with  a  practice  which  destroys  all  that  beauty  and  fitness 
which  it  is  the  aim  of  dental  aesthetics  to  cultivate. 

There  are  other  objections  to  the  use  of  these  teeth.  In  the  first 
place,  they  ai-e  only  covered  anteriorly  with  enamel;  in  the  second, 
their  dentinal  structure  is  less  dense  than  that  of  human  teeth,  and. 
consequently,  they  are  more  easily  acted  on  by  chemical  agents.  They 
are,  therefore,  less  durable,  seldom  lasting  more  than  from  two  to  four 
years.  Another  objection  to  their  use  is,  they  can  be  employed  in  only 
the  very  few  cases  where  short  teeth  are  required,  owing  to  the  larg^ 
size  of  their  nerve  cavities.  It  is  seldom,  therefore,  that  they  can  bo 
advantageously  used  as  substitutes  for  human  teeth. 

IVORY   OF   THE   ELEPHANT   AND   HIPPOPOTAMUS. 

Artificial  teeth  made  from  the  ivory  of  the  tusk,  both  of  the  elephant 
and  hippopotamus,  have  been  sanctioned  by  usage  from  the  earliest 
periods  of  the  existence  of  this  branch  of  the  art.  We  must  not  hence 
conclude  that  it  has  been  approved  by  experience ;  on  the  contrary, 
of  all  the  substances  that  have  been  used  for  this  purpose  this  is  cer- 
tainly the  most  objectionable. 

The  ivory  of  the  elephant's  tusk  is  decidedly  more  permeable  than 
that  obtained  from  the  hippopotamus.  So  readily  does  it  absorb  the 
buccal  fluids  that,  in  three  or  four  hours  after  being  placed  in  the 
mouth,  it  becomes  completely  saturated  with  them.  Consequently,  it 
is  not  only  liable  to  chemical  changes,  but  the  absorbed  secretions 
undergo  decomposition ;  and  when  several  such  teeth  are  worn,  they 
affect  the  breath  to  such  a  degree  as  to  render  it  exceedingly  offensive. 
Again,  on  account  of  its  softness,  teeth  are  easily  shaped  from  it ;  but 
not  being  covered  with  enamel,  they  soon  become  dark,  and  give  to 
the  mouth  a  repulsive  appearance.  Fortunately,  however,  in  the 
United  States,  elephant's  ivory  is  rarely  used,  either  as  a  base-plate  or 
for  the  teeth  themselves. 

The  ivory  of  the  tusk  of  the  hippopotamus  is  much  firmer  in  its 
texture  than  that  obtained  from  the  elephant ;  being  covered  with  a 
hard,  thick  enamel,  teeth  may  be  cut  from  it,  which,  at  first,  very 
closely  resemble  the  natural  organs.  There  is,  however,  a  peculiar 
animation  about  human  teeth,  which  those  made  from  this  substance 
do  not  possess  :  moreover,  they  soon  change  their  color,  assuming  first 
a  yellow  and  then  a  dingy  bluish  hue.  They  are,  also,  like  elephant 
iTory,  very  liable  to  decay.  "We  have  in  our  possession  a  number  of 
blocks  of  this  sort,  some  of  which  are  nearly  half  destroyed.     The 


494       SUBSTANCES    EMPLOYED    AS    SUBSTITUTES. 

same  objection  lies  against  teeth  made  from  the  hippopotamus  ivory 
sufficient  to  conderau  its  use.  Like  those  formed  from  elephant  ivory, 
they  give  to  the  breath  an  offensive  odor,  which  no  amount  of  care  or 
cleanliness  can  wholly  correct  or  prevent. 

PORCELAIN,   OR   INCORRUPTIBLE  TEETH. 

The  manufiicture  of  porcelain  teeth  did  riot  for  a  long  time  promise 
to  be  of  much  advantage  to  dentistry.  But  through  the  ingenuity  and 
indefatigable  exertions  of  a  few,  they  have  within  the  last  thirty  years 
been  brought  to  such  perfection  as  to  supersede  all  other  kinds  of  arti- 
ficial teeth. 

The  French,  with  whom  the  invention  of  these  teeth  originated, 
encouraged  their  manufacture  by  favorable  notices;  and  the  rewards 
offered  by  some  of  the  learned  and  scientific  societies  of  Paris  con- 
tributed much  to  bring  it  to  perfection.  They  were  still,  however, 
deficient  in  so  many  particulars  that  they  received  the  approbation  of 
very  few  of  the  profession,  and  then  only  in  some  special  cases.  It  is 
principally  to  American  dentists  that  we  are  indebted  for  that  which 
the  French  so  long  labored  in  vain  to  accomplish. 

A  want  of  resemblance  to  the  natural  organs,  in  color,  translucency, 
and  animation,  was  the  great  objection  urged  against  porcelain  teeth  ; 
and,  had  not  this  been  obviated,  it  would  have  constituted  an  insuper- 
able objection  to  their  use.  Until  1833,  all  that  were  manufactured 
had  a  dead,  opaque  appearance,  which  rendered  them  easy  of  detection, 
when  placed  beside  the  natural  teeth*  and  gave  to  the  mouth  an  unna- 
tural aspect.  But  so  great  have  been  the  improvements  in  their 
manufacture,  that  few  can  now  distinguish  between  the  natural  teeth 
and  their  artificial  companions,  if  well  selected  and  skilfully  applied. 

The  advantages  which  mineral  teeth  possess  over  every  sort  of  animal 
substance  are  numerous.  They  can  be  more  readily  secured  to  the 
plate,  and  are  worn  with  greater  convenience.  They  do  not  absorb 
the  secretions,  and,  consequently,  when  proper  attention  is  paid  to 
their  cleanliness,  they  do  not  contaminate  the  breath,  or  become  in  any 
way  offensive.  Their  color  never  changes.  They  are  not  acted  on  by 
the  chemical  agents  found  in  the  mouth,  and  hence  the  name  incor- 
mptihle,  which  has  been  given  them. 

The  objections  that  have  been  urged  to  the  use  of  porcelain  teeth  — 
such  as  want  of  congeniality  between  them  and  the  mouth,  their  better 
conducting  power,  and  their  consequent  greater  liability  to  the  action 
of  heat  and  cold — have  so  little  foundation,  that,  when  compared 
with  the  advantages  they  confessedly  possess,  they  must  be  regarded  as 
unworthy  of  consideration.  The  vast  extension  of  mechanical  practice 
is  due,  more  than  to  any  other  one  cause,  to  these  improvements  in  the 


EETENTION    OF    ARTIFICIAL    TEETH.  495 

manufacture  of  porcelain  teeth,  —  improvements  essentially  American, 
and  so  important  as  fairly  to  justify  a  little  of  that  boasting  spirit 
which,  transplanted  from  the  mother  country,  has  attained  such  luxu- 
riant growth  in  American  soil. 

The  beautifully  exact  imitation  of  the  varying  shades  of  the  natural 
gum,  Avhich  as  yet  has  been  found  possible  only  in  porcelain,  would  of 
itself  give  to  this  material  a  claim  over  every  other.  All  attempts  to 
color  ivory  have  failed  to  produce  any  permanent  results.  More  recent 
experiments  in  the  several  vulcanizable  materials  have  thus  far  given 
opaque  and  lifeless  colors,  which  no  stretch  of  the  imagination  can 
compare  with  the  natural  gum.  When  a  material  shall  have  been 
discovered  possessing  the  valuable  properties  of  the  vulcanite  com- 
bined with  the  beauty  of  a  porcelain  artificial  gum,  dental  prosthesis 
will  have  nearly  reached  perfection. 


CHAPTER  III. 

RETENTIOX    OF    ARTIFICIAL    TEETH. 

THE  methods  of  retaining  artificial  teeth  in  place  are — first,  by 
pivoting  to  the  natural  roots  ;  second,  by  attaching  to  metallic  or 
other  kind  of  base-plate,  secured  either  by,  1,  clasps;  2,  spiral  springs; 
or,  3,  atmospheric  pressure.  The  peculiar  advantages  of  each  of  these 
methods  we  shall  now  proceed  to  point  out,  and  the  cases  to  which 
they  are  particularly  applicable. 

ARTIFICIAL   TEETH   PLACED   ON   NATURAL   ROOTS. 

This  method  of  securing  artificial  teeth  was,  until  recently,  on  ac- 
count of  its  simplicity,  more  extensively  practised  than  any  other;  and, 
under  favorable  circumstances,  is  unquestionably  one  of  the  best  that 
can  be  adopted.  If  the  roots  on  which  they  are  placed  be  sound  and 
healthy,  and  the  back  part  of  the  jaws  supplied  with  natural  teeth, 
so  as  to  prevent  those  with  which  the  artificial  antagonize  from  strik- 
ing them  too  directly,  they  will  subserve  the  purposes  of  the  natural 
organs  more  perfectly  than  any  other  description  of  dental  substitute, 
and  can  be  made  to  present  an  appearance  so  natural  as  to  escape 
detection  upon  the  closest  scrutiny.  If  properly  fitted  and  secured, 
not  only  is  their  connection  with  the  natural  roots  not  easily  detected, 
but  they  may  render  valuable  service  for  many  years.  The  incisors 
and  cuspids  of.  the  upper  jaw  are  the  only  teeth  which  it  is  proper  to 
replace  in  this  way. 


496  RETEXTION    OF    ARTIFICIAL    TEETH. 

The  lower  incisors,  from  their  small  size  and  the  dangerous  sequelae 
of  abscess,  should  never  be  pivoted.  Many  upper  laterals  are  also  too 
small  to  admit  a  pivot.  In  practice,  the  pivoting  of  cuspids  is  seldom 
called  for.  These  teeth  being  very  persistent,  their  loss  usually  im- 
plies that  of  many,  perhaps  all,  others,  and  the  entire  deficiency  is 
replaced  by  teeth  attached  to  a  base-plate. 

The  insertion  of  an  artificial  tooth  on  a  diseased  root,  or  on  a  root 
having  a  diseased  socket,  is  almost  always  followed  by  injurious  con- 
sequences. Filling  the  root,  together  with  proper  accompanying  treat- 
ment, will  sometimes  so  completely  arrest  disease  as  to  make  pivoting 
safe ;  but  there  is  always  risk  in  these  cases.  The  morbid  action  already 
existing  in  the  root,  or  its  socket,  is  aggravated  by  the  operation,  and 
often  caused  to  extend  to  the  contiguous  parts,  and  occasionally  even 
to  the  whole  mouth.  Even  in  a  healthy  root,  it  is  not  always  proper 
to  apply  a  tooth  immediately  after  having  prepared  the  root.  If  any 
irritation  is  produced  by  this  preparatory  process,  the  tooth  should  not 
be  inserted  until  it  has  wholly  subsided.  The  neglect  of  this  pre- 
caution not  unfrequently  gives  rise  to  inflammation  of  the  alveolo- 
dental  periosteum  and  to  alveolar  abscess. 

Apart  from  the  condition  of  the  root,  the  question  of  pivoting  — 
or  of  a  plate  tooth  without  gum,  resembling  a  pivot  tooth  —  may  de- 
pend upon  the  adjoining  tooth  or  roots.  If,  in  any  space  to  be  sup- 
plied, one  root  is  absent,  all  should  be  extracted,  for  the  peculiar  beauty 
of  a  pivot  tooth  is  lost  if  its  neighbor  has  an  artificial  gum. 

Although  this  method  of  securing  artificial  teeth  has  received  the 
sanction  of  the  most  eminent  dental  practitioners,  and  is  one  of  the 
best  that  can  be  adopted  for  replacing  loss  in  the  six  upper  front 
teeth,  yet,  on  account  of  the  facility  with  which  the  operation  is 
performed,  it  is  often  resorted  to  under  the  most  unfavorable  circum- 
stances ;  in  consequence  of  which,  the  method  has  been  undeservedly 
brought  into  discredit.  Apart  from  the  proneness  of  operators  to 
resort  to  this  method  when  its  adoption  is  unjustifiable,  we  may  name 
two  objections  to  the  use  of  pivot  teeth,  as  ordinarily  prepared  and 
inserted.  First,  the  difficulty  of  preventing  the  presence  of  secretions 
between  the  crow^n  and  root,  which  make  the  breath  offensive  and 
cause  the  root  gradually  to  decay.  Secondly,  the  more  or  less  rapid 
enlargement  of  the  canal  requiring  frequent  replacement  and  the 
ultimate  loss  of  the  root. 

The  efforts  of  the  economy  for  the  expulsion  of  the  roots  of  the 
bicuspid  and  molar  teeth,  after  the  destruction  of  their  lining  mem- 
brane, are  rarely  exhibited  in  the  case  of  roots  of  teeth  occupying  the 
anterior  part  of  the  mouth.  This  circumstance  has  led  us  to  believe 
that  the  roots  of  these  teeth  receive  a  greater  amount  of  vitality  from 


EETENTIOX    OF    ARTIFICIAL,    TEETH.  497 

their  investing  membrane  than  do  the  roots  of  those  situated  farther 
back  in  the  mouth ;  and  that  the  amount  of  living  principle  thus 
applied  is  sufficient  to  prevent  them  from  becoming  manifestly  ob- 
noxious to  their  sockets. 

Another  explanation  assumes  the  equal  vitality  of  all  the  roots, 
and  attributes  the  persistence  of  front  roots,  upon  which  a  crown  has 
been  placed,  to  the  continuance  of  that  pressure  to  which  it  was  sub- 
ject so  long  as  it  had  its  natural  crown.  It  is  asserted,  in  mainten- 
ance of  this  view,  that  front  roots,  left  to  themselves,  will  disappear 
in  the  same  manner  as  bicuspid  and  molar  roots,  and  that  the  latter 
may  be  retained,  if  the  artificial  crown  (attached  to  a  plate)  is  set 
upon  them ;  also,  that  the  process  of  expulsion  is  analogous  to  that  by 
which  a  tooth  is  elongated,  which  has  lost  its  antagonist. 

It  is  well  known  that  a  dead  root  is  always  productive  of  injury  to 
the  surrounding  parts,  and  that  nature  calls  into  action  certain  agen- 
cies for  its  expulsion.  Therefore,  attaching  a  tooth  to  a  completely 
dead  root  is  manifestly  improper ;  but  the  roots  of  the  front  teeth  are 
rarely  entirely  deprived  of  vitality,  and  hence,  after  the  destruction  of 
their  lining  membrane,  they  often  remain  ten,  fifteen,  and  sometimes 
twenty  years,  without  very  obviously  afiecting  the  adjacent  parts. 

Teeth  attached  to  a  plate  and  resting  upon  natural  roots  have  all 
the  beauty  which  so  strongly  recommends  pivot  teeth.  They  are  not 
so  securely  held  in  position  ;  but  the  ability  to  remove  them  is  in  itself 
an  advantage.  This  method  is  applicable  in  many  cases  where  the 
drilling  for  a  pivot  is  impossible.  It  is  perhaps  preferable  to  a  pivot 
tooth,  in  all  cases  where  the  absence  of  other  teeth  calls  for  a  plate. 

ARTIFICIAL   TEETH   SECURED   BY    CLASPS. 

This  method  of  inserting  artificial  teeth,  first  introduced  by  the  late 
Dr.  James  Gardette,  of  Philadelphia,  is,  perhaps,  in  favorable  cases, 
one  of  the  firmest  and  most  secure  that  can  be  adopted.  By  this  means, 
the  loss  of  a  single  tooth,  or  of  several  teeth,  may  be  supplied.  A  plate 
may  be  so  fitted  to  a  space  in  the  dental  circle,  and  secured  with  clasps 
to  other  teeth,  as  to  afford  a  firm  support  to  six,  eight,  or  ten  artificial 
teeth. 

Teeth  applied  in  this  way,  when  properly  constructed,  will  last  for 
several  years,  and  sometimes  during  the  life  of  the  individual.  But  it 
is  essential  to  their  durability  that  they  should  be  correctly  arranged, 
accurately  fitted,  and  firmly  secured  to  the  plate;  that  the  plate  itself 
be  properly  adapted  to  the  gums,  and  the  clasps  attached  with  the 
utmost  accuracy  to  teeth  firmly  fixed  in  their  sockets. 

Gold  is  perhaps  the  best  material  that  can  be  employed  for  both 
plate  and  clasps.  Since  the  application  of  vulcanized  rubber  to  dental 
82 


498  RETENTION    OF    ARTIFICIAL    TEETH. 

purposes,  plates  of  this  latter  material  with  gold  clasps  attached  have 
been  much  used.  When  gold  is  employed  for  the  plate  it  should  be 
from  twenty  to  twenty-one  carats  fine,  and  from  eighteen  to  nineteen 
for  the  clasps.  If  gold  of  an  inferior  quality  is  used,  it  will  be  liable 
to  be  acted  on  by  the  secretions  of  the  mouth.  Platina  perfectly 
resists  the  action  of  these  secretions,  and  would,  perhaps,  answer 
the  purpose  as  well  as  gold,  were  it  not  for  its  softness  and  pliancy  :  in 
full  cases,  and  in  some  partial  cases,  the  shape  of  the  plate  may,  more 
or  less,  overcome  this  difficulty,  especially  when,  as  in  the  continuous 
gum  work,  stiffened  by  other  materials. 

The  plate  should  be  thick  enough  to  afford  the  necessary  support  to 
the  teeth  ;  but  not  so  thick  as  to  be  clumsy  or  inconvenient  from  its 
weight.  The  clasps  generally  require  to  be  about  one-third  or  one-half 
thicker  than  the  plate,  and  sometimes  double  the  thickness.  The  gold 
used  for  this  purpose  is  sometimes  prepared  in  the  form  of  half-round 
wire;  but,  in  the  majority  of  cases,  it  is  preferable  to  have  it  flat,  as 
such  clasps  afford  a  firmer  and  more  secure  support  to  artificial  teeth 
than  those  which  are  half-round  ;  they  also  occasion  less  inconvenience 
to  the  patient,  and  are  productive  of  less  injury  to  the  teeth  to  which 
they  are  attached. 

Artificial  teeth,  applied  in  this  way,  may  be  worn  with  great  comfort, 
and  can  be  taken  out  and  replaced  at  the  pleasure  of  the  person  wearing 
them.  It  is  important  that  they  should  be  very  frequently  cleansed, 
to  remove  the  secretions  of  the  mouth  that  get  between  the  plate  and 
gums  and  between  the  clasps  and  teeth,  which,  becoming  vitiated,  may 
irritate  the  soft  parts  and  corrode  the  teeth  and  taint  the  breath.  This 
precaution  should,  on  no  account,  be  neglected.  Great  care,  therefore, 
should  be  taken  to  fit  the  clasps  in  such  a  manner  as  will  admit  of  the 
easy  removal  and  replacement  of  the  piece,  and,  also,  that  they  may 
not  exert  any  undue  pressure  upon  the  teeth  to  which  they  are 
applied. 

If  the  clasp,  in  consequence  of  inaccurate  adjustment,  strains  the 
position  of  the  tooth  in  its  socket,  it  may  excite  inflammation  in  the 
alveolo-dental  periosteum,  and  the  gradual  destruction  of  the  socket 
will  follow  as  a  natural  consequence.  Also,  if  the  clasp  press  too  closely 
upon  the  neck  of  the  tooth,  it  may  develop  a  morbid  sensibility  in  the 
cementum,  causing  great  annoyance,  and  possibly  exciting  inflamma- 
tion and  alveolar  absorption  or  loosening  of  the  tooth. 

Several  years  since,  Dr.  Goodall  obtained  a  patent  for  a  method  of 
retaining  partial  sets  of  artificial  teeth  by  elastic  or  spring  plates  of 
vulcanized  rubber,  the  utility  of  which,  indiscriminately  applied,  as 
well  as  the  validity  of  the  patent,  some  are  disposed  to  doubt,  contend- 
ing that  these  plates  differ  but  little  from  metallic  ones  formerly  in 


RETENTION    OF    ARTIFICIAL,    TEETH.  499 

use,  constructed  in  the  same  manner,  and  described  as  partial  or  stay- 
clasps. 

This  form  of  clasp,  instead  of  embracing  the  natural  tooth,  simply 
presses  against  the  inner  surface  of  the  contracted  portion  of  the  crown 
near  the  gum  with  a  force  which  is  sufficient  to  keep  the  substitute  in 
place. 

Prof.  Austell's  method  of  taking  plaster  impressions  in  partial  cases 
was  designed  by  him,  in  1858,  with  special  reference  to  obtaining  an 
accurate  copy  of  the  inner  surface  of  bicuspids  and  first  molars.  Accu- 
rate fitting  of  the  vulcanite  plate  against  one  or  two  such  teeth  on  each 
side  prevents  lateral  motion,  and  gives  great  stability  to  the  piece.  It 
takes  the  place  of  the  vacuum  cavity  with  much  better  results  ;  in  fact, 
he  regards  this  form  of  stay-plate  essential  to  every  partial  piece  not 
clasped,  whilst  he  regards  the  cavity  worse  than  useless. 

ARTIFICIAL   TEETH  WITH  SPIRAL   SPRINGS. 

The  difference  between  the  method  last  noticed,  of  applying  artificial 
teeth,  and  the  one  now  to  be  considered,  consists  in  the  manner  of  con- 
fining them  in  the  mouth.  The  former  is  applicable  in  cases  where 
there  are  other  teeth  in  the  mouth  to  which  clasps  may  be  applied : 
the  latter  is  designed  for  confining  a  double  set ;  more  rarely  a  single 
set  or  part  of  a  set.  When  plates  with  spiral  springs  are  used,  the 
teeth  are  attached  to  them  in  the  same  manner  as  when  clasps  are  em- 
ployed ;  but  instead  of  being  fastened  in  the  mouth  to  other  teeth,  they 
are  kept  in  place  by  means  of  the  spiral  springs,  lying  one  on  each  side 
of  the  artificial  dentures  between  them  and  the  cheeks,  passing  from 
the  upper  piece  to  the  lower. 

Spiral  springs  were  formerly  much  used,  and  although  various  other 
kinds  of  springs  have  been  used,  none  seem  to  answer  the  purpose  as 
well  as  these.  When  they  are  of  the  right  size,  and  attached  in  a 
proper  manner,  they  afford  a  very  sure  and  convenient  support.  They 
exert  a  constant  pressure  upon  the  artificial  pieces,  whether  the  mouth 
is  opened  or  closed.  They  do  not  interfere  with  the  motions  of  the  jaw, 
and,  although  they  may  at  first  seem  awkward,  a  person  will  soon 
become  so  accustomed  to  them,  as  to  be  almost  unconscious  of  their 
presence.  They  are,  however,  liable  to  derangement  from  accident ; 
they  make  the  piece  awkward  to  handle  in  the  necessary  daily  cleans- 
ing ;  they  retain  the  secretions  offensively ;  and  not  unfrequently  are 
a  source  of  much  irritation  to  the  cheek. 

It  is  therefore  a  subject  of  congratulation  that  successive  improve- 
ments in  the  process  of  adapting  the  plate  to  the  mouth  have  gradually 
lessened  the  number  of  cases  in  which  spiral  springs  are  thought  neces- 
sary.    It  is  now  rare  to  meet  with  a  case  in  which  they  are  absolutely 


600  RETENTION    OF    ARTIFICIAL    TEETH. 

essential  for  the  permanent  retention  of  the  piece.  Occasional  use  is 
made  of  them  for  the  temporary  retention  of  a  piece  made  soon  after 
extraction,  in  which  the  plate  is  designedly  made  more  even  than  the 
irrcnilar  alveolar  border;  which  plate  cannot  of  course  fit  the  mouth, 
until  the  inequalities  of  the  gum  have  yielded  to  the  pressure  of  the 
plate. 

TEETH    RETAINED   BY   ATMOSPHERIC    PRESSURE. 

The  method  last  described,  of  confining  artificial  teeth  in  the  mouth, 
is  often  inapplicable,  inefficient,  and  troublesome,  especially  for  the 
upper  jaw;  in  such  cases,  the  atmospheric  pressure,  or  suction  method, 
is  very  valuable.  It  was,  for  a  long  time,  thought  to  be  applicable 
only  to  an  entire  upper  set,  because  it  was  supposed  that  a  plate  suffi- 
ciently large  to  afford  the  necessary  amount  of  surface  for  the  atmos- 
phere to  act  upon  could  not  be  furnished  by  a  piece  containing  a  smaller 
number  of  teeth.  Experience,  however,  has  proved  this  opinion  to  be 
incorrect.  A  single  tooth  may  be  mounted  upon  a  plate  presenting  a 
surface  large  enough  for  the  atmosphere  to  act  upon  for  its  retention 
in  the  mouth ;  but,  when  only  a  partial  upper  set  is  required,  it  is  often 
more  advisable  to  secure  the  piece  by  means  of  clasps.  For  a  like 
reason,  it  was  thought  that  the  narrowness  of  the  inferior  alveolar 
ridge  would  preclude  the  application  of  a  ])late  to  it  upon  this  principle, 
and  in  this  opinion  the  author  once  coincided ;  but  he  has  succeeded  so 
perfectly  in  confining  lower  pieces  by  this  means,  that  he  now  never 
finds  it  necessary  to  employ  spiral  springs  for  their  retention. 

The  principle  upon  which  this  plan  is  founded  may  be  simply  illus- 
trated by  taking  two  small  blocks  of  marble  or  glass,  the  flat  surfaces 
of  which  accurately  fit  each  other.  If  now  the  air  between  them  is 
replaced  by  water,  the  atmospheric  pressure  upon  their  external  sur- 
faces will  enable  a  pex'son  to  raise  the  under  block  by  lifting  the  upper. 
Upon  the  same  principle,  a  gold  plate,  or  any  other  substance  impervi- 
ous to  the  atmosphere,  and  perfectly  adapted  to  the  gums,  may  be 
made  to  adhere  to  them. 

The  firmness  of  the  adhesion  of  the  plate  or  base  to  tlie  gums  depends 
on  the  accuracy  of  its  adaptation.  If  this  is  perfect,  it  will  adhere 
with  great  tenacity  ;  but  if  the  plate  is  badly  fitted,  or  becomes  Avarped 
in  soldering  on  the  teeth,  its  retention  will  often  be  attended  with  diffi- 
culty. It  is  also  important  that  the  teeth  should  be  so  arranged  and 
antagonized,  that  they  shall  strike  those  in  the  other  jaw  on  both  sides 
at  the  same  instant.  This  is  a  matter  that  should  never  be  overlooked, 
for  if  they  meet  on  one  side  before  they  come  together  on  the  other, 
the  part  of  the  plate,  or  base,  not  pressed  upon,  may  be  detached,  and 
by  admitting  the  air  between  it  and  the  gums,  cause  it  to  drop. 


RETENTION    OF    AETIFICIAL,    TEETH.  501 

Since,  in  the  act  of  mastication,  pressure  is  made  on  one  side,  with 
no  counter-pressure  on  the  other,  this  inequality  will  not  necessarily 
detach  a  well-made  piece.  But  when  the  upper  molars  are  set  so  far 
from  the  median  line  of  the  mouth  that  the  line  of  pressure  falls  outside 
the  alveolar  ridge,  it  is  difficult  to  retain  the  best-fitting  piece  in  place 
during  mastication. 

It  is  also  of  utmost  importance  that,  by  proper  selection  of  the  im- 
pression materia],  and  judicious  management  of  subsequent  processes, 
the  plate  should  bear  upon  the  ridge  more  than  upon  the  palate.  In 
doing  this,  however,  no  more  space  should  be  left  than  a  few  days'  wear 
will  obliterate,  giving  absolute  contact  over  the  entire  surface.  For 
there  is  no  kind  of  space,  cavity,  or  chamber  which  gives  so  complete 
a  vacuum  as  contact,  or  which  secures  such  permanently  useful  adhe- 
sion of  the  plate. 

The  application  of  artificial  teeth  on  this  principle  has  been  prac- 
tised for  a  long  time.  Its  practicability  was  first  discovered  by  the  late 
Mr.  James  Gardette,  of  Philadelphia.  But  the  plates  formerly  used 
were  ivory  instead  of  gold,  and  could  seldom  be  fitted  with  sufficient 
accuracy  to  the  mouth  to  exclude  the  air ;  so  that,  in  fact,  it  could 
hardly  be  said  that  they  were  retained  by  its  pressure ;  except  in  that 
class  of  cases  in  which  the  mouth,  by  virtue  of  a  soft  membrane,  has 
power  to  adapt  itself  to  the  plate.  Unless  fitted  in  the  most  perfect 
manner,  the  piece  is  constantly  liable  to  drop;  and  the  amount  of  sub- 
stance necessary  to  leave  in  an  ivory  substitute  renders  it  so  aAvkward 
and  clumsy  that  a  set  of  teeth  mounted  upon  a  base  of  this  material 
can  seldom  be  worn  with  much  comfort  or  satisfaction. 

The  firmness  with  which  teeth  applied  upon  this  principle  can  be 
made  to  adhere  to  the  gums,  and  the  facility  with  which  they  can  be 
?:emoved  and  replaced,  renders  them,  in  many  respects,  more  desirable 
<;han  those  fixed  in  the  mouth  with  clasps.  But,  unless  judgment  and 
proper  skill  are  exercised  in  the  construction  of  the  work,  a  total 
failure  may  be  expected,  or,  at  least,  the  piece  will  never  be  worn  with 
satisfaction  and  advantage. 

There  were  few  writers,  at  the  time  of  the  publication  of  the  first 
edition  of  this  work,  Avho  had  even  adverted  to  this  mode  of  applying 
artificial  teeth.  Drs.  L.  S.  Parmly  and  Koecker  had  each  bestowed 
.on  it  a  passing  notice.  The  former,  in  alluding  to  the  subject,  thus 
remarks :  "  Where  the  teeth  are  mostly  gone  in  both  or  in  either  of 
the  jaws,  the  method  is,  to  form  an  artificial  set  by  first  taking  a 
mould  of  the  risings  and  depressions  of  every  point  along  the  surface 
of  the  jaws,  and  then  making  a  corresponding  artificial  socket  for  the 
whole.     If  this  be  accurately  fitted,  it  will,  in  most  cases,  retain  itself 


502  RETENTIOX    OF    ARTIFICIAL    TEETH. 

sufficiently  firm,  by  its  adhesion  to  the  gums,  for  every  purpose  of 
speech  and  mastication." 

Dr.  Koecker  tells  us  that  he  has  "been  completely  successful  in 
several  instances,  in  the  application  of  sets  for  the  upper  jaw  in  this 
manner  ;  they  should  be  made  either  of  gold  plate  mounted  with  natural 
or  artificial  teeth,  or  of  one  piece  of  hippopotamus  tooth."  Having 
already  stated  the  objections  that  exist  to  the  use  of  the  latter  sub- 
stance, we  cannot  join  with  Dr.  K.  in  its  recommendation.  At  the 
time  when  we  first  substituted  the  gold  plate  for  ivory,  we  had  not  seen 
his  late  work  on  artificial  teeth,  and  consequently  were  not  aware  that 
the  use  of  metal  for  a  base  had  ever  before  been  recommended. 

Modifications  of  the  atmospheric  pressure  principle  have  been  made 
since  1845,  by  constructing  the  plate  with  an  air-chamber  or  cavity,  so 
that  when  the  air  is  exhausted  from  between  it  and  the  parts  against 
which  it  is  placed,  a  more  or  less  complete  vacuum  is  formed,  causing 
it  to  adhere  when  first  introduced  with  greater  tenacity  to  the  gums 
than  a  base  fitted  without  such  cavity.  This  modification  might  be 
termed  an  improvement,  were  it  not  that  its  introduction  has  become 
so  unnecessarily  general,  has  so  often  induced  a  diseased  condition  of 
the  mucous  membrane,  and  has  led  to  a  slovenly,  careless  method  of 
swaging  and  fitting  plates.  For  these  and  some  other  reasons,  Prof. 
Austen  regards  its  introduction  as  a  positive  detriment,  at  the  same 
time  that  he  acknowledges  its  occasional  utility.  He  argues  that 
theory  and  practice  alike  condemn  the  use  of  a  cavity  for  the  perma- 
nent retention  of  any  piece;  and  suggests  for  its  temporary  reten- 
tion, whilst  the  work  is  going  through  its  stage  of  adaptation,  some 
other  plan  than  this  permanent  disfigurement.  The  so-called  vacuum 
cavity  can,  at  best,  be  only  partially  a  vacuum,  hence  cannot  give  the 
amount  of  atmospheric  pressure  that  perfect  contact  will.  So  long  as 
it  acts  in  the  retention  of  a  piece,  it  necessarily  draws  the  yielding 
membrane  into  the  space,  and  must  ultimately  fill  it.  When  this  is 
done,  the  piece  is  evidently  retained  by  the  "vacuum  of  contact."  If, 
in  any  case,  the  mouth  does  not  show  the  size  and  depth  of  the  cavity 
imprinted  on  the  palate,  it  proves  that  the  vacuum  force  is  not  exerted, 
and  that  the  piece  is  retained  by  contact  of  the  parts  around  the 
cavity.  In  these  cases,  of  constant  occurrence,  the  cavity  diminishes 
the  adhesion  of  the  plate,  and  can  only  be  of  service  where  it  helps  to 
remove  pressure  from  a  hard  palate.  But  as  this  can  be  done  in  a 
better  way,  it  is  no  argument  in  favor  of  the  cavity. 

The  only  cases  in  which  this  chamber  is  permanently  useful  are 
very  flat  mouths  with  scarcely  any  perceptible  ridge.  A  sharply  de- 
fined cavity,  varying  in  depth  from  one-half  to  one  line,  according  to 


PEEPAEATORY  TREATMENT  OF  THE  MOUTH.   503 

the  softness  of  the  membrane,  when  filled  by  this  membrane,  tends  to 
prevent  that  lateral  motion  of  the  piece  so  troublesome  in  such  cases. 

Partial  pieces  not  retained  by  clasps,  or  the  lateral  pressure  of  stays, 
or  their  closeness  of  adaptation,  are  never  permanently  improved  by 
the  cavity.  Even  in  pieces  made  soon  after  extraction  (so  unfortu- 
nately named  temporary  sets),  the  temporary  action  of  the  cavity  is  of 
very  questionable  utility. 


CHAPTER  IV. 

PEEPAEATORY  TREATMENT  OF  THE  MOUTH. 

THE  condition  of  the  mouth  is  not  sufiiciently  regarded  in  the 
application  of  artificial  teeth,  and  to  the  neglect  of  this  the  evil 
effects  that  so  often  result  from  their  use  are  frequently  attributable. 
An  artificial  appliance,  no  matter  how  correct  it  may  be  in  its  con- 
struction and  in  the  mode  of  its  application,  cannot  be  worn  with 
impunity  in  a  diseased  mouth.  Of  this  fact,  every  day's  experience 
furnishes  the  most  abundant  proof  Yet  there  are  men  in  the  profes- 
sion so  utterly  regardless  of  their  own  reputation,  and  of  the  conse- 
quences to  their  patients,  as  wholly  to  disregard  the  condition  of  the 
mouth,  and  are  in  the  constant  habit  of  applying  artificial  teeth  upon 
diseased  roots  and  gums,  or  before  the  curative  process,  after  the 
extraction  of  the  natural  teeth,  is  half  completed. 

The  dentist,  it  is  true,  may  not  always  be  to  blame  for  omitting  to 
employ  the  means  necessary  for  the  restoration  of  the  mouth  to  health. 
The  fault  is  often  with  the  patient.  There  ai'e  many  who,  after  being 
fully  informed  of  the  evil  effects  which  must  of  necessity  result  from 
such  injudicious  practice,  still  insist  on  its  adoption.  But  the  dentist, 
in  such  cases,  does  wrong  to  yield  his  better  informed  judgment  to  the 
caprice  or  timidity  of  his  patient,  knowing,  as  he  should,  the  lasting, 
pernicious  consequences  that  must  result  from  doing  so.  If  he  is  not 
permitted  to  carry  out  such  plan  of  treatment  as  may  be  necessary  to 
put  the  mouth  of  his  patient  in  a  healthy  condition  previously  to  the 
application  of.  artificial  teeth,  he  should  refuse  to  render  his  services. 
No  professional  man  can  be  permitted  to  plead  in  excuse  for  any  pro- 
fessional error  that  his  patient  over-persuaded  him.  No  community 
will  accept  such  excuse,  or  hold  the  patient  in  any  degree  responsible 
■%r  the  consequences. 

Dr.  Koecker,  in  treating  upon  this  subject,  says :  "  There  is,  perhaps, 


504   PREPARATORY  TREATMENT  OF  THE  MOUTH. 

not  oue  case  in  a  hundred,  requiring  artificial  teeth,  in  wliich  the  other 
teeth  are  not  more  or  less  diseased,  and  the  gums  and  alveoli,  also, 
either  primarily  or  secondarily  aflected.  The  mechanical  and  chemi- 
cal bearing  of  the  artificial  teeth,  even  if  well  contrived  and  inserted 
upon  such  diseased  structures,  naturally  becomes  an  additional  aggra- 
vating cause  of  disease  iu  parts  already  in  a  sufficient  state  of  excite- 
ment ;  if,  however,  they  are  not  well  constructed,  and  are  inserted 
with  undue  means  or  force,  or  held  by  too  great  or  undue  pressure,  or 
by  ligatures  or  other  pernicious  means  for  their  attachment,  tlie  morbid 
effects  are  still  more  aggravated,  and  a  general  state  of  inflammation 
in  the  gums  and  sockets,  and  particularly  in  the  periosteum,  very 
rapidly  follows.  The  patient,  moreover,  finds  it  impossible  to  preserve 
the  cleanliness  of  his  mouth  ;  and  his  natural  teeth,  as  well  as  the  arti- 
ficial apparatus,  in  combination  with  the  diseases  of  the  structures, 
become  a  source  of  pain  and  trouble ;  and  the  whole  mouth  is  rendered 
highly  offensive  and  disgusting  to  the  patient  himself  as  well  as  to 
others."  * 

The  first  thing,  then,  claiming  the  attention  of  the  dentist,  when 
applied  to  for  artificial  teeth,  is  to  ascertain  the  condition  of  the  gums, 
and  of  such  teeth  as  may  be  remaining  in  the  mouth.  If  either  or 
both  are  diseased,  he  should  at  once  institute  such  treatment  as  the 
circumstances  of  the  case  may  indicate  ;  but  as  this  has  been  described 
in  a  preceding  chapter,  the  reader  is  referred  for  directions  upon  the 
subject  to  what  is  there  said.  Without,  however,  repeating  previous 
medical  and  surgical  directions,  a  few  brief  hints  are  necessary  as  to 
what  teeth  or  roots  should  be  extracted  and  what  allowed  to  remain 
in  preparation  for  a  dental  plate. 

All  incurably  diseased  roots  or  teeth  should  be  removed,  also  all 
roots  of  molars  in  either  jaw,  and  all  roots,  without  exception,  in  the 
lower  jaw.  Firm  and  healthy  roots  of  bicuspids  may  sometimes  be 
retained,  the  plate  coming  to  the  inner  edge  of  such  root  and  the  arti- 
ficial crown  resting  upon  it.  It  is  desirable  to  retain  upper  incisors  or 
canine  roots,  unless  an  adjacent  tooth  has  lost  its  root  or  is  incurably 
diseased.  These  cases  of  retention  of  roots  presuppose  the  presence 
of  other  teeth  ;  for  when  only  roots  remain  in  the  jaw,  they  must  be 
extracted.  Also,  they  must  be  removed,  however  sound,  if  they  are 
sources  of  irritation  in,  or  are  partially  covered  with,  mucous  membrane. 

Very  loose  teeth,  although  not  carious,  should  be  extracted ;  but  teeth 
in  which  caries  or  abscess  can  be  permanently  cured  rank  as  sound 
teeth.  All  sound  teeth  must  be  retained,  if  there  are  more  than  four 
in  either  jaw,  unless  some  peculiar  circumstances  justify  their  removal. 
Cases  of  this  kind  are  so  varying  that  no  fixed  rule  can  be  laid  down ; 
*  Koecker's  Essay  on  Artificial  Teeth,  pp.  27,  28. 


PREPARATORY  TREATMENT  OF  THE  MOUTH.   505 

but  a  few  cases  may  be  given  in  illustration  of  the  princij^les  that 
should  guide  the  practitioner. 

Two,  three,  or  four  molars  alone  remaining  should  be  retained,  espe- 
cially if  they  have  antagonists.  They  do  not  complicate  the  construc- 
tion of  the  piece  or  interfere  with  its  utility ;  but  they  should  not  be 
clasped,  since  the  whole  weight  being  in  front  of  the  clasp  brings  too 
much  strain  on  the  teeth.  Two;  three,  or  four  incisors  alone  remain- 
ing cannot  be  extracted  except  by  request  of  the  patient ;  for  although 
they  complicate  the  construction,  and  may  interfere  somewhat  with  the 
strength  and  beauty  of  the  work,  they  may  be  too  valuable  to  justify 
their  loss.  The  cuspids  must  be  retained,  if  sound,  not  displaced,  and 
free  from  alveolar  absorption,  although  their  retention  may  greatly 
complicate  the  work. 

In  cases  of  protrusion  of  the  lower  jaw,  it  may  be  advisable  to 
extract  the  five  front  teeth  in  either  jaw,  where  these  are  the  sole 
remaining  ones,  with  a  view  to  correct,  in  part,  the  protrusion  of  the 
mouth.  Bat  this  cannot  be  clone  without  fullest  consent  of  the  patient; 
even  then  is  scarcely  advisable  unless  these  teeth  are  frail  in  texture, 
or  their  position  amounts  to  deformity. 

In  all  cases  it  should  be  the  rule  never  to  sacrifice  a  sound  tooth  for 
the  purpose  of  replacing  an  artificial  one,  unless  the  benefit  of  the 
exchange  is  so  undoubted  as  to  be  recognized  by  both  patient  and 
operator. 

When  artificial  teeth  are  to  be  secured  in  the  mouth  in  any  other 
way  than  by  pivoting  upon  the  roots,  if  the  patient  desires  but  one 
piece,  sufficient  time  should  elapse,  before  its  insertion,  for  the  comple- 
tion of  those  changes  in  the  alveolar  ridge  that  follow  extraction. 

It  is  often  necessary  to  wait  from  eight  to  fifteen  months,  after  the 
removal  of  the  natural  teeth,  for  the  completion  of  these  changes. 
Comparatively  few  persons,  however,  are  willing  to  remain  for  so  long  a 
time  without  teeth  ;  nor,  on  many  accounts,  is  it  desirable  that  they 
should.  In  this  long  interval  the  lips  lose  somewhat  their  natural  ex- 
pression, and  the  under  jaw  forgets  its  natural  motion,  and  inclines  to 
project.  The  artificial  piece  or  pieces  feel  more  awkward  and  unman- 
ageable than  if  inserted  at  once ;  they  also  interfere  more  with  the 
articulation  and  motions  of  the  tongue,  which  have  become  accustomed 
to  the  absence  of  the  teeth. 

Hence  the  insertion  of  artificial  pieces  may  become  advisable  very 
soon  after  extraction — the  interval  varying  from  hours  or  days  to 
weeks  or  months.  In  some  of  these  cases  the  piece  will  have  to  be 
remodelled  at  short  intervals ;  in  other  cases  the  piece,  as  first  made, 
continues  to  be  worn  for  many  years  v/ith  much  comfort.  It  is  not 
easy  to  explain  these  differences.     Much  depends  upon  the  nature  of 


606   PREPARATORY  TREATMENT  OF  THE  MOUTH. 

the  mucous  and  submucous  tissues,  ^Yhether  liard  or  soft ;  and  much 
also  upon  the  manner  in  which  the  alveolar  ridge  changes.  It  may 
take  place  rapidly,  and  with  slight  regard  to  the  shape  of  the  plate ; 
in  which  case  tlie  patient  has  to  use  much  tact  in  retaining  the  piece 
in  place.  Or  it  may  take  place  slowly,  following,  as  it  is  apt  more  or 
less  to  do,  the  shape  of  the  plate;  in  which  case  it  may  be  worn  with 
some  comfort,  or  even  with  great  satisfaction,  for  a  long  time. 

A  plate  made  immediately  after  extraction  should  not  fit  the  ridge 
exactly  ;  but  allowance  should  be  made  for  the  rapid  absorption  of 
the  prominent  edges  of  the  alveoli.  Some  practitioners  advise  the 
anticipation  of  this  process  by  "  paring  down ''  the  alveolar  ridge. 
This  "  bold  surgery"  has  its  advantages  and  its  advocates.  The  opera- 
tors say  it  does  not  hurt  much  ;  but  the  testimony  of  the  patient,  on 
this  point,  is  more  trustworthy. 

The  almost  universal  use  of  the  term  "  temporary,"  applied  to  a 
piece  made  within  six  months  after  extraction  of  the  teeth,  is  much 
to  be  regretted.  It  tempts  the  dentist  to  a  slovenly  style  of  half  made 
work,  good  enough,  in  his  estimation,  for  what  is  so  soon  to  be  replaced. 
It  also  renders  the  patient  reluctant  to  make  proper  compensation  for 
the  time  and  skill  employed.  Both  feelings  react,  until  it  has  become 
a  notorious  fact  that  much  low-priced  work  passes  from  the  hands  of 
skilful  mechanicians  which  they  would  indignantly  disown  as  specimens 
of  their  workmanship. 

Yet  they  are  specimens  which  a  community  is  right  in  judging  by. 
It  is  unfortunate  for  dentistry  that  so  many,  using  their  best  efforts, 
accomplish  poor  results.  But  it  is  infinitely  more  damaging  to  its 
character,  that  a  skilled  operator  should,  under  any  pretext,  permit 
himself  to  be  false  to  the  trust  reposed  in  his  professional  capacity.  A 
chain  is  judged  by  its  weakest  link,  and  a  workman's  reputation  turns 
on  his  poorest  work.  This  seemingly  harsh  verdict  is  a  just  one,  because 
necessary  to  keep  the  majority  of  men  to  the  full  measure  of  their 
ability. 

Let  the  work  be  done  as  if  it  never  was  to  be  done  again.  Many 
circumstances  may  prevent  the  return  of  the  patient :  it  also  frequently 
happens  that  no  necessity  is  felt,  especially  if  properly  done,  for  the 
renewal  of  the  piece.  If  the  patient  understands  that  the  necessity  of 
renewal  is  not  in  the  work  itself,  but  arises  fi'om  unavoidable  changes 
in  the  mouth,  there  will  be  no  difficulty  about  proper  compensation. 
But  if  the  absurd  practice  of  half  price  at  one  time  for  what  receives 
full  price  at  another  must  be  maintained,  then,  by  all  means,  let  the 
second  piece  be  the  half-paid  one. 

The  point,  however,  involves  far  higher  questions  than  the  one  of 
fees.     No  dentist  who  properly  respects  himself  or  his  profession,  will, 


PREPARATION    OF    A    NATURAL    ROOT,    ETC.         507 

either  on  the  score  of  insufficient  pay  or  temporary  use,  permit  himself 
to  issue  two  grades  of  work.  Like  Pharaoh's  lean  kiue,  the  low  grade 
will,  slowly  perhaps,  but  inevitably  destroy  the  high  grade.  The  only 
safe  rule  is  "  excelsior  "  in  every  case. 


CHAPTER  V. 


PREPARATION    OF    A   NATURAL   ROOT   AND   ATTACHMENT   OF   AN 
ARTIFICIAL   CROWN. 

PREVIOUS  to  the  preparation  of  a  natural  root  for  the  reception 
of  an  artificial  crown,  the  remaining  teeth  and  gums,  if  diseased, 
should  be  restored  to  health.  This  done,  such  portion  of  the  crown, 
as  may  not  have  been  previously  destroyed  by  caries,  should  be  re- 
moved. 

The  usual  method  of  performing  this  part  of  the  operation,  when 
much  of  the  crown  remains,  consists  in  cutting  the  tooth  about  three- 
fourths  off,  with  a  file  or  very  fine  saw  (Fig.  189),  and  then  removing 

Fig.  189. 


it  with  a  pair  of  excising  forceps.  But  the  forceps  should  not  be  applied 
until  the  tooth  has  been  cut  with  a  file  on  every  side,  nearly  to  the 
pulp-cavity,  and  even  then  great  care  is  necessary  to  prevent  jarring, 
or  otherwise  injuring  the  root.  When  too  large  a  portion  of  the  crown 
is  clipped  off  suddenly  with  excising  forceps,  the  concussion  is  often  so 
great  as  to  excite  inflammation  in  the  socket  of  the  tooth,  and  some- 
times to  fracture  the  root. 

When  excising  forceps  are  used  in  this  way,  they  should  be  strong, 
so  as  not  to  spring  under  the  pressure  of  the  hand,  with  cutting  edges 

Fig.  1*90. 


about  an  eighth  of  an  inch  wide  (Fig,  190).     But  we  should  prefer, 
where  a  large  part  of  the  crown  is  left,  to  remove  it  entirely  with  the 


508  PREPARATION    OF    A    NATURAL    ROOT 

fine  saw  or  separating  file.  Where  there  is  only  a  jagged  remnant  of 
the  crown  left,  it  should  be  gradually  cut  away  by  a  pair  of  cutting 
forceps  made  as  light  as  possible,  with  a  spring  between  the  blades 
of  the  handle  to  keep  them  apart.  The  cutting  edges  may  be  shaped 
as  in  the  ordinary  excising  forceps  (Fig.  190),  or  somewhat  like  the 
beaks  of  Parmly's  duck-bill  root  forceps,  represented  in 

Fig.  191. 


After  the  removal  of  the  remaining  portion  of  the  crown,  the  nerve, 
if  still  alive,  should  be  immediately  destroyed,  by  introducing  a  silver 
or  untempered  steel  wire,  or  some  other  small,  sharp-pointed  instrument, 
up  to  the  extremity  of  the  root,  by  giving  it,  at  the  same  time,  a  quick 
rotary  motion.  It  is  important  that  the  instrument  used  for  this  pur- 
pose should  be  soft  and  yielding,  otherwise  any  sudden  motion  of  the 
patient  might  break  it  off  in  the  tooth.  Its  extremity  should  also  be 
barbed  or  bent  so  as  to  entangle  and  drag  out  the  nerve  when  with- 
drawn. Some  recommend  destroying  the  nerve  by  the  intx'oduction 
of  a  hot  wire  into  the  canal  of  the  root,  but  as  this  is  very  liable  to 
produce  irritation  in  the  surrounding  tissues,  the  other  method  is  pre- 
ferable. 

The  nerve  having  been  destroyed,  the  remainder  of  the  operation 
will  be  painless.  The  root  may  now  be  filed  off,  a  little  above  the  free 
edge  of  the  gum,  with  an  oval  or  half-round  file.  The  file  should  be 
new  and  sharp  so  as  to  cut  rapidly,  but  not  too  coarse,  lest  it  jar  the 
root  to  much.  It  must  be  kept  cold  and  clean  by  frequently  dipping 
in  water.  The  exposed  extremity  of  the  root,  after  having  been  thus 
filed,  should  present  a  slightly  arched  appearance,  corresponding  with 
the  festooned  shape  of  the  anterior  margin  of  the  gum. 

After  having  completed  this  part  of  the  operation,  the  natural  canal 
in  the  root  should  be  slightly  enlarged  with  a  burr-drill,  or  a  broach 
prepared  for  the  purpose.  A  slightly  projecting  point  on  the  end  of  the 
drill  will  serve  by  entering  the  canal  to  guide  the  instrument,  which 
must  be  held  steadily  in  one  direction.  The  canal  thus  formed  in 
the  root  for  the  pivot  should  never  exceed  the  sixteenth  part  of  an 
inch  or  a  line  in  diameter,  and  a  quarter  or  three-eighths  of  an  inch  in 
length. 

If  from  any  peculiar  constitutional  susceptibility  there  is  reason  to 
apprehend  inflammation  of  the  alveolo-dental  membrane,  the  insertion 


AND  ATTACHMENT  OF  AN  ARTIFICIAL   CROWN 


509 


of  the  tooth  may  be  delayed  a  few  days  for  the  subsidence  of  any  irri- 
tation which  may  have  been  occasioned  by  the  preparation  of  the  root. 
It  will  be  prudent  to  do  this  in  all  cases,  although  it  rarely  happens 
that  the  operation  is  followed  by  any  unpleasant  effects,  unless  the  root 
has  previously  lost  its  vitality  by  the  spontaneous  disorganization  of 
the  nervous  pulp.  In  this  case,  an  outlet  is  sometimes  made  by  cutting 
a  groove  on  the  side  of  the  pivot,  or  in  some  other  way,  for  the  escape 
of  any  matter  which  may  form  at  the  apex  of  the  root ;  but  it  is  far 
better  in  such  cases  to  extract  the  root,  unless  the  discharge  can  be  per- 
manently arrested.  Dr.  Maynard  believes  that  the  irritation  in  most 
cases  arises  from  an  accumulation  of  acrid  matter  in  the  upper  part  of 
the  root ;  by  removing  which,  and  by  filling  the  natural  canal  above 
the  terminus  of  the  pivot,  up  to  the  extremity,  it  may  generally  be 
prevented.  This  should  always  be  done  before  deciding  to  extract  the 
root. 

After  having  prepared  the  root,  an  artificial  crown,  of  the  right 
shape,  color,  and  size,  is  accurately  fitted  to  it.  It  should  touch  every 
part  of  the  filed  extremity  of  the  root,  and  be  made  to  rest  firmly  upon 
it,  to  give  security  of  suppoi't,  and  to  exclude  food  and  other  substances 
which  by  their  decay  will  give  rise  to  unpleasant  odors.  Care  must 
also  be  used  to  have  the  tooth  placed  in  exact  line  with  the  other  teeth, 
not  inclining  unnaturally  to  either  side,  and  not  so  long  as  to  touch 
the  lower  teeth  when  the  mouth  is  closed.  To  fit  the  crown  accurately 
is  often  a  tedious  process,  and  wearies  the  patient.  To  avoid  this,  an 
impression  of  the  space  may  be  taken,  and  the  crown  adapted  to  the 
model,  which  should  be  hardened  by  varnish  or  soluble  glass. 

The  canal  in  the  root,  and  that  in  the  artificial  crown,  should  be 
directly  opposite  to  each  other.  When  the  crown  of  a  natural  tooth 
is  used,  it  can  be  adapted  to  the  root  by  the  use  of  the  file ;  the  proper 
place  for  the  pivot  is  indicated  by  the  pulp-cavity,  but  in  porcelain 
teeth  the  hole  is  not  always  in  the  centre. 

In  selecting  a  suitable  artificial  pivot 
tooth,  it  is  often  difficult  to  find  the  several 
conditions  of  length,  width,  color,  and  po- 
sition of  pivot-hole  just  as  required.  The 
last  two  cannot  be  changed,  but  the  first 
two  may  often  be  modified  by  the  corun- 
dum wheel.  If  the  color  cannot  be  ex- 
actly matched,  it  is  perhaps  better  to 
select  one  a  shade  darker  rather  than 
lighter. 

For  grinding  the  edge,  sides,  or  base 
of  the  tooth,  any  of  the  hand-lathes  in 


Fig.   192. 


610 


PREPARATION    OF    A    NATURAL    TOOTH 


use  will  answer  very  well.  Fig.  192  represents  one  where  tlie  wheel, 
either  of  stone  or  corundum,  revolves  in  a  vessel  containing  water. 
Figs.  193  and  194  represent  very  convenient  and  useful  forms  of  the 


fiG.  193. 


hand-lathe.  The  foot-lathe,  elsewhere  described,  is  best  suited  for  the 
laboratory ;  but,  for  such  grinding  and  fitting  of  teeth  as  must  be  done 
at  the  operating  chair,  a  hand-lathe  will  be  found  very  convenient. 


The  artificial  crown  may  be  secured  to  the  root  by  means  of  a  pivot 
made  of  wood  or  metal ;  when  the  latter  is  em2:)loyed,  gold  or  platina 
is  to  be  preferred,  inasmuch  as  silver  or  any  baser  metal  is  liable  to  be 
oxidized  by  the  fluids  of  the  mouth.  If  wood  is  used,  it  should  be  of 
the  best  quality  of  well-seasoned  young  white  hickory,  as  this  possesses 
greater  strength  and  elasticity  than  any  other  that  can  be  produced  in 
this  country.  After  being  reduced  nearly  to  the  size  of  the  canal  in 
the  artificial  tooth,  it  should  be  forced  through  a  smooth  hole,  of  the 
proper  size,  in  a  piece  of  ivory,  bone,  steel,  or  some  other  hard  sub- 
stance, for  the  purpose  of  compressing  its  fibres  as  closely  together  as 
possible.  Thus  prepared,  one  end  is  forced  into  the  cavity  in  the  arti- 
ficial crown,  and  the  projecting  part  cut  ofi"  about  a  quarter  or  three- 
eighths  of  an  inch  from  the  tooth,  according  to  the  depth  of  the  canal. 
If  the  canals  in  crown  and  root  are  equal  in  size,  the  pivot  is  ready  to 


AND   ATTACHMENT  OF  AN  ARTIFICIAL  CROWN.      511 

be  pressed  into  place,  which  should  be  done  with  the  thumb  and  fore- 
finger, if  the  pivot  is  made  of  compressed  wood.  But  if  the  canals 
differ  in  size,  the  wood  must  be  compressed  to  the  size  of  the  larger, 
and  then  trimmed  down  to  fit  the  smaller.  The  end  thus  trimmed 
should  require  more  force  for  its  introduction,  since  the  compressed 
wood  swells  most  from  moisture.  The  part  of  the  pivot  going  into  the 
root,  if  made  of  compressed  wood,  should  never  be  so  large  as  to  require 
any  other  pressure  than  that  which  can  be  applied  with  the  thumb  and 
forefinger,  as  the  swelling  of  the  wood  will  soon  render  it  sufficiently 
tight  to  hold  it  firmly  in  its  place,  and  if  too  tight,  the  subsequent  swelling 
will  split  the  root.  The  practice  of  driving  a  pivot  up  with  a  hammer, 
or  by  very  strong  pressure,  as  is  often  done,  is  a  bad  one.  It  is  apt  to 
cause  inflammation  and  suppuration  of  the  soft  tissues  about  the  apex 
of  the  root.  The  utmost  force  admissible,  and  this  only  in  the  case  of 
uncompressed  pivot-wood,  is  somewhat  more  than  can  be  made  with 
the  thumb  and  finger,  applied  by  means  of  a  small  pine  stick,  notched 
at  the  end  to  receive  the  cutting  edge  of  the  tooth. 

It  is  important  that  the  pivot  should  exactly  equal  the  depth  of  the 
canal.  If  too  long,  the  crown  will  not  go  up  to  its  place  ;  if  too  short, 
there  will  be  either  an  unnecessary  weakening  of  the 
root  or  the  crown  will  be  insecure.  A  small  piece  of 
smooth  wire  or  knitting-needle,  with  a  sliding  collar  of 
wood  or  gutta-percha,  forms  a  simple  instrument  for 
measuring  the  depth  of  the  canal  in  the  root.  Fig.  196 
represents  a  convenient  gauge  for  this  purpose.     A  porcelain  tooth 

Fig.  196. 


with  a  wooden  pivot  presents,  before  insertion,  the  appearance  repre- 
sented in  Fig.  195. 

It  sometimes  becomes  necessary  to  remove  the  artificial  crown,  and 
in  doing  this  the  pivot  often  remains  in  the  root.  For  the  extraction 
of  this,  the  forceps  represented  in  Fig.  197,  invented  by  Dr.  W.  H. 
Elliott,  will  be  found  very  useful.  With  this  instrument  the  pivot 
may  be  removed  from  the  root  without  jarring  it  in  the  least,  or  ex- 
erting any  extractive  force  upon  it.  The  manner  of  applying  and 
using  the  instrument  will  be  readily  understood  by  examining  the 
drawing. 

AVhen  a  metallic  pivot  is  used,  the  end  going  into  the  artificial 
crown  may  be  fastened  in  either  of  the  following  ways.  First,  by 
cutting  a  screw  on  it,  either  with  a  file  or  passing  it  through  a  screw- 


512  PREPARATION    OF    A    NATURAL    ROOT 

plate;  the  cavity  in  the  crown  should  next  be  filled  with  a  wooden 
tube,  and  the  pivot  then  screwed  into  it ;  or  the  pivot  may  be  first 
screwed  into  a  small  block  of  pivot  wood,  and  the  wood  then  trimmed 
to  fit  the   crown.     Second,  by  filling  the  pivot-hole  with  pulverized 

FiQ.  197. 


borax,  moistened  with  water,  inserting  the  end  of  the  pivot  into  it, 
which  should  be  large  enough  to  fill  the  cavity,  placing  several  small 
pieces  of  solder  around  it,  and  fusing  them  with  the  blow^-pipe.  The 
solder,  adapting  itself,  Avhen  in  a  state  of  fusion,  to  the  rough  walls  of 
the  cavity  in  the  crown  of  the  tooth,  will  prevent  the  pivot  from  loos- 
ening or  coming  out.  The  projecting  part  of  the  pivot  should  be  about 
half  an  inch  in  length.  By  some  it  is  made  square  and  pointed,  as  in 
the  figure ;  but  the  best  form  is  a  polished  cylinder.  The  latter  resists 
more  firmly  any  downward  traction  ;  while  the  curve  of  the  face  of  the 
root  will  prevent  the  pivot  turning  on  its  axis.  The  cavity  in  the  root, 
which  requires  to  be  deeper  for  a  metallic  than  for  a  wood  pivot,  should 
Fig  198.   ^®  filled  with  wood,  having  a  small  hole  through  the  centre. 

Into  this,  the  end  of  the  pivot  is  introduced  and  forced  up, 

IL  I    until  the  tooth  and  root  come  firmly  together.     The  appear- 
11     ance  of  a  porcelain  tooth  prepared  with  a  metallic  pivot, 
f      for  insertion  in  this  manner,  is  shown  in  Fig.  198. 
But  when  a  metallic  pivot  is  used,  a  plate  tooth  is  preferable  to  one 
made  expressly  for  pivoting.     The  manner  of  attaching  a  pivot  to  the 
former  is  as  follows :  the   root  is  first  prepared,  after  which  an  im- 
pression is  taken  ;  from  this  a  plaster  model  is  made,  and  from  the 
latter  metallic  dies.     This  done,  a  piece  of  gold  plate,  large  enough 


AND  ATTACHMENT   OF   AN  ARTIFICIAL   CROWN.      513 

to  cover  the  root,  should  be  swaged  up  between  the  dies,  a  plate  tooth 

of  the  proper  size,  shape,  and  color  is  then  fitted  to  the  root,  backed 

with  gold,  and  soldered  to  the  plate.     To  the  upper 

or  convex  surface  of  this  last,  and  immediately  be-        ^^^-  •^^^• 

neath  the  canal  in  the  root,  a  gold  pivot  is  attached. 

The  position  and  direction  of  this  pivot  is  thus  secured. 

Press  the  plate,  covered  with  a  very  thin  film  of  wax, 

against  the  root;  at  the  point  opposite  the  canal,  thus 

marked  on  the  plate,  drill  a  hole ;  through  this  pass 

a  gold  pivot  into  the  canal ;  press  softened  sealing-wax  around  the  part 

of  the  pivot  (made  purposely  too  long)  below  the  plate,  and  remove 

the  fixture  from  the  mouth.     Invest  the  upper  part  of  the  pin  anCi 

plate  in  plaster  (keeping  it,  by  means  of  a  minute  collar  of  wax,  out 

of  the  hole  through  which  the  pin  passes),  remove  the  sealing-wax, 

cut  off  the  pin  even  with  the  plate  and  solder.     A  front  and  side  view 

of  a  tooth  thus  prepared  is  shown  in  Fig.  199. 

A  pivot,  consisting  of  gold  encased  in  a  thin  layer  of  wood,  con- 
stitutes about  as  secure  a  means  of  attachment  as  can  be  employed. 
It  is  prepared  in  the  following  manner.  The  gold  is  first  made  into 
wire  of  proper  size,  and  passed  through  a  screw-plate ;  a  hole  is  then 
drilled  lengthwise  into  a  piece  of  well-seasoned  hickory,  as  far  as  required 
for  the  length  of  the  pivot,  and  a  thread  cut  with  the  corresponding  screw- 
tap  ;  into  this  the  wire  is  screwed,  and  then  cut  off  close  to  the  wood, 
which  is  reduced  with  a  file  or  knife  nearly  to  the  size  of  the  orifice  in 
the  artificial  crown,  and  then  condensed  by  passing  through  a  pivot 
draw-plate.  Subsequent  manipulations  are  the  s'ame  as  given  for  the 
simple  wooden  pivot ;  from  which  it  differs  in  being  stronger,  also  in 
permitting  a  slight  bend  in  the  pivot  in  case  the  canals  in  root  and 
crown  are  not  in  precisely  the  same  direction.  The  wood  prevents  the 
gold  from  enlarging  the  cavity  of  the  root,  or  from  being  worn  hj 
friction  in  the  pivot-hole  of  the  artificial  tooth ;  and  at  the  same  time, 
by  the  swelling  of  this  encasement,  the  pivot  is  firmly  retained  in. 
both. 

There  is  some  diversity  of  opinion  with  regard  to  the  best  kind  of 
pivot.  Some  prefer  wood,  others  metal.  Dr.  Fitch,  on  this  subject,, 
observes :  "  The  metallic  pivots  are  far  better  than  any  other ;  their 
only  objection  is,  that  they  are  apt  to  wear  the  tooth  that  is  placed 
upon  them,  and  the  stump  in  which  they  are  inserted.  So  much  so  do 
they  have  this  effect  that  we  are  induced  to  use  pivots  of  wood.  This 
last  has  the  advantage,  if  perfectly  seasoned,  of  swelling  in  the  stump- 
by  the  moisture  which  they  absorb,  and,  in  this  way,  becoming  very 
firm.  The  advantages  and  disadvantages  of  the  two  kinds  are,  per- 
haps, nearly  balanced." 
33 


514  PREPARATION    OF    A    NATURAL    ROOT 

To  the  use  of  wood,  Dr.  Koecker  is  decidedly  opposed.  "  The  pivots 
should  be  made  only  of  fine  gold  or  platina  ;  every  other  metal,  su'^h 
as  brass,  copper,  silver,  and  even  inferior  gold,  are  highly  objectionable, 
being  more  or  less  liable  to  corrode,  and  thus  become  injurious  to  other 
teeth  and  the  general  health.  There  is,  however,  a  practice  which  is 
still  more  improper,  namely,  the  use  of  pivots  made  of  wood  ;  these 
pivots  expand  considerably  after  insertion,  from  the  moisture  of  the 
mouth,  and  consequently  remain  perfectly  firm  in  the  roots  for  several 
years,  which  deceives  not  only  the  patient  but  the  dentist  also,  and 
induces  them  to  consider  the  case  very  successful,  until  they  at  last 
find  that  the  root  is  either  split  by  the  swelling  of  the  pivot,  or  nearly 
destroyed  by  the  rapid  decay  of  the  wood  in  the  cavity,  which,  by  its 
chemical  and  mechanical  irritation,  is  very  apt  to  produce  serious 
inflammation,  and  other  affections  of  the  gums  and  sockets;  by  no 
means  the  least  objection  is  the  disagreeable  breath  which  must  be  an 
unavoidable  concomitant  of  this  practice.  I  have  made  it  a  universal 
rule  to  insert  the  tooth  in  such  a  manner  that  the  patient  shall  be 
able,  after  receiving  the  necessary  instructions,  to  remove  it  and  re- 
place it  at  pleasure  ;  for  this  purpose  I  have  found  it  best  and  most 
effectual  to  Avind  a  little  cotton  round  the  pivot,  which  should  be 
somewhat  roughened  previously  to  its  insertion  into  the  fang." 

The  description  here  given  of  the  effects  supposed  to  be  produced 
by  a  wood  pivot  is  exaggerated.  If  properly  made  of  good  wood,  it 
is  no  more  liable  to  produce  irritation,  and  to  affect  the  breath,  than 
one  made  of  gold  or  any  other  metal,  and  wrapped  in  cotton.  The 
fact  that  wooden  pivots  remain  firmly  in  the  roots  for  several  years 
ought  rather  to  be  considered  as  a  recommendation  than  an  objection, 
and  would  go  far  toward  determining  our  preference  in  their  favor. 
The  frequent  removal  and  replacement  of  a  pivoted  tooth  greatly 
tends  to  hasten  the  destruction  of  the  root  and  to  irritate  surrounding 
parts,  and  prevents  the  possibility  of  having  a  firml3'^-fitting  crown. 
In  fact,  we  are  disposed  to  regard  the  wooden  pivot,  either  simple  or 
stiffened  by  a  gold  wire,  as  much  the  best  for  a  sound  root  normally 
placed  in  the  alveolus. 

As  a  general  rule,  not  more  than  two  roots  should  be  prepared  at 
one  sitting,  though  sometimes  four  or  even  six  may  be  prepared  with- 
out incurring  any  risk.  "When  a  tooth  is  attached  by  any  of  the 
ordinary  modes  of  pivoting,  the  wall^  of  the  canal  in  the  root  are,  of 
necessity,  exposed  to  the  action  of  the  fluids  of  the  mouth,  and,  conse- 
quently, are  gradually  softened  and  broken  down  ;  so  that,  in  the 
course  of  a  few  years,  a  larger  pivot  will  be  required,  and  this,  too, 
will  have  to  be  again  replaced  with  one  still  larger,  until,  finally,  the 
root  is  destroyed.     This  destructive  process  proceeds  more  rapidly  in 


AND  ATTACHMENT  OF  AN   ARTIFICIAL  CROWN.      515 

some  cases  than  in  others,  accordingly  as  the  root  is  hard  or  soft,  and 
as  the  secretions  of  the  mouth  are  in  a  healthy  or  vitiated  condition. 
This  may  be  prevented  by  introducing  a  gold  cylinder  for  the  reception 
of  the  pivot.  This  protects  the  walls  of  the  canal  against  the  action 
of  corrosive  agents,  and  a  root  thus  prepared  will  support  an  artificial 
crown  more  than  twice  as  long  as  when  prepared  in  the  ordinary  way. 
The  operation,  however,  is  moi-e  tedious  and  expensive,  and  only  the 
larger  roots  will  permit  the  enlarged  size  of  canal  required. 

For  the  preparation  of  a  tooth  in  this  manner,  the  following  is  the 
method  of  procedure  :  First,  the  crown  of  the  natural  tooth  is  removed, 
the  nerve,  if  alive,  destroyed,  and  the  canal  in  the  root  enlarged  as 
before  directed.  Secondly,  a  screw-tap  is  introduced  for  the  purpose 
of  cutting  a  screw  on  its  inner  walls.  Thirdly,  a  corresponding  screw- 
thread  is  cut  on  a  piece  of  hollow  gold  wire,  during  which  process  the 
gold  tube  is  slipped  over  a  steel  mandril  to  prevent  compression.  This 
done,  it  may  be  screwed  into  the  root  about  a  quarter  of  an  inch  ;  the 
mandril  is  then  withdrawn,  and  the  lower  or  protruding  extremity 
dressed  off,  even  with  the  root,  with  a  very  fine  file.  Fourthly,  an  arti- 
ficial tooth  is  selected,  of  the  right  size,  shape,  and  color,  and  fitted  to 
the  root ;  after  which  a  gold  pivot  is  fixed  in  it  in  the  manner  before 
described,  corresponding  in  size  and  length  to  the  gold  tube  in  the  root. 
Having  proceeded  thus  far,  the  operation  is  completed  by  applying 
the  tooth  to  the  root,  but  little  pressure  being  required  to  force  up  the 
pivot. 

The  stability  of  a  tooth  secured  in  this  manner,  if  the  pivot  be  of 
the  proper  size,  is  as  great  when  first  inserted  as  one  prepared  by  any 
of  the  other  methods,  and  it  may  be  removed,  cleansed,  and  replaced 
at  the  pleasure  of  the  patient.  But  rnetal  against  metal  inevitably 
wears,  and  rapidly  so,  if  removed  from  time  to  time.  Hence  many 
prefer  the  wooden  pivot,  with  a  wire  run  through  its  centre.  When  the 
walls  of  the  canal  are  so  much  enlarged  by  decay  as  to  have  formed  a 
conical  shaped  cavity  in  the  lower  extremity  of  the  root,  the  upper  end 
only  of  the  cylindrical  screw  will  take  effect.  In  this  case,  the  space 
between  the  lower  extremity  and  the  walls  of  the  root  must  be  thor- 
oughly filled  with  gold  before  the  wire  on  the  inside  is  withdrawn ;  after 
which  the  tube  and  extruding  portions  of  the  gold  are  filed  off  even 
with  the  root,  and  polished,  before  the  artificial  tooth  is  applied. 

The  hollow  wire  is  made  by  partly  folding  a  narrow,  evenly-cut  strip 
of  gold  around  a  steel  mandril,  (a  knitting-needle  makes  an  excellent 
one,)  and  passing  thi'ough  a  draw-plate ;  withdraw  the  mandril  and 
solder  the  seam  ;  then  replace  the  mandril,  and  complete  the  drawing 
until  the  proper  thickness  is  given.  If  too  thin,  it  will  not  hold  the 
screw-thread ;  if  too  thick,  it  will  either  make  the  canal  too  small  or 


516  PREPARATION    OF    A    NATURAL    ROOT 

require  too  large  an  opening  in  the  root.  Hollow  wire  may  be  pro- 
cured of  the  proper  size  at  less  expense  of  time  and  money  than  it  can 
be  made  by  a  dentist.  It  is  known  by  jewellers  as  joint  idre,  because 
used  for  the  hinges  of  breast-pins,  etc.;  but  such  wire  is  rarely  over 
twelve  carats  fine. 

It  sometimes  happens  that  the  natural  root,  instead  of  occupying  its 
proper  position  in  the  jaw,  runs  very  obliquely;  so  that  if  the  pivot  con- 
necting the  artificial  tooth  to  it  be  straight,  the  latter  will  either  over- 
lap the  adjoining  teeth  or  else  project  outward  or  inward.  To  obviate 
this,  an  angle  should  be  given  to  the  pivot,  immediately  at  the  point 
of  junction  between  the  tooth  and  root.  If  this  obliquity  be  slight,  the 
wooden  pivot,  stiffened  with  wire,  can  easily  be  bent  to  suit ;  but  in 
cases  of  greater  obliquity,  a  solid  gold  pin  will  be  required. 

Some  cases  are  met  with  presenting  a  still  more  formidable  difficulty; 
as,  for  example,  when  the  root  is  situated  behind  the  circle  of  the  other 
teeth.  In  a  case  of  this  sort,  a  different  kind  of  tooth  and  an  entirely 
different  course  of  procedure  is  necessary.  After  having  pi'epared  the 
root,  an  impression  of  the  parts  is  taken  in  wax,  from  which  a  plas- 
ter model  is  obtained,  and  from  this  two  metallic  dies.  With  these  a 
gold  plate  is  to  be  swaged,  extending  backward  so  as  to  cover  the  root, 
and  forward  to  form  a  line  with  the  outer  circle  of  the  teeth.  To  the 
posterior  part  of  the  plate  covering  the  root,  and  directly  beneath  the 
cavity  in  it,  a  gold  pivot,  about  three-eighths  of  an  inch  long,  is  sol- 
dered, and  to  the  anterior  part  of  it  a  plate  tooth  of  the  right  size, 
shape,  and  shade  is  attached.  A  piece  of  hollow 
wood,  or  a  hollow  gold  screw  as  before  described,  is 
now  introduced  into  the  root,  and  into  this  the  gold 
pivot  is  inserted.  A  right  superior  central  incisor, 
mounted  on  a  plate  w'ith  a  pivot,  for  insertion  in 
the  manner  here  described,  is  represented  in  Figs. 
200  and  201. 

A  method  of  inserting  an  artificial  tooth  on  a  metallic  pivot  is  de- 
scribed by  the  late  Dr.  James  B.  Bean,  in  Vol.  III.,  1869-70,  of  the 
American  Journal  of  Dental  Science.  "  Having  filed  or  sawed  off 
the  remaining  portions  of  the  crown,  the  exposed  surface  of  the  root 
is  smoothly  filed  to  within  one-half  or  one-fourth  of  a  line  below  the 
margin  of  the  gum,  giving  it  a  slight  concave  appearance,  so  as  to 
accommodate  the  neck  of  the  plate  tooth  which  is  to  rest  against  it. 
It  is  well  at  this  stage  of  the  operation  to  stop  the  canal  loosely  with 
a  pellet  of  cotton  or  floss  silk  saturated  with  spirits  of  camphor,  and 
to  dismiss  the  patient  for  two  or  three  days.  If  no  inflammation  be 
present,  the  canal  may  then  be  cleaned  out  and  carefully  filled  with 
gold  foil  from  the  apex  to  within  four  or  five  lines  of  the  orifice. 


AT^D  ATTACHMENT   OF   AN  AETIFICIAL  CROWN.      517 

"The  remaining  portion  of  the  canal  not  filled  should  now  be  enlarged 
to  about  one  line  in  diameter,  if  the  size  of  the  root  will  admit  of  it, 
down  to  the  gold  filling,  making  the  bottom  smooth  and  solid  and  the 
sides  parallel.  The  orifice,  to  the  depth  of  nearly  a  line,  is  again 
enlarged  with  a  burr-drill  to  about  two  lines  in  diameter,  and  a  small 
groove  or  undercut  is  formed  around  the  margin  for  the  retention  of 
the  gold  filling  subsequently  to  be  introduced  around  the  tube. 

"  Hollow  gold,  jeweller's  wire,  or  simple  gold  tubes  made  of  gold  plate, 
may  be  employed.  If  the  latter  is  chosen,  it  is  formed  by  bending  a 
piece  of  ordinary  gold  plate  around  a  wire,  so  as  to  form  a  cylinder 
sufiiciently  large  to  fit  the  smaller  portion  of  the  canal  prepared  for 
it ;  then  solder  with  the  finest  gold  solder.  A  piece  of  the  tube  half 
an  inch  in  length  should  be  cemented  with  shellac  into  a  hole  bored 
through  a  piece  of  wood  half  an  inch  in  thickness,  to  serve  for  a  han- 
dle ;  the  interior  is  then  carefully  dressed  out  with  a  jeweller's  broach 
which  has  a  slight  taper,  making  it  smooth  and  regular  within.  A 
solid  gold  wire  pivot  is  now  carefully  filed  and  fitted,  by  grinding  it 
with  fine  emery  and  water,  making  a  'ground  joint,'  whereby  the 
pivot  is  firmly  held  when  in  place.  Any  portion  of  the  wire  that  may 
project  beyond  the  smaller  end  of  the  tube  should  be  cut  evenly  off", 
while  at  the  larger  end  it  should  project  at  least  one-fourth  of  an  inch. 

"  The  tube  must  be  taken  out  of  the  cement  and  a  piece  of  plate  sol- 
dered to  the  smaller  end,  forming  a  bottom.  An  easier  flowing  solder 
should  be  used  for  this,  so  as  not  to  disturb  the  first.  This  tube  thus 
formed,  after  being  cleansed  in  acid  and  smoothly  filed,  is  ready  to  be 
inserted  into  the  root. 

"Some  have  proposed  to  cut  a  screw  on  the  tube,  whereby  it  is  firmly 
secured  in  its  place,  and  to  fill  then  around  with  gold.  But  the  most 
convenient  way  is  to  cut  a  number  of  barbs  with  a  sharp  knife  on  the 
outside  looking  toward  the  open  end ;  this  retains  the  gold  in  place 
nearly  or  quite  as  well  as  the  screw.  Being  made  so  as  to  enter  the 
root  rather  loosely,  several  folds  of  gold  foil  are  wrapped  around  it, 
and  after  carefully  drying  the  parts  with  bibulous  paper — the  pivot 
being  in  its  place  in  the  tube  —  the  whole  is  forced  to  the  bottom  of 
the  cavity,  and  the  loose  portions  of  foil  removed. 

"Having  previously  prepared  some  adhesive  foil,  the  space  around 
the  tube  is  perfectly  filled  with  gold.  The  gold  pivot  is  now  removed, 
and  the  tube  carefully  sawed  or  filed  off*  nearly  level  with  the  end  of 
the  root,  and  the  surface  of  the  gold  and  the  root  well  polished. 

"Thus  far  we  have  the  root  preserved  with  a  good  filling,  and  a  gold 
tube  firmly  secured  in  it  containing  an  accurately  fitting  gold  pivot. 

"The  next  operation  is  to  attach  a  suitable  tooth  to  the  pivot,  and  for 
this  purpose  a  plain  plate  tooth  is  selected  that  will  be  suitable  in  size, 


518  PREPARATION    OF    A    NATURAL    ROOT 

shape,  and  color.  This  tooth  should  be  so  ground  and  fitted  to  the 
anterior  edge  of  the  root  that  the  free  margin  of  the  gum  will  cover 
the  point  of  union.  Then  after  soldering  a  strong  backing  to  the  tooth, 
it  is  fitted  to  its  position,  with  the  gold  pivot  in  place,  on  which  has 
been  soldered  a  small  shoulder  or  ring  of  plate,  and  the  projecting 
portion  of  the  wire  cut  off.  This  shoulder  is  to  be  made  in  the  form  of 
a  disk,  cut  out  of  gold  plate,  larger  than  the  diameter  of  the  pivot,  then 
perforated  with  a  hole  just  large  enough  to  admit  the  pivot  up  to  the 
point  a  little  less  than  the  depth  of  the  tube.  Being  retained  at  this 
point,  it  is  made  to  fit  closely  down  on  the  root;  the  whole  is  then  care- 
fully withdrawn  and  bedded  up  to  the  ring  in  plaster  and  asbestos, 
thoroughly  dried,  the  wax  removed,  and  the.  piece  soldered  with  fine 
solder.  If  the  ring  is  loose,  it  must  be  kept  in  place  by  wax  or  plaster 
in  the  act  of  withdrawing  it  from  the  tube.  The  pivot  is  again  tried 
in  the  mouth,  and,  if  satisfactory,  the  projecting  portion  is  cut  off, 
smoothly  filed,  and  the  tooth  attached  to  it  with  shellac ;  then  try  in 
the  mouth,  and  alter  its  position  if  necessax-y.  If  the  pivot  does  not  fit 
too  tightly,  the  whole  can  be  withdrawn  together,  carefully  invested  in 
plaster  and  asbestos,  and  strongly  soldered.  The  piece  is  now  finished 
up,  reducing  the  shoulder  around  the  pivot  to  less  than  half  a  line  in 
breadth  ;  a  large  plate  covering  the  end  of  the  root  has  no  advantage, 
and  would  only  form  a  lodgment  for  food  and  the  secretions  of  the 
mouth,  inducing  decomposition  and  the  destruction  of  the  root. 

"  If  the  pivot  is  not  retained  sufficiently  firm  in  the  tube,  it  may  be 
wrapped  with  a  few  fibres  of  floss  silk  or  cotton,  and  when  forced  into 
its  place  with  a  slight  rotary  motion,  it  will  remain  quite  firm,  and  can 
be  used  with  great  satisfaction.  If  the  adjustments  have  been  properly 
made,  the  shoulder  or  flange  will  fit  closely  on  the  edge  of  the  tube, 
the  neck  of  the  tooth  resting  on  the  beveled  edge  made  for  it,  thereby 
preventing  the  tooth  from  turning  on  its  axis.  Proper  care  and  clean- 
liness, removing  the  tooth  at  least  three  times  a  week,  will  enable  such 
a  piece  to  be  used  with  satisfaction  for  many  years." 

Fig.  202  represents  an  antero-posterior  section  of  a 
superior  central  incisor  root  pivoted  in  the  manner 
above  described,  a,  dentine  of  root ;  b,  porcelain  tooth ; 
c,  pivot  surrounded  by  the  tube;  d,  backing,  which  is 
soldered  to  the  tooth  and  to  the  pivot ;  e,  filling  be- 
tween the  end  of  tube  and  apex  of  the  root ;  /,  filling 
around  the  tube  by  which  it  is  retained  in  place;  g, 
flange  resting  on  the  edge  of  the  tube ;  h,  junction  of 
the  tooth  and  root,  concealed  by  the  margin  of  gum. 

Another  method  for  inserting  an  artificial  crown  on 
a  metallic  pivot  is  that  of  Dr.  T.  J.  Thomas,  by  which 


AND  ATTACHMENT  OF  AN  ARTIFICIAL  CROWN.      519 

the  end  of  the  root  is  protected  from  the  action  of  deleterious  agents, 
and  a  firm  support  given  to  the  tooth.  It  is  thus  described  hj  Prof. 
Gorgas : 

"Prepare  the  root  as  for  an  ordinary  wooden  pivot;  then  select  a 
plate  tooth  of  the  proper  size,  shape,  and  shade,  and  fit  it  by  grinding 
accurately  to  the  prepared  root. 

"  After  this  is  done,  enlarge  the  pulp-canal  by  reaming  it  out  as 
large  as  the  root  will  permit ;  that  is,  make  a  conical-shaped  cavity 
in  the  exposed  surface  of  the  root,  allowing  the  margin  of  this  cavity 
to  be  quite  near  to  the  periphery  of  the  root,  with  slight  undercuts  or 
retaining  points  on  the  anterior  and  posterior  walls, 

"  After  this  cavity  is  prepared,  and  that  portion  of  the  pulp-canal 
beyond  it  filled  to  the  apex  of  the  root  with  gold,  make  a  square  me* 
tallic  pivot  of  twenty-carat  gold  alloyed  with  platinum,  in  the  propor- 
tion of  five  parts  of  gold  to  one  of  platinum.  This  pivot  is  made  in 
two  parts,  which  are  soldered  together  at  the  base  of  the  artificial 
crown,  and  slightly  wedge-shaped.  After  the  pivot  is  prepared,  a  thin 
piece  of  platinum  plate  is  bent  around  it,  thus  forming  a  square  cylin- 
der into  which  the  pivot  perfectly  fits.  The  pivot  is  then  carefully 
drawn  out  of  the  square  cylinder,  and  the  edges  of  this  cylinder  sol- 
dered with  pure  gold.  The  pivot  is  again  inserted,  and  the  excess  of 
solder  and  any  rough  edges  which  may  be  found  in  the  cylinder  filed  off. 

"After  this  is  done,  the  cavity  in  the  root  is  carefully  dried  and  pro- 
tected from  moisture,  and  the  square  cylinder,  with  the  pivot  inside 
of  it,  is  placed  in  the  centre  of  this  cavity,  which  is  filled  around  it 
with  gold  in  as  careful  and  perfect  a  manner  as  any  crown  cavity. 
The  gold  is  allowed  to  overlap  the  margin  of  the  cavity,  so  as  to  per- 
fectly protect  all  of  the  exposed  —  or  what,  in  the  ordinary  method, 
would  be  the  exposed  —  surface  of  the  root. 

"  The  gold  filling,  besides  protecting  the  root,  retains  the  square 
cylinder  in  the  centre  of  it.  In  placing  the  cylinder  in  the  root  with 
the  pivot  in  it,  preparatory  to  inserting  the  gold  filling  around  it,  the 
split  in  the  pivot  should  range  directly  back  from  the  labial  to  the 
palatine  surfaces,  and  not  transversely.  The  pivot,  after  the  filling  is 
inserted,  is  drawn  out  of  the  cylinder,  which  remains  firmly  fixed  in 
the  root,  and  that  part  of  the  cylinder  which  projects  beyond  the  gold 
is  filed  down  to  a  level  with  the  surface  of  the  filling.  An  impression 
of  this  surface  is  then  taken  with  wax  or  gutta-percha,  and  die  and 
counter-die  made  of  fusible  metal,  by  means  of  which  a  disk  of  plati- 
num plate  is  swaged  to  fit  accurately  the  concave  surface  of  the  gold 
filling  in  the  root. 

"  When  this  is  done,  the  convex  surface  of  the  disk  is  thinly  covered 
with  wax,  and  the  disk  placed  in  its  proper  position  over  the  gold  fill- 


520       PREPARATION    OF    A    NATURAL    ROOT,    ETC. 

ing  in  the  root  and  sliglitly  pressed  on  it,  in  order  to  obtain  an  impres- 
sion of  the  square  orifice  of  the  cylinder,  by  which  a  hole  correspond- 
ing in  shape  and  position  may  be  cut  in  the  disk.  The  outer  end  of 
the  pivot  is  then  inserted  in  the  square  hole  made  in  the  disk,  secured 
by  means  of  wax,  and  the  whole  returned  to  the  root,  (with  pivot  ih 
the  cylinder,)  in  order  to  make  certain  that  the  pivot  is  in  its  proper 
position  ;  then  it  is  carefully  removed  and  secured  by  an  investment 
i)f  plaster  and  asbestos,  that  the  pivot  may  be  soldered  to  the  disk, 

"The  projecting  portion  of  the  pivot  above  is  filed  down  to  a  level 
with  the  concave  surface  of  the  disk,  and  the  disk  and  pivot  returned 
to  the  cylinder  in  the  root,  when  the  j^livte  tooth  is  j)laced  in  position 
and  secured  to  the  disk  by  means  of  wax. 

'  "  This  done,  tlie  pivot,  disk,  and  the  plate  tooth  are  carefully  re- 
moved and  invested  in  plaster  and  asbestos,  in  order  that  a  backing  of 
gold  may  be  made,  and  the  tooth  soldered  to  it  and  the  disk.  The 
tooth  is  now  ready  to  be  inserted,  and  by  slightly  separating  the  two 
parts  which  form  the  pivot,  at  its  apex  or  free  extremity,  it  will  tightly 
fit  the  cylinder,  the  two  halves  acting  as  springs  and  pressing  against 
the  walls  of  the  square  cylinder  inserted  in  the  root." 

In  the  chapter  on  vulcanite,  the  use  of  that  material  in  attaching 
an  artificial  crown  to  a  natural  root  is  described. 

Prof.  Austen,  in  summing  up  the  merits  of  pivot -teeth  and  of  the 
various  processes  used,  concludes :  That  the  old  -  fasliioued  jDJain 
hickory  (or  other  hard  wood)  pivot  is  the  firmest,  and,  whenever  appli- 
cable, the  best ;  that  one  or  both  central  incisors,  if  no  other  deficien- 
cies call  for  a  plate,  are  best  inserted  in  this  way ;  but  that  three  or 
more  roots  in  the  same  mouth  (and,  of  course,  in  the  same  jaw,  since 
lower  teeth  should  never  be  pivoted)  are  better  replaced  by  teeth  fitted 
to  the  roots,  but  attached  to  a  plate;  in  which  case  a  slight  projection 
of  the  plate  (if  vulcanite)  into  the  canal  would  perhaps  give  greater 
steadiness  to  the  piece.  In  reference  to  metallic  j^ivots  and  other  very 
ingenious  attachments,  they  require  much  care,  skill,  and  time ;  hence 
are  necessarily  expensive.  He,  therefore,  does  not  advise  their  use  in 
any  mouth  containing  a  base-plate  for  other  teeth  ;  but  when  the  diffi- 
cult case  is  the  only  lost  tooth  to  be  replaced,  the  circumstances  may 
be  such  as  to  justify  any  amount  of  trouble  or  expense.  It  should  be 
remembered  that  very  delicate  mechanism  is  liable  to  injury  under 
the  strong  force  of  mastication ;  tliat  a  metallic  pin  cannot  be  as  firm 
in  its  canal  as  a  wooden  one  tightened  by  swelling;  and  that  the 
habitual  removal  of  the  tooth  necessarily  wears  and  loosens  the  pin. 


MANNEE    OF    EEFIJSriNG    GOLD,    ETC.  521 


CHAPTER  VI. 

MAYNER    OF    REFINING    AND    ALLOYING    GOLD,    AND    CALCULA- 
TING  ITS    FINENESS. 

GOLD  is  the  best  metal  and,  for  general  use,  the  best  material,  that 
can  be  used  for  the  attachment  of  artificial  teeth.  When  used 
of  proper  fineness,  it  resists  the  most  acrid  secretions  of  the  mouth,  and 
undergoes,  during  long  years  of  use,  no  change  in  its  strength,  form,. 
or  texture.  Other  metals  and  materials  have  a  special  utility,  but 
none  have  so  wide  a  range  of  usefulness,  and  none  can  take  the  place 
which  this  royal  metal  holds  in  dental  prosthetics. 

Although  thre  manner  of  refining,  alloying,  and  manufacturing  gold 
into  plate,  solder,  etc.,  may  not,  perhaps,  be  regarded  as  coming  prop- 
erly within  the  province  of  the  dentist,  yet,  as  he  often  experiences 
great  difficulty  in  procuring  them  of  the  right  quality,  a  brief  descrip- 
tion of  these  several  processes  is  necessary.  Especially  is  this  neces- 
sary, since  the  dental  depots  seldom  keep  on  hand  any  gold  plate  finer 
than  eighteen  carats.  This  we  consider  discreditable  to  the  profession 
which  calls  for  so  inferior  a  quality  of  metal,  rather  than  to  those  whose 
business  it  is  to  supply  their  demands.  Twenty-carat  plate  can  as  readily 
be  kept  on  hand  by  manufacturers  as  tvrenty-four  carat  foil.  Moreover, 
some  practitioners  are  so  situated  that  they  cannot  use  gold  plate,  un- 
less they  know  how  to  prepare  it  from  coin. 

Gold  in  its  pure  state,  free  from  alloy,  is  too  soft  and  yielding  to  serve 
as  a  suitable  support  for  artificial  teeth ;  but  if  it  contains  too  much  or 
an  improper  alloy,  it  will  become  tarnished  by  the  secretions  of  the 
mouth,  rendered  too  brittle  for  service,  through  those  molecular  changes 
which  take  place,  wnth  greater  or  less  rapidity,  if  the  plate  is  less  than 
twenty  carats  fine.  It  is,  therefore,  of  the  utmost  importance  that  the 
gold  used  in  connection  with  artificial  teeth  should  be  of  the  proper 
fineness,  and  possessed  of  the  requisite  malleability.  To  secure  these 
qualities,  it  is  necessary  to  know  the  kind  and  quantity  of  metal  with 
which  to  alloy  it  before  it  is  made  into  plate  or  other  forms  necessary 
for  the  purposes  for  whica  it  is  to  be  employed. 

Gold  clippings,  filings,  and  other  scraps  and  parts  of  old  gold  pieces, 
as  found  in  the  laboratory,  are  apt  to  become  mixed  with  base  metals, 
such  as  iron  from  the  wearing  of  files,  and,  occasionally,  small  particles 
of  lead,  tin,  or  zinc.  If  these  are  melted  with  and  permitted  to  remain 
in  the  gold,  they  will  destroy  its  ductility,  and  render  it  unfit  for  use. 


522  GOLD    ALLOYS. 

Iron,  less  objectionable  than  the  lead  or  tin,  may  ahvays  be  removed 
with  a  magnet  before  the  gold  is  melted ;  but  to  free  it  perfectly  fi-om 
the  others,  it  will  sometimes  be  necessary  to  refine  it  in  the  manner 
presently  to  be  described.  A  two-thousandth  part  of  tin  or  lead  de- 
stroys the  ductility  of  gold,  and  even  exposure  to  the  fumes  of  red-hot 
tin  or  lead  renders  it  exceedingly  hard  and  brittle.  Antimony,  or 
bismuth,  when  mixed  with  gold,  exerts  upon  it  a  very  similar  effect. 
So  marked  is  the  influence  of  antimony  in  injuring  one  of  the  most 
valuable  properties  of  gold,  that  its  original  name  regulus  (little  king), 
by  which  it  is  best  known  in  commerce,  was  given  in  view  of  this  con- 
trolling effect  upon  the  king  of  metals.  It  is  of  the  utmost  importance 
to  bear  in  mind  the  actioA  of  minute  quantities  of  these  four  metals, 
so  much  used  in  tlie  laboratory,  upon  gold,  platina,  and  silver. 

Platina,  united  with  gold  in  certain  proportions,  has  the  effect  of 
hardening  the  latter  metal  and  making  it  very  elastic,  but  does  not 
materially  affect  its  ductility.  The  affinity  of  the  alloy  for  oxygen, 
however,  is  so  great,  that  it  is  readily  acted  upon  by  nitric  acid.  The 
acids  of  the  mouth  will  often  make  this  alloy  very  brittle.  But  for  this, 
the  two  metals,  combined  in  the  proportion  of  fifteen  parts  of  gold  to  one 
of  platina,  would  form  an  exceedingly  useful  alloy  for  the  construction 
of  spiral  springs.  That  a  combination  of  two  metals  should  be  thus 
easily  acted  on  by  an  agent  incapable  of  acting  on  either,  when  in  a 
separate  state,  may  appear  somewhat  remarkable,  but  it  is,  neverthe- 
less, true.  We  have  in  the  effect  of  platina  upon  steel  an  analogous 
case.  It  makes  the  steel  exceedingly  hard  and  fine-grained ;  but 
although  itself  totally  insensible  to  the  action  of  oxygen,  when  alloyed 
in  minute  quantity  with  steel,  it  causes  this  latter  metal  to  oxidize  with 
such  readiness  as  to  make  it  unfit  for  use. 

Hence  may  be  seen  the  fallacy  of  the  idea  entertained  by  many  that 
because  platina  is  a  more  indestructible  metal  than  silver  or  copper, 
it  must  necessarily  make  a  purer  plate.  The  properties  of  alloys  are, 
in  fact,  so  often  and  so  widely  different  from  those  of  their  component 
metals,  that  they  can  be  ascertained  only  by  experiment.  Of  the  three 
metals,  platina,  silver,  and  copper,  speculative  theory  might  select  the 
first  and  purest  as  the  best  alloy  for  gold ;  whereas  actual  experience 
demonstrates  that  copper,  itself  the  most  injurious  to  the  mouth,  im- 
parts most  perfectly  to  gold,  if  kept  within  pi'oper  limits,  those  quali- 
ties which  are  required  in  a  dental  plate. 

In  view,  then,  of  the  importance  of  having  gold,  which  is  to  be  placed 
in  the  mouth,  of  the  right  quality,  every  dentist,  who  has  connected 
with  his  practice  a  mechanical  laboratory,  should  have  the  necessary 
fixtures  for  melting  and  working  this  metal  into  the  various  forms 
required  for  dental  purposes.     The  principal  of  these  are,  a  small 


EEFINING    GOLD.  523 

furnace,  with  crucibles  and  tongs,  ingot-moulds,  an  anvil  and  ham- 
mers, and  a  rolling  mill ;  a  ]Dlate-gauge,  draw-plate,  and  bench-vice ; 
fluxing  and  refining  chemicals,  etc. 

REFINING   GOLD. 

It  is  not  our  intention,  in  describing  the  manner  of  refining  gold, 
to  enter  into  a  minute  detail  of  the  various  methods  employed  for 
assaying  or  refining  this  metal,  but  to  point  out,  as  briefly  as  possible, 
the  manner  of  separating  it  from  the  several  metals  with  which  it  is 
most  frequently  combined  in  the  dentist's  laboratory. 

The  method  usually  employed  by  assayers  for  separating  gold  from 
silver  is  to  roll  the  alloy  out  into  very  thin  plates,  and  put  it  in  nitric 
acid ;  this  will  dissolve  most  of  the  silver,  and  leave  the  gold  behind 
in-  the  form  of  brown  plates,  scales,  or  powder,  which  after  being 
thoroughly  washed  is  put  into  a  crucible  with  borax  and  melted 
down  into  an  ingot  of  pui'e  gold.  But  this  method  will  not  succeed, 
unless  the  quantity  of  silver  be  equal  to  two  or  three  times  that  of  the 
gold ;  for  the  nitric  acid  which  acts  only  upon  the  silver  (and  copper) 
cannot  eat  out  all  the  alloy  if  its  particles  are  too  much  surrounded 
with  the  particles  of  gold.  From  the  old  rule — one-fourth  gold, 
three-fourths  alloy — came  the  name  given  to  this  process,  quartation : 
it  is  also  known  as  the  nitric  acid  process.  It  is  well  adapted  to  the 
purification  of  gold  upon  a  large  scale,  and  is  the  process  used  in  the 
U.  S.  Mint.  But  it  does  not  remove  the  platina  so  generally  found 
in  dentists'  scrap ;  and  is  not  so  well  adapted  for  gold  of  eighteen 
carat  fineness  and  upward  as  the  next  process. 

The  nitro-muriatic  or  aqua-regia  process  dissolves  all  the  metals  of 
the  alloy,  but  immediately  precipitates  the  silver.  The  gold  is  subse- 
quently precipitated  in  a  state  of  purity,  thoroughly  washed,  dried,  and 
melted  down  with  borax.  The  process  is  briefly  as  follows.  Melt  the 
scrap  to  be  refined ;  roll  into  a  thin  strip  and  curl  it  up  into  what  is 
technically  termed  a  cornet;  place  in  a  porcelain  vessel  and  pour  on 
the  aqua-regia,  three  or  four  ounces  to  the  ounce  of  alloy,  which  must 
be  mixed  at  the  moment  of  using,  in  the  proportion  of  one  part  of  pure 
nitric  acid  to  two,  two  and  a  half,  or  three  parts  of  hydrochloric  acid ; 
quicken  the  solution  by  heat  from  a  spirit-lamp,  setting  the  vessel  where 
the  nitrous  fumes  can  escape  from  the  room ;  decant  or  filter  the  solu- 
tion so  as  to  separate  the  precipitated  silver ;  evaporate  the  clear  solu- 
tion over  a  spirit-lamp,  nearly  to  dryness,  add  hydrochloric  acid  and 
evaporate  a  second  time,  so  as  to  get  rid  of  all  nitric  acid. 

The  concentrated  orange-colored  solution  is  the  chloride  of  gold  to- 
gether w^ith  the  chloride  of  platina  and  other  metals  from  which  it 
must  be  separated  by  precipitation.     Dilute  largely  with  water,  and 


524  REFINING    GOLD. 

add  little  by  little  a  solution  of  the  proto-sulphate  of  iron  (green  vit- 
riol), until  the  dark  olive-brown  precipitate,  -which  instantly  appears, 
ceases  to  form.  Pour  on  this  precipitate  some  sulphuric  acid  to  remove 
all  trace  of  iron,  and  then  wash  several  times  with  hot  water,  dry  it, 
and  melt  with  borax  in  a  crucible. 

If  the  presence  of  much  platina  is  suspected,  the  solution  should  be 
treated  with  muriate  of  ammonia  (sal  ammoniac)  after  the  gold  has 
been  removed.  This  will  precipitate  the  platina,  which  should  be  washed, 
dried,  and  sold,  inasmuch  as  the  dentist  has  no  heat  sufficiently  intense 
to  melt  it.  If  the  alloy  to  be  refined  consists  simply  of  gold  and 
platina,  the  aqua-regia  solution,  after  being  made  neutral  by  twice 
evaporating  nearly  to  dryness,  should  be  diluted  with  water  and  the 
platina  precipitated  by  muriate  of  ammonia;  then  decant  the  gold 
solution  from  the  platina  and  precipitate  the  gold  by  the  proto-sulphate 
of  iron. 

A  third  method  of  refining  is  the  sulphuric  acid  process,  which  it  is 
unnecessary  to  describe  further  than  to  say  that  it  resembles  the  quarta- 
tion  process.  Gold  is  melted  with  five  to  seven  times  as  much  silver, 
granulated  and  then  boiled  three  or  four  hours  in  a  platina  or  iron 
retort  with  sulphuric  acid. 

By  any  of  these  three  processes,  but  most  conveniently  by  the  sec- 
ond, dental  scrap  may  be  refined  to  a  purity  suflacient  for  every  practi- 
cal purpose.  The  assayer  resorts  to  other  methods  to  obtain  the  absolute 
purity  required  in  analyses. 

Gold  still  containing  traces  of  silver  may  be  treated  with  sulphuret 
of  antimony.  This  is  done  with  a  strong  heat  in  a  covered  crucible, 
and  after  the  gold  has  been  kept  in  a  state  of  fusion  for  some  thirty  or 
forty  minutes  it  should  be  poured  out  into  an  ingot-mould,  and  sepa- 
rated from  the  antimony,  which  will  lie  at  the  top.  It  may  be  neces- 
sary to  melt  it  in  this  way  two  or  three  times,  adding,  each  time,  a  less 
quantity  of  antimony ;  at  the  last  melting,  a  current  of  air,  from  a  pair 
of  bellows,  should  be  thrown  upon  the  surface  of  the  fused  metal  to 
evaporate  the  antimony,  and  after  the  vapor  ceases  to  escape,  a  little 
refined  nitre  and  borax  should  be  thrown  into  the  crucible.  It  should 
then,  in  a  few  minutes,  be  poured  into  the  ingot-mould  ;  should  it  crack 
in  hammering  or  rolling,  it  must  be  again  melted,  and  a  little  more 
nitre  and  borax  thrown  on  it. 

Still  another  process  for  refining  gold  is  occasionally  used,  called 
cementation.  It  consists  in  first  rolling  the  gold  out  into  exceedingly 
thin  plates,  then  placing  it  in  a  crucible  with  a  mixture  of  four  parts 
of  brickdust,  one  of  calcined  sulphate  of  iron,  and  one  of  chloride  of 
soda.  A  bed  of  this  mixture  or  cementing  powder  is  first  placed  in 
the  bottom  of  the  crucible ;  the  gold  is  then  put  in  and  covered  with 


EEFIXIXG    GOLD.  525 

it.  The  crucible  is  covered  with  anotlaer  crucible,  the  joints  well  luted 
with  clay,  and  gradually  raised  to  a  red  heat,  at  which  temperature  it 
should  be  kept  from  twenty  to  twenty-four  hours.  The  crucible  is  then 
removed  from  the  fire,  the  top  broken  off,  and  after  it  has  cooled,  the 
gold  may  be  separated  from  the  cement  and  washed,  or,  what  is  still 
better,  boiled  in  hot  water. 

The  form  of  furnace  for  melting  gold  depends  much  upon  the  kind 
of  fuel.  Charcoal,  coke,  and  anthracite  are  the  three  kinds  used ;  bitu- 
minous coal  is  inadmissible  until  converted  into  coke.  The  stove  fac- 
tories now  furnish  so  many  convenient  forms  for  the  use  of  any  of  these 
fuels  that  we  shall  not  occupy  time  or  space  in  their  detailed  descrip- 
tion. A  pipe  six  feet  high  Avill  give  to  the  ordinary  "preserving  fur- 
nace "  a  draft  sufiicient  to  melt  gold  with  charcoal :  coke  gives  a  very 
intense  heat,  but  needs  a  stronger  draft ;  anthracite  requires  a  powerful 
draft,  but  gives  a  more  steady  heat,  needs  less  frequent  renewal,  and 
hence  is  better  for  long-continued  heats. 

As  regards  the  shape  and  size  of  the  stove,  the  following  points  should 
be  attended  to :  convenience  of  access  to  the  crucible  ;  sufficient  depth 
and  width  to  surround  the  crucible  with  a  good  body  of  fuel,  without 
unnecessary  waste  of  material.  Furnaces  acting  by  simple  draft  will 
be  found  to  answer  better  than  blast  furnaces. 

The  Ceylonese  goldsmiths  use  a  blast  furnace  of  very  rude  and  sim- 
ple construction.  It  consists  of  a  small,  low,  earthen  pot,  filled  with 
chafi",  or  sawdust,  on  which  a  little  charcoal  fire  is  made,  which  is  excited 
with  a  small  bamboo  blow-pipe,  about  six  inches  long,  the  blast  being 
directed  through  a  short  earthen  pipe  or  nozzle,  the  end  of  which  is 
placed  at  the  bottom  of  the  fire.  By  this  simple  contrivance,  a  most 
intense  heat  may  be  obtained,  greater,  it  is  said,  than  is  required  for 
melting  gold  or  silver. 

For  separating  iron,  copper,  tin,  lead,  or  zinc,  from  gold,  the  follow- 
ing simple  method  may  be  adopted :  after  passing  a  magnet  a  number 
of  times  through  the  filings  or  fragments,  to  remove  all  traces  of  h'on 
or  steel,  put  the  gold  in  a  clean  crucible,  covered  with  another  crucible, 
having  a  small  opening  or  hole  through  the  top ;  lute  the  two  together 
with  clay,  place  them  in  a  bed  of  charcoal  in  the  furnace,  ignite  the 
coal  gradually,  afterward  increase  the  combustion  by  means  of  a  cur- 
rent of  air  from  a  pair  of  bellows  or  by  turning  on  the  draft ;  after  the 
gold  has  melted,  throw  in  at  intervals  of  about  ten  minutes  several 
small  lumps  of  nitrate  of  potash  (saltpetre)  and  sub-borate  of  soda 
(borax),  and  keep  it  in  a  fused  state  for  thirty  or  forty  minutes  ;  then 
remove  the  crucible,  and  plunge  in  water  to  cool  it;  break  it  and  sep- 
arate the  lump  of  gold  from  the  dross ;  then  put  into  another  crucible, 
melt  with  a  little  borax,  and  pour  into  an  ingot-mould,  of  the  proper 


526  REFINING    GOLD. 

size,  previously  warmed  and  oiled.  Bichloride  of  mercury  (corrosive 
sublimate)  is  sometimes  used  instead  of  or  after  nitre  for  the  purpose 
of  dissipating  the  base  metals,  and  often  with  more  certain  and  better 
results,  csi)ecially  where  the  presence  of  any  tin  is  suspected.  If  the 
gold  cracks  on  being  hammered  or  rolled,  it  should  be  melted  again, 
and  more  nitre  and  borax  thrown  into  it ;  the  inside  of  the  crucible 
should  also  be  well  rubbed  with  borax,  before  the  metal  is  put  in.  It 
is  sometimes  necessary  to  repeat  this  process  several  times,  and  if  the 
gold  still  continues  brittle,  a  little  muriate  of  ammonia  (sal  ammoniac) 
may  be  thrown  into  the  crucible  when  the  gold  is  in  a  fused  state ;  after 
the  vapor  ceases  to  escape,  the  metal  should  be  poured  into  an  ingot- 
mould,  warmed  and  oiled  as  before  directed.  This  last  method  of  treat- 
ment will  make  the  gold  tough,  and  prevent  it  from  cracking  under  the 
hammer,  or  while  being  rolled,  provided  it  is,  from  time  to  time,  prop- 
erly annealed  during  the  process. 

By  this  method  of  refining  gold,  known  as  the  drxj  process,  or  "  re- 
fining by  fire,"  sufficiently  accurate  results  will  be  obtained  for  many 
of  the  practical  purposes  of  mechanical  dentistry ;  since  the  variation  of 
an  eighth  or  a  quarter  of  a  carat  in  the  fineness  of  gold  plate  is  not  often 
a  matter  of  much  consequence.  Comparing  the  two  classes  of  refining 
processes  —  the  hiunid,  by  acids,  and  the  dry,  by  fire  —  the  first  is  the 
more  accurate,  and  the  only  way  to  remove  platina  or  silver;  but  it  is 
the  most  troublesome,  and  requires  a  familiarity  with  chemical  details, 
which,  unfortunately,  many  dentists  are  totally  ignorant  of.  The 
second  may  remove  the  lead,  tin,  zinc,  antimony,  and  bismuth,  if  in 
small  quantity ;  and  if  continued  for  a  sufficient  length  of  time,  with 
a  free  use  of  nitre,  may  remove  a  large  proportion  of  copper.  It  can 
scarcely  be  depended  upon  if  the  object  is  to  make  an  ingot  of  pure 
gold,  but  will  answer  admirably  if  the  purpose  is  merely  to  lessen  the 
alloy  or  remove  certain  impurities. 

As  the  dry  process  is  one  that  the  dentist  will  often  have  occasion 
to  resort  to,  we  shall  give  (from  the  seventh  volume  of  the  American 
Journal  of  Dental  Science)  the  following  description  of  the  very  ex- 
cellent method  pursued  by  Dr.  Elliot,  of  Montreal : 

"  The  following  implements  are  necessary  for  this  purpose  :  a  small 
draught  furnace,  a  quantity  of  fine  hard-wood  coal,  a  clean  crucible 
with  a  sheet-iron  cover  (a  lump  of  charcoal  is  better),  a  light  pair  of 
crucible-tongs,  an  ingot-mould  made  of  soapstone,  a  little  nitrate  of 
potash,  carbonate  of  potash,  borax  and  oil.  The  fireplace  of  the  fur- 
nace should  be  about  ten  inches  in  diameter,  and  eight  or  ten  deep ; 
this  should  be  connected  by  means  of  a  pipe  with  the  chimney,  so  that 
a  powerful  draught  may  be  made  to  pass  through  the  coal.  A  blast- 
furnace is  objectionable,  for  the  reason  that  the  bellows  burns  out  the 


MELTING    GOLD.  527 

coal  immediately  under  the  crucible,  and  it  is,  therefore,  constantly 
dropping  down,  which  is  not  the  case  with  the  draught-furnace ;  be- 
sides, the  draught-furnace  produces  a  more  even  fire,  a  quality  equally 
indispensable. 

"  In  preparing  for  a  heat,  the  furnace  should  be  filled  about  half  full 
of  coal,  and  after  it  is  well  ignited,  it  should  be  consolidated  as  much 
as  practicable  without  choking  the  draught.  The  crucible  containing 
the  metal  and  a  little  borax  may  then  be  set  on,  and  more  coal  placed 
around  and  over  it,  the  door  of  the  furnace  closed,  and  the  damper 
opened.  It  should  remain  in  this  way  until  the  gold  is  perfectly  fused. 
The  coal  may  then  be  removed  from  over  the  crucible,  and  a  bit  of 
nitrate  of  potash  ,dropped  in,  in  quantity  equal  to  the  size  of  a  pea  to 
every  ounce  of  gold,  and  the  crucible  immediately  covered  with  a  plate 
of  iron.  More  coal  rnay  then  be  placed  over  and  around  the  crucible, 
and  the  gold  kept  in  a  fused  state  at  a  high  temperature,  until  the 
scoria  ceases  to  pass  off",  which  it  will  do  in  the  course  of  five  or  six 
minutes.  The  ingot-mould,  having  been  previously  warmed,  should  be 
placed  in  a  convenient  position  for  pouring,  and  filled  about  half  full 
of  lamp-oil.  The  cover  should  now  be  thrown  off  quickly,  the  crucible 
seized  with  the  tongs,  and  at  the  same  instant  another  small  bit  of 
nitrate  of  potash  should  be  thrown  into  it,  and  the  gold  rapidly,  but 
carefully,  poured  into  the  mould. 

"  The  ingot  always  cools  first  at  the  edges,  and  shrinks  away  from 
the  middle.  On  that  account,  the  mould  should  be  a  little  concave 
on  the  sides,  so  that  the  shrinking  will  not  reduce  the  ingot  thinner  in 
the  centre  than  at  the  edges. 

"  Moulds  of  the  best  form  will  sometimes  produce  ingots  of  irregular 
thickness.  Such  ingots  should  be  brought  to  a  uniform  thickness 
under  the  hammer,  using  the  common  callipers  as  a  gauge.  If  this 
be  neglected,  the  plate  will  be  found  imperfect  at  those  points  where 
the  ingot  was  thinnest.  The  plate  should  be  annealed  occasionally 
during  the  process  of  hammering  and  rolling,  and  should  be  reduced 
about  one  number  in  thickness  each  time  it  passes  between  the  rolls. 
If  any  lead,  tin,  or  zinc  be  mixed  with  the  gold,  the  nitrate  of  potash 
must  be  used  in  much  larger  quantities,  and,  in  that  case,  it  is  better 
to  let  the  button  cool  in  the  bottom  of  the  crucible.  Then  break  the 
crucible,  and  melt  it  in  a  clean  one  for  pouring,  using  borax  and  nitrate 
of  potash  in  very  small  quantities  for  the  last  melting. 

"  In  case  the  subject  of  assay  be  in  the  form  of  filings  or  dust,  a 
magnet  should  be  passed  through  it  so  as  to  remove  every  particle  of 
iron,  and  then,  instead  of  melting  it  with  borax,  it  should  be  melted 
first  with  carbonate  of  potash,  and  afterward  with  nitrate  of  potash,  in 
quantities  proportioned  to  the  necessities  of  the  case,  as  before  directed. 


528  ALLOYING    GOLD. 

Carbonate  of  potash  is  the  only  flux  that  will  bring  all  the  small 
particles  of  metal  into  one  mass.  Without  it,  a  great  portion  of  the 
gold  will  be  found  among  the  scorirc,  adhering  to  the  sides  of  the  cru- 
cible, in  the  form  of  small  globules.  This  process  of  refining  answers 
equally  aa  well  for  silver  as  gold." 

ALLOYING   GOLD. 

Gold,  when  in  an  unalloyed  or  pure  state,  as  before  stated,  is  too 
soft  to  be  used  as  a  support  for  artificial  teeth ;  consequently,  it  has 
been  found  necessary  to  combine  with  it  some  other  metal,  in  order  to 
harden  it.  Silver  and  copper  are  the  alloys  most  frequently  employed. 
Many  dentists  prefer  the  former,  erroneously  supposing  that  it  does 
not  increase  the  liability  of  gold  to  tarnish  as  much  as  the  latter.  But 
this  opinion  is  sustained  neither  by  fixcts  nor  experience.  Gold,  when 
alloyed  with  copper,  unless  reduced  altogether  too  much  for  dental 
purposes,  will  resist  the  action  of  acids  as  effectually  as  when  alloyed 
with  silver,  and  the  former  renders  it  much  harder  than  the  latter. 
Besides,  it  renders  the  gold  susceptible  of  a  higher  and  more  beautifuil 
finish.  If,  therefore,  but  one  of  these  metals  is  used,  copper  may  b3 
regarded  as  j^referable  to  silver. 

The  gold  employed  in  mechanical  dentistry  by  most  practitioners  is 
altogether  too  impure  for  the  purpose,  it  being  not  more  than  eighteen 
carats  fine,  and  sometimes  it  is  reduced  even  to  fourteen.  When  not 
above  these  standards  of  fineness,  it  is  discolored  by  the  buccal  secre- 
tions, imparts  a  disagreeable  taste  to  the  mouth,  and  becomes  brittle 
after  it  has  been  worn  for  a  few  years.  The  plate  which  is  to  serve  as 
a  basis  for  artificial  teeth  should  never  be  reduced  below  twenty  carats ; 
and  as  that  for  the  upper  jaw  does  not  require  to  be  more  than  one-third 
or  one-half  as  thick  as  that  of  the  lower,  the  gold  for  the  latter  may 
be  a  little  finer  than  that  employed  for  the  former,  as  it  is  necessary 
that  it  should  be  more  malleable.  The  following  standards  of  fineness 
may  be  regarded  as  the  best  that  can  be  adopted  for  gold  used  in  con- 
nection with  artificial  teeth :  i^late  for  the  upper  jaw,  twenty  carats ; 
for  the  lower,  twenty-one  ;  and  for  clasps  and  wire  for  spiral  springs, 
eighteen. 

In  reducing  jierfectly  pure  or  twenty-four  carat  gold  to  these  stand- 
ards, first  make  an  alloy  of  copper  and  silver,  which  may  be  either  in 
the  proportion  of  copper  4,  silver  1,  or  copper  9,  silver  1,  according  to 
the  qualities  required  in  the  plate.  The  effects  of  the  two  metals  are 
in  strong  contrast,  —  copper  giving  hardness  and  elasticity,  and  deep- 
ening the  color  into  a  red ;  silver  preserving  the  softness,  and  giving  a 
greenish-white  shade  to  the  original  yellow  of  the  pure  gold.  Of  these 
alloys  take  —  to  twenty -one  grains  of  pure  gold,  three  grains ;  to  twenty 


ALLOYING    GOLD.  529 

grains  of  pure  gold,  four  grains  ;  and  to  eighteen  grains  of  pure  gold, 
six  grains ;  to  make,  respectively,  twenty-one,  twenty,  and  eighteen 
carat  gold.  In  the  latter  case,  the  alloy  should  be  used  containing 
most  silver,  as  so  large  a  percentage  of  copper  makes  the  gold  too  hard 
and  elastic,  and  gives  it  rather  too  red  a  color. 

The  gold  should  be  first  melted  in  a  clean  crucible,  and  as  soon  as 
it  has  become  thoroughly  fused,  the  silver  and  copper  alloy  may  be 
thrown  in,  with  two  or  three  small  lumps  of  borax.  After  keeping 
the  whole  in  a  melted  state  for  some  five  or  ten  minutes,  it  should  be 
quickly  poured  into  an  ingot-mould  of  the  proper  size,  previously 
warmed  and  oiled.  If  the  gold  cracks  during  the  process  of  hammer- 
ing or  rolling,  it  must  be  melted  again,  and  a  few  small  pieces  of  borax 
with  a  little  muriate  of  ammonia,  thrown  in,  and  in  five  or  ten  min- 
utes recast  into  an  ingot. 

When  scraps  and  filings  are  to  be  converted  into  plate,  they  should 
first  be  refined,  afterward  properly  alloyed.  This  may  also  be  neces- 
sary with  all  gold  the  quality  or  fineness  of  which  is  not  known ;  but 
with  national  coins  having  a  known  fixed  standard  this  will  not  be 
necessaiy.  When  they  are  above  these  standards  of  fineness,  the 
amount  of  alloy  necessary  to  reduce  them  to  the  required  fineness  may 
be  readily  found  by  calculation.  It  is  often  unnecessary  to  change 
the  fineness  of  either  American  (21.6  carat)  or  English  (22  carat) 
coin ;  especially  when  the  depth  of  the  plate  in  upper  cases,  or  the 
prominence  of  the  ridge  in  lower,  gives  additional  stiffness  to  the: 
plate. 

There  are  two  principles  upon  which  plates  are  alloyed.  The  first, 
and  common  one,  is  to  add  as  much  alloy  as  the  gold  will  stand  ;  the 
second  is  to  add  the  least  possible  quantity.  The  first  results  in 
eighteen  carat  gold,  and  uses  mainly  silver,  lest  the  six  grains  of 
alloy  should  make  it  too  brittle.  The  last  results  in  twenty  or  twenty- 
two  carat  gold,  and  uses  chiefly,  or  exclusively,  copper ;  since  the 
least  quantity  of  this  gives  greatest  stiffness. 

The  simple  rule  is  to  have  the  purest  plate  which  the  form  of  the 
mouth  will  permit.  For  shallow  mouths,  requiring  increased  stiffiiess, 
a  twenty-carat  plate  may  be  used ;  but  better  pi'actice  still  is  to  increase 
the  rigidity  by  greater  thickness,  or  sometimes  by  doubling  some  part 
of  the  plate. 

In  connection  with  the  alloying  of  gold,  it  is  proper  to  make  some 
remarks  upon  the  terms  in  which  the  fineness  of  alloys  is  expressed,, 
and  the  means  of  ascertaining  it. 

Pure  gold  being  taken  as  the  starting-point,  it  may  be  expressed  by 
unity  (1),  or  by  24,  or  by  1000.     In  the  first  case,  fineness  is  given  in. 
fractions.     In  the  second  case,  by  parts,  called  carats,  which,  for  con- 
34 


530 


CALCULATION    OF    FINENESS. 


venience,  may  be  considered  as  equivalent  to  a  grain  ;  thus  represent- 
ing pure  gold  by  24  grains,  or  1  dwt.  In  the  third  case,  value  is 
expressed  in  decimals,  and  is  the  most  convenient  system,  although  the 
second  is  the  most  customary  with  jewellers  and  dentists. 

The  following  table,  prepared  by  Prof.  Austen,  will  show  the  rela- 
tive value  of  these  three  systems  in  a  few  of  the  most  usual  forms  of 
gold  alloy : 


Fractions. 

Carats. 

Decimals. 

Pure  Gold 

1. 

24. 

1000. 

English  Coin      .... 

i^ 

22. 

91G.6 

American  Coin       .... 

1^ 

21.6 

900. 

Dentists'  Gold,  best    . 

-1 

20. 

833.3 

♦'             "      good 

1 

19.2 

800. 

Jewellers'  Gold,  best 

3. 

18. 

750. 

"             "      good     . 

f 

15. 

625. 

"             "      common    . 

i 

12. 

500. 

Commonest  Solder 

i 

8. 

333.3 

The  table  gives  the  amount  of  pure  gold;  subtracting  which  from 
the  number  at  the  head  of  each  column  will  give  the  amount  of  alloy. 
For  example:  best  jewellers'  gold  contains  eighteen  carats  of  pure  gold 
and  six  carats  of  alloy ;  or  three-fourths  pure  gold  and  one-fourth  alloy; 
or  750  parts  pure  gold  and  250  parts  alloy. 

To  know  how  much  alloy  is  required  to  reduce  gold  from  one  fine- 
ness to  another,  Prof  Austen  gives  the  following  rule :  Divide  the  lower 
carat  (c)  hy  the  difference  betiveen  the  lower  carat  (c)  and  the  higher  (C) ; 
divide  the  weight  (W)  of  the  gold  by  this  quotient  (c-^(C — c)  ),  and  it 
will  give  the  amount  of  alloy  (A)  to  be  added.  He  also  gives  the  follow- 
ing table  of  DIVISORS,  Avhich  will  be  found  convenient,  as  saving  the 
necessity  of  much  calculation : 


Carats. 

22. 

21. 

20. 

19. 

18. 

16. 

14. 

12. 

24. 

11. 

7. 

5. 

3.8 

3. 

2. 

1.4 

1. 

22. 

21. 

10. 

6.3 

4.5 

2.6 

1.7 

1.2 

21.6 

35. 

12.5 

7.3 

5. 

2.8 

1.8 

1.3 

20. 

19. 

9. 

4. 

2.3 

1.5 

18. 

8. 

3.5 

2. 

The  first  vertical  column  represents  the  fineness  before  alloying ;  the 
first  horizontal  column  the  fineness  after  alloying.  Example:  To  reduce 
a  double  eagle  (weighing  516  grains,  and  21.6  carats  fine)  to  20,  18, 
.and  12  carat  plate,  divide  the  weight  by  122,  5,  and  IJ;  this  gives  the 


CALCULATION    OF    FINENESS. 


;.3i 


amounts  of  alloy  to  be  added  —  for  the  first,  41.3  grains ;  for  the  sec- 
ond, 103.2  grains ;  and  for  the  third,  387  grains. 

When  it  is  required  to  know  the  fineness  of  the  plate  or  solder  made 
from  known  quantities  of  gold  and*  alloy,  multiply  the  weight  (W)  of 
gold,  before  alloying,  by  its  carat  valuation  (C)  ;  divide  this  product  (C  W) 
by  the  weight  of  the  gold  after  alloying  (W  +  A);  the  quotient  will  be 
the  carat-value  (c)  of  the  alloyed  gold. 

This  and  the  preceding  rules  may  be  also  expressed  by  algebraic  for- 
mulae: 


(1-) 


A=W 


C— ( 


(2.)      c  = 


CW 
W-f  A 


Tlie  fineness  of  any  mixture  of  alloys  of  known  value  may  be  found 
by  a  simple  arithmetical  rule.  Multiply  each  weight  by  its  carat  (pure 
gold  being  24),  divide  the  sum  of  the  products  by  the  sum  of  the  weights, 
and  the  quotient  will  be  the  carat-value  of  the  mass. 

The  following  formulas  may  beemployed  for  manufacturing  gold  plate 
from  pure  gold  for  dental  purposes :  Nos.  1,  2,  and  3  for  the  base,  and 
No.  4  for  clasps : 


No.  1. 

Gold  Plate  18  carats  fine. 

18  dwts.     .         .         .  pure  gold, 

pure  copper, 
.    pure  silver. 

No.  3. 


4  dwts. 
2  dwts. 


Gold  Plate  2]    carats  fine. 

21  dwts.     .         .         .    pure  gold, 
2  dwts.         .         .         pure  copper, 
1  dwt.       .         .         .    pure  silver. 

The  following  formulas  may  be 
plate  from  coin  gold;  No.  1  for  the 


No.  2. 
Gold  Plate  20  carats  fine. 

20  dwts.     .         .        • .    pure  gold, 
2  dwts.         .         .        pure  copper, 
2  dwts.     .         .         .    pure  silver. 

No.  4. 
Gold  Plate  20  carats  fine. 

20  dwts.     .         .         .   pure  gold, 
2  dwts.         .         .         pure  copper, 
1  dwt.       .         .         .    pure  silver, 


1  dwt. 


platinum. 


employed  for  manufacturing  gold 
base,  and  No.  2,  for  clasps : 


No.  1. 

No.  2. 

Gold  Plate  18  carats  fine. 

Gold  Plate  20  carats  fine. 

20  dwts.     .         .         .  gold  coin, 

20  dwts.     .         .         .  coin  gold, 

2  dwts.          .         .      pure  copper, 

8  grs.           .         .        pure  copper 

2  dwts.     .         .         .  pure  silver. 

10  grs.        .         .         .  pure  silver, 

20  grs.   .         .        ,        platinum. 

532 


INGOT- MOULDS. 


CHAPTER  VII. 

INGOT-MOULDS,    ROLLING-MILLS,   SOLDER. 

THE  gold,  after  being  refined  or  alloyed,  should  then  be  rcmelted 
in  a  clean  crucible,  well  rubbed  on  the  inside  "with  borax,  and 
poured  into  an  ingot-mould  (Figs.  203,  204,)  of  proper  length,  width, 
and  thickness. 


Fir..  200. 


Fig.  204. 


Ingot-moulds  may  be  of  iron,  soapstone,  or  charcoal.  The  first  is 
perhaps  most  convenient.  The  second  gives,  with  the  same  gold,  a . 
tougher  ingot;  whilst  with  the  last  the  greatest  toughness *of  metal  is 
obtained,  so  far  as  the  nature  of  the  ingot-mould  can  modify  it.  Pig- 
iron,  from  the  same  furnace,  run  into  iron  moulds,  may  be  white  and 
brittle;  or  into  sand  moulds,  gray  and  less  brittle;  or  into  charcoal, 
dark  gray  and  soft.  Some  such  modification  of  the  molecular  arrange- 
ment of  gold,  due  to  its  manner  of  cooling,  is  probably  the  correct 
explanation  of  the  fact  that  a.  charcoal  mould  yields,  other  things 
being  equal,  a  tougher  ingot  than  iron. 

The  charcoal  ingot-mould  is  easily  made.  Select  a  firm-grained  piece ; 
saw  in  half,  and  make  smooth  by  rubbing  the  surfaces  together.  Then 
make  the  matrix  in  one  of  three  ways  :  either  cut  the  shape  required  out 
of  one-half  with  the  proper  gate ;  or  bend  a  heavy  wire  into  shape  of  the 
ingot  and  gate  and  bind  it  between  the  surfixces ;  or  saw  off  a  charcoal 
slab,  and  after '  cutting  out  the  shape  of  the  ingot  and  gate,  bind  it 
between  the  surfaces.  Those  who  have  once  used  a  charcoal  ingot, 
will  seldom  use  any  other. 


EOLLING-MILLS. 


533 


After  it  has  become  sufficiently  cool,  it  may  be  placed  on  an  anvil, 
and  its  thickness  reduced  to  about  an  eighth  of  an  inch,  with  a  ham- 
mer weighing  from  one  to  one  and  a  half  pounds.  It  should  then  be 
well  annealed  by  being  placed  in  the  furnace,  lightly  covered  with 
small  pieces  of  charcoal,  and  heated  until  it  assumes  a  uniform  cherry- 
red  color;  or  it  may  be  annealed  with  the  blow-pipe.  It  may  be  neces- 
sary, during  the  operation  of  hammering,  to  subject  it  once  or  twice 
to  this  process,  to  prevent  the  gold  from  cracking.  If,  notwithstand- 
ing this  precaution,  it  should  crack,  it  must  be  again  melted,  and  re- 
fined with  muriate  of  ammonia.  Sudden  cooling  does  not  make  it  brittle. 
On  the  contrary,  some  jewellers  maintain,  that  if  plunged  in  alcohol 
and  water,  it  is  softer  than  when  slowly  cooled.  A  little  sulphuric 
acid  in  the  water  will  give  a  bright  surface  to  the  plate,  by  cleansing 
off  the  oxide  of  copper ;  but  this  acid  pickle  is  only  necessary  for 
removal  of  the  metal  of  the  dies,  used  in  swaging,  or  of  the  borax 
used  in  soldering;  in  all  other  cases  we  prefer  to  have  the  oxide 
coating. 

After  the  gold  has  been  reduced  to  the  thickness  just  mentioned, 
and  well  annealed,  it  may  be  placed  between  the  rolls  of  the  mill, 
previously  so  adjusted  as  to  be  the  same  distance  apart  at  both  ends,, 
and  not  so  near  to  each  other  as  to  require  a  great  effort  to  force  it 
between  them.  The  rollers,  however,  should  be  brought  a  little  nearer 
to  each  other  every  time  the  plate  is  passed  between  them,  and  during 
this  process  they  should  be  kept  well  oiled,  so  that  there  may  be  as 
little  friction  as  possible.  Many  roll  the  ingot  without  any  previous 
hammering.  In  the  process  of  rolling,  care  must  be  had  to  anneal 
often,  and  to  roll  in  one  direction  until  sufficient  width  of  plate  is 


Fig.  205. 


Fig.  206. 


obtained ;  then,  before  cross-rolling,  be  sure  to  anneal,  else  the  plate 
will  be  very  apt  to  crack. 


534 


EOLLIXG-MILLS. 


Rolling-mills  for  gold  are  variouslv  constructed.  Some  are  very 
simple,  while  others  are  quite  complex,  having  a  great  deal  of  machinery 
connected  with  them.  The  rollers  also  vary  in  length,  from  three  to 
five  inches.  For  the  gold  plate  used  by  dentists,  they  need  not  be 
more  than  three  or  three  and  a  half  inches  long.  Fig.  205  represents 
a  simple  form  of  rolling-mill,  without  the  cog-gearing,  as  seen  in  Fig. 
206.  The  latter  is  a  strong  but  simple  mill,  and  is  very  well  suited  to 
the  dental  laboratory.  The  set  screws  at  the  top  are  turned  with  a 
rod,  and  must  be  both  moved  alike,  else  the  plate  will  be  thicker  on 
one  side,  and  will  curve  laterally  in  rolling. 

Fis.  207  represents  a  more  complicated  mill,  designed  for  those  who 
do  nuich  or  heavy  rolling.  "With  such  a  mill,  all  the  rolling  of  a 
laboratorv  could  be  done  without  the  aid  of  an  assistant. 

The  thickness  of  the  plate  may  be  determined  by  a  gauge-plate. 

That  which  is  to  serve  as  a  basis 
for  artificial  teeth  for  the  upper 
jaw  may  be  reduced  until  it  fits 
the  gauge  at  25,  26,  or  27,  accord- 
ing to  the  quality  of  the  plate 
and  the  depth  or  irregularity  of 
the  arch.  For  the  lower  jaw,  and 
for  backings  and  clasps,  it  may 
range  from  21  to  24.  When  the 
whole  alveolar  border  and  a  por- 
tion of  the  roof  of  the  mouth  is 
to  be  covered,  it  may  be  a  little 
thinner  than  when  applied  only 
to  a  small  surface ;  also  thinner 
when  the  arch  is  deep  or  irregular. 
The  purer  the  gold  is,  the  thicker 
must  be  the  plate.  When  very 
wide  clasps,  too,  are  employed,  it 
is  not  necessary  that  the  gold 
should  be  as  thick  as  if  required 
for  narrow  ones  ;  and  low  or  wide 
backings  need  not  be  so  thick  as 
long  or  narrow  ones.  Lower 
plates,  if  wired  around  the  edge 
or  doubled  over  the  middle  third, 
mav  be  made  of  the  same  thickness  as  an  upper  plate.  But  these  are 
mattei-s  which  the  judgment  of  the  dentist  alone  can  properly  deter- 
mine, and,  consequently,  no  rules  can  be  laid  down  upon  this  subject 
from  which  it  will  not  sometimes  be  necessary  to  deviate. 


GAUGE-PLATES. 


535 


Gauge-plates  are,  unfortunately,  not  uniform.  For  many  years  the 
most  reliable  were  those  manufactured  by  Stubbs.  But  it  is  difficult 
to  procure  them.  At  the  same  time  it  is  very  important  that  some 
standard  should  be  adopted  in  the  profession.  Under  these  circum- 
stances we  approve  the  suggestion  of  Dr.  S.  S.  White,  who  recommends 
the  gauge-plate  given  in  Fig.  208,  which  has  been  adopted  by  the 

principal  brass  manufacturers 

\.  ^1  .  ,  Fig.  208. 

01  this  country. 

It  may  be  necessary  some- 
times to  make  gold  wire  for 
spiral   springs  or  other   pur- 
poses, also  hollow-tube  wire.  A     //  '^ 
draw-plate  (Fig.  209),  strong   /^^y 
pliers,  and   bench-vice    (Fig.  pO^g 
210)  are  the  necessary  tools 
for  this  purpose.     The  draw- 
plate  should  be  of  the  hardest 
steel,  with  the  holes  diminish- 
ing    very     gradually.       The 
pliei^  should  be  rough  at  the 
end    for    grasping    the   wire, 
which  must  be  often  annealed 
during  the  process. 

Tube-wire  may  be  obtained  from  the  jewellers,  by  whom  it  is  known 


Fig.  209. 


#900#90#9 


as  joint-wire.  But  it  is  seldom  over  sixteen  carats  fine.  For  use  in  the 
mouth  it  should  be  not  less  than  twenty  carats ;  but  for  many  purposes, 
pure  gold  or  platinum  tubing  is  better.  It  is  easily  made  as  follows : 
Take  a  small  strip  of  plate  one-fourth  of  an  inch  wide,  one  or  two 


536 


SPIRAL    SPRINGS. 


inches  long;  slightly  taper  one  end ;  bend  it  around  a  mandril  or  com- 
mon knitting-needle,  and  pass  into  one  of  the  larger  holes  of  the  draw- 
plate.  Then  with  the  pliers  draw  it  through,  and  repeat  until  the 
edges  of  the  strip  meet.  Remove  the  mandril,  and  solder  the  seam 
with  fine  gold  or  else  pure  gold.  Lastly,  select  a  mandril  or  needle, 
the  size  of  the  required  tube,  and  draw  the  wire  until  it  has  the  proper 
thickness.  If  the  bore  is  to  be  smaller  than  any  needle  at  hand,  the 
last  drawing  may  be  done  without  the  mandril. 

The  simplest  method  of  winding  wire  into  a  spiral  spring  is  to  secure 

Fig.  210. 


it  between  two  blocks  of  wood,  held  between  the  jaws  of  a  small  bench- 
vice,  as  shown  in  Fig.  210.  The  upper  end  of  the  wire  is  then  grasped 
by  a  hand-vice  or  sliding-tongs,  in  connection  with  a  spindle  or  steel 
wire  the  size  of  a  small  knitting-needle,  six  or  eight  inches  in  length. 
The  spindle,  resting  on  the  blocks  of  wood,  is  made  to  revolve,  and  by 
this  movement  the  gold  wire  is  drawn  through  the  blocks  and  wound 
firmly  and  closely  round  the  steel  rod. 


GOLD  SOLDER. 

In  making  gold  solder,  the  materials  employed  for  the  purpose,  if 
not  pure,  should  be  refined  separately.  Unless  this  is  done,  it  will  be 
difficult,  and  often  impossible,  to  ascertain  their  relative  purity,  which 
should  be  known  to  insure  the  desired  result.  The  gold  is  j^laced  in 
a  clean  crucible  with  a  little  borax,  and  as  soon  as  it  has  become  per- 
fectly melted,  the  silver,  and  afterward  the  copper,  are  added.  When 
all  are  melted,  the  alloy  may  be  immediately  poured  into  an  ingot- 


SOLDER.  537 

mould,  previously  warmed  and  oiled.  The  process  of  hammering  and 
rolling  the  solder  is  the  same  as  that  described  for  gold  plate.  In  con- 
sequence of  the  large  amount  of  alloy  in  solder,  it  is  sometimes  so 
stiff,  and  even  brittle,  as  to  be  Avith  great  difficulty  rolled  ;  this  diffi- 
culty is  increased  by  the  fact  that  its  low  fusibility  makes  it  not  very 
easy  to  anneal  without  melting.  This  is  especially  the  case  with  sol- 
ders in  which  zinc  or  brass  is  used. 

In  making  solder  into  the  composition  of  which  zinc  enters,  the  other 
ingredients  must  be  thoroughly  melted,  then  the  zinc  (or  brass)  intro- 
duced at  the  last  moment,  rapidly  stirred,  and  the  metal  poured.  A 
piece  of  charcoal  will  be  found  better  for  making  small  quantities  of 
solder  than  a  crucible. 

The  solder  employed  for  uniting  the  various  parts  of  a  piece  of 
dental  mechanism  should  be  sufficiently  fine  to  prevent  it  from  being 
easily  acted  on  by  the  secretions  of  the  mouth. 

If  pure  gold  is  used,  the  solder  will  be  of  finer  quality  than  if  twenty- 
two  carat  gold  is  used,  but  will  not  flow  quite  so  readily.  But  twenty- 
two  carat  plate  may  be  used,  if  its  alloy  is  known,  by  making  due 
allowance  for  the  amount,  which  is  easily  calculated  by  use  of  preced- 
ing rules.  The  following  makes  a  solder  sixteen  carats  fine,  and  may 
be  used  for  eighteen  or  twenty  carat  gold  plate ;  it  flows  very  freely. 

No.  1. — Pure  gold    .......     6  dwts. 

Fine  silver       ......  1      " 

Roset  copper        .         .         .         .         .         .     2     " 

By  adding  one  or  two  grains  of  zinc,  a  solder  may  be  made  that 
will  flow  at  a  lower  temperature  than  that  made  by  recipe  No.  1.  It 
will  also  have  a  finer  gold  color  ;  but  it  is  apt  to  impart  to  the  piece  a 
brassy  taste,  and  for  this  reason  the  author  rarely  uses  it.  Zinc  solders 
are  apt  not  only  to  have  a  brassy  taste,  but  also  to  become  brittle  after 
long  use. 

The  following  formulas,  taken  from  Dr.  Richardson's  work  on  "Me- 
chanical Dentistry,"  furnish  solders  (No.  2)  over  fifteen  carats  fine,  and 
(No.  3)  eighteen  carats  fine. 

No.  2.  No.  3. 

Gold  coin  . 
Silver     . 
Copper 
Brass     ... 

Other  recipes  might  be  added,  but  the  foregoing  have  been  found 
with  us  to  answer  every  purpose.  More  difficulty  arises  in  the  use  of 
solders  from  a  wrong  method  of  soldering  than  from  defect  in  the  sol- 


6  dwts. 

Gold  coin 

.     30  parts 

30  grs. 

Silver 

4      " 

20    " 

Copper    . 

.  ■      .       1      « 

10     " 

Brass 

1      " 

538  IMPRESSION    CITPS. 

ders  themselves.  Almost  every  dentist  will  be  found  to  have  his 
favorite  recipe,  which  "invariably  flows  smoothly."  The  very  fact 
that  so  many  hundred  different  solders  work  so  well  goes  far  to  prove 
what  we  have  said.  Some  will  boast  of  using  a  solder  as  fine  as 
the  plate.  Tliis  may  be  true  if,  by  "fineness,"  we  mean  simply  carat 
valuation.  But  a  solder  containing  two  grains  ol'  zinc  to  the  dwt.  is 
in  no  true  sense  as  fine  as  a  plate  alloyed  with  thcvt  amount  of  copper; 
yet  both  are  twenty-two-carat  metal.  Rules  foi*  che  management  of 
solder,  plate,  and  blow-pipe,  in  the  act  of  solderf.ig,  will  be  hereafter 
given. 


CHAPTER   VIII. 


CUPS   AND    MATERIALS   FOR    IMPRESSIOavS   OF  THE   MOUTH  — 
PLASTER    MODELS. 

IN  the  construction  of  a  dental  substitute,  mounted  upon  a  plate  or 
base,  it  is  necessary  to  obtain  an  exact  model  of  the  parts  uj)on 
■which  it  is  to  rest,  and  to  which  it  is  to  be  attached.  For  this  purpose 
a  perfect  impression  of  these  parts  must  be  obtained,  involving — First, 
the  choice  of  a  suitable  impression  cup ;  secondly,  the  selection  of  an 
impression  material. 

IMPRESSION   CUPS 

Must  be  of  such  size  and  shape  as  to  permit  their  easy  introduction 
into  the  mouth  ;  also  must  they  follow,  as  nearly  as  possible,  the  out- 
line of  the  surfaces  to  be  copied,  allowing  a  uniform  space  of  one-fourth 
or  one-eighth  of  an  inch  for  the  material.  These  cups  are  sometimes 
called  mouth-cups,  or  wax-holders;  but  we  think  the  name  given,  and 
now  generally  used,  is  greatly  to  be  preferred.  They  are  of  two  kinds, 
metallic  and  gutta-percha. 

Metallic  cups  formerly  were  made  of  sheet-tin  (Fig.  211),  cut  into 

shape  and  soldered,  and  were  so  imperfect 

Fig.  211.  xn     7   •.  I  4- 

that  it  was  very  olten  necessary  to  swage 

metallic   cups  to  suit   special  cases.     The 

depots  now  supply  an  excellent  assortment 

of  well-shaped  Britannia  impression  cups, 

of  which  sixteen  will  constitute  a  full  set ; 

namely,  six  sizes  for  full  upper  cases  (Figs. 

212   and  213),   and   three   for   full   lower 

(Fig.  215)  ;  three  sizes  for  partial  upper  cases  (Fig.  214),  (in  these 


IMPEESSION    CUPS. 


539 


the  outer  rim  rises  at  a  right  augle)  ;  and  four  for  partial  lower  (these 
Gups  have  a  depression  (Fig.  216)  or  a  place  cut  out  (Figs.  217,  218) 
to  receive  the  front  teeth). 

Fig.  219  represents  Dr.  Franklin's  cup  for  full  lower  impressions : 
the  slot  and  upper  groove  permit  secondary  pressure  of  the  wax  or 
plaster,  after  the  surplus  material  is  forced  up,  as  it  is  pressed  on  the 
alveolus. 

Exceptional  cases,  which  no  form  of  purchased  cup  will  suit,  may- 
require  a  swaged  brass,  zinc,  copper,  or  silver  cup  ;  or  a  cup  cast  out 


Fig.  212. 


Fig.  213. 


Fig.  214. 


Fig.  215. 


Fig.  216. 


Fig.  217. 


Fig.  218. 


Fig.  219. 


of  Britannia  metal,  or  other  tin  alloy.  The  process  of  swaging  will 
hereafter  be  described ;  also,  the  method  of  moulding  a  cup  from  a 
pattern  of  wax.    Most  of  these  cases,  however,  may  be  met  by  bending, 


540  IMPRESSION    CUPS. 

hammering,  or  cutting  the  ordinary  Britannia  cup :  remembering 
always  that  a  wise  economy  never  hesitates  to  sacrifice  the  cup,  to 
secure  excellence  of  the  impression  or  the  saving  of  time.  Without 
this  adaptation  of  the  cup  to  the  form  of  the  alveolar  ridge  and  palate, 
it  is  impossible,  in  certain  mouths,  to  get  a  good  wax  or  gutta  percha 
imiiression. 

Cups  similar  in  shape  to  the  Britannia,  but  not  in  so  many  varieties 
of  size,  arc  also  made  of  hard  rubber  and  porcelain.  The  first  cannot 
easily,  and  the  latter  cannot  at  all,  be  modified  in  shajje  to  suit  special 
cases.  The  porcelain  cups  are  handsome  and  clean  looking ;  but  they 
are  easily  broken,  and,  when  plaster  is  used,  it  will  sometimes  leave 
the  glazed  surface  and  cling  to  the  mouth.  We,  therefore,  prefer  the 
Britannia  cup,  unless  the  case  requires  Prof.  Austen's  gutta-percha  cup. 

These  cups  were  originally  devised  to  meet  a  difficulty  incident  to 
vulcanite  partial  pieces.  Perfect  imjiressions  of  dovetailed  interdental 
sjDaces,  and  the  lingual  side  of  molars  and  bicuspids,  often  undercut, 
are  impossible  in  wax  or  gutta-percha.  Yet  Prof  A.  regards  this  as 
'essential  to  the  proper  construction  of  a  partial  vulcanite  set  of  teeth. 

They  are  thus  made:  Take  a  wax  impression  and  make  a  model ; 
in  partial  cases,  brush  over  the  teeth  of  the  model  one  or  two  la3''ers 
of  thin  plaster,  to  fill  up  all  undercuts,  and  to  make  the  plate  fit  loosely; 
saturate  the  model  with  water,  and  mould  over  it  a  gutta-percha  cup. 
This  last  is  done,  not  by  using  the  gutta-percha  in  sheet,  but  by  first 
making  into  a  ball ;  then  working  it  from  the  palate  outward,  leaving 
a  thick  mass  in  the  centre.  It  should  be,  on  the  inside,  from  one- 
fourth  to  one-half  of  an  inch  thick,  so  as  to  be  stiff  and  unyielding;  but 
on  the  outside  not  more  than  one-eighth  or  one-sixteenth  thick,  so  as 
to  be  slightly  elastic  and  yielding.  The  whole  inside  of  the  cup  must 
be  roughened  up  with  a  scaler  or  excavator  in  such  a  way  that  the 
plaster  can  take  firm  hold.  In  most  partial  cases,  the  impression  will 
have  to  be  removed  in  sections ;  the  inside  remaining  entire,  but  the 
outside  and  the  parts  between  the  teeth  coming  away  separately.  In 
certain  cases,  it  is  necessary  to  partially  cut  through  the  cup  before 
putting  in  the  plaster,  and  usually  upon  the  thick  masses  of  gum 
which  fill  the  interdental  spaces.  A  cut  on  thfe  inside,  in  line  with  the 
ridge,  gives  pliancy  to  an  otherwise  rigid  cup,  and  permits  its  easy 
removal.  When  it  is  desirable  to  extend  the  cup  around  the  entire 
arch,  so  as  to  get  an  exact  plaster  impression,  not  only  of  the  gum  but 
of  all  the  remaining  teeth,  this  rim  of  gutta-percha  must  be  slit  at 
two  or  three  points,  to  give  that  pliancy  which  is  a  chief  merit  in  this 
form  of  cup.  These  cups  have  no  handle,  but  are  removed  by  inserting 
a  plugging  instrument  into  a  small  hole  previously  made  in  the  back 
part  of  the  cup  where  it  is  thickest. 


IMPEESSION    MATERIALS.  541 

IMPRESSION   MATERIALS 

Must  possess  the  following  properties:  (1.)  Plasticity  in  sufficient 
degree  to  copy  mucous  tissues,  avoiding  the  extremes  of  softness,  which 
permits  them  to  flow  from  the  cup,  and  of  hardness,  which  requires 
excessive  pressure.  (2.)  The  property  of  hardening  within  a  short  time, 
and  under  conditions  nut  incompatible  with  the  mouth.  (3.)  Absence 
of  expansion  or  contraction,  except  in  very  moderate  degree.  It  may 
also  be  added  that  the  materials  should  not  be  such  as  in  taste,  smell, 
or  appearance  are  calculated  to  disgust  a  patient. 

There  are  three  materials  answering  to  these  requirements,  and  pos- 
sessing properties  as  distinctive  as  the  sources  whence  they  are  derived. 
From  the  Animal  kingdom.  Beeswax  ;  from  the  Vegetable  kingdom, 
Gutta-Percha;  from  the  Mineral  kingdom.  Plaster.  After  their 
separate  description,  a  brief  review  of  their  distinctive  properties  will 
be  given.  No  one  of  the  three  can  be  dispensed  with ;  no  one  should 
be  exclusively  used. 

Beeswax.  —  Formerly  the  only  material  used.  It  is  still  the  only 
one  fit  for  certain  cases,  and  is  absolutely  indispensable.  The  best ' 
wax  is  from  virgin  combs,  and  has  a  rich  golden  color.  Commercial 
adulterations  with  tallow,  etc.,  injure  it,  and  mixture  with  resin  makes 
it  harsh  and  difficult  to  manage.  Gutta-percha  is  sometimes  incor- 
porated with  it  to  give  hardness  in  warm  weather ;  bleached  or  white 
wax  is  also  used  for  the  same  purpose. 

A  very  valuable  addition  is  paraffine.  Pure  paraffine  is  very  plastic, 
softening  at  a  low  temperature  (100^)  ;  but  the  folds  of  soft  paraffine 
have  no  tendency  to  reunite,  and  consequently  the  mass  is  full  of  easily 
separated  flakes  or  layers.  It  imparts  this  property  to  wax,  if  in  too 
large  proportion  ;  but  its  moderate  use  greatly  improves  the  wax.  It 
causes  it  to  soften  at  lower  heat,  makes  it  more  plastic  when  warm,  and 
harder  when  cool. 

The  depots  furnish  wax  arid  its  compounds  in  very  pUre,  neat,  and 
convenient  forms ;  so  that  there  is  now  little  necessity  for  the  dentist  to 
spend  the  time  once  demanded  to  reduce  the  thick  cakes  into  serviceable 
shape.  It  may  be  well,  however,  to  state  briefly  how  to  prepare  wax 
for  impressions.  Melt  and  pour  into  cakes  one-quarter  of  an  inch 
thick;  cut  into  pieces  about  two  inches  square;  and  when  nearly  cold, 
roll  on  a  wet  board,  with  a  wet  wooden  roller,  to  one-half  or  one-fourth 
this  thickness.  This  breaks  down  the  crystallization,  and  reduces  it 
to  a  form  very  convenient  for  softening  when  wanted  for  use.  It  may 
be  softened  over  a  broad  flame,  or  before  a  fire  or  stove,  or  in  warm 
water.  In  using  dry  heat,  be  careful  not  to  melt  the  surface,  or  give 
the  peculiar  whitish  appearance  that  precedes  melting.  In  using 
water,  have  a  large  quantity,  to  secure  uniformity  of  temperature,  and 


542  BEESWAX. 

keep  it  at  r20°-130^  Fahrenheit.  Below  tliis  it  will  not  yield  readily 
to  tlie  gum  ;  above  this  it  becomes  adhesive. 

Some  practice  is  necessary  in  knowing  the  proper  quantity  of  wax  to 
use  in  the  cup  ;  the  usual  mistake  is  to  take  too  much.  Select  a  cup  of 
proper  shape  and  size;  if  the  arch  is  a  deep  one,  put  some  hard  wax 
or  gutta-percha  in  the  centre,  to  force  up  the  wax  at  that  point.  This 
is  much  better  than  to  have  a  hole  in  the  cup  through  which  to  make 
pressure  \vith  the  finger.  Such  cups  are  worse  than  useless,  for  it  is 
impossible  to  make  secondary  pressure  without  injury  to  other  parts 
of  the  impression ;  except  in  case  of  wax  projecting  above  the  cup, 
outside  the  ridge.  Put  the  wax  in  the  cup;  smooth  the  surface,  which 
should  be  a  little  softer  than  the  body  of  the  wax  ;  then  introduce  and 
press  against  the  gums  or  teeth  with  a  steady,  uniform,  and  moderately 
strong  pressure ;  also,  as  nearly  as  possible,  iu  a  direction  at  right 
angles  to  the  plane  of  the  alveolar  ridge. 

Tli3  wax  above  the  cup  is  pressed  against  the  gums  on  each  side, 
so  that  an  exact  impression  may  be  obtained  of  all  the  depressions  and 
prominences  on  the  outside  of  the  arch.  But  this  must  be  done  with 
great  care,  holding  the  cup  firmly  and  pressing  the  finger  against  the 
cheek  or  lip,  rather  than  directly  upon  the  wax.  It  is  much  better  in 
all  cases  to  have  the  sides  of  the  cup  high  enough  to  give  the  wax 
support  at  all  points.  For  this  purpose,  it  becomes  necessary  some- 
times to  swage  or  cast  a  special  cup.  Very  perfect  wax  impressions 
can  be  taken  in  such  cups.  On  the  removal  of  the  cup  and  wax 
from  the  mouth,  the  greatest  precaution  is  necessary  to  prevent 
injuring  or  altering  the  shape  of  the  impression.  Holding  the  handle 
firmly,  it  must  be  drawn  directly  downward,  in  case  there  are  front 
teeth,  in  the  direction  of  the  axes  of  these  teeth.  Impressions  of  a 
full  upper  arch  sometimes  adhere  very  tightly.  They  can  generally 
be  loosened  by  drawing  up  the  cheek  and  lip  on  one  side  or  both  sides 
alternately ;  or  by  a  slight  Qough,  which,  acting  upon  the  palate,  ad- 
mits air  behind  and  above  the  impression.  Any  violence  or  twisting 
motion  injures  the  impression;  in  wax  or  gutta-percha  such  defects 
cannot  be  detected  until,  on  completion  of  the  plate,  maladjustment 
creates  suspicion  of  its  cause.  The  wax  must  be  kept  in  the  mouth 
long  enough  to  cool  and  harden.  A  small  piece  of  ice  in  a  napkin, 
held  against  the  under  side  of  the  cup,  Avill  rapidly  harden  it.  This 
simple  plan  is  preferable  to  the  use  of  double  cups,  into  which  a  stream 
of  cold  water  is  injected.  The  latter  are  not  only  expensive  and  trou- 
blesome to  use,  but  they  endanger  the  accuracy  of  the  impression.  All 
wax  impressions,  unless  for  models  on  which  other  cups  are  to  be  made, 
should  be  hardened  by  artificial  cold ;  it  greatly  helps  to  prevent 
change  of  shape  on  withdrawal.     If  the  surplus  wax,  by  contact  with 


GUTTA-PERCHA.  543 

the  lips  or  teeth,  injures  the  impression,  then,  if  it  is  a  full  case,  cut  off 
the  surplus,  dip  into  warox  water,  and  introduce  the  same  impression  a 
second  time ;  but  if  it  is  a  partial  case,  it  must  be  taken  anew,  for  the 
teeth  cannot  with  any  accuracy  enter  their  wax  impressions. 

Gutta-Pereha.  —  This  very  valuable  material  will  be  found  useful  in 
taking  impressions  of  the  lower  jaw  and  in  some  partial  cases,  also  fre- 
quently in  full  upper  cases  when  the  teeth  are  set  on  a  vulcanite  base. 
The  manipulations  are  different  accordingly  as  we  wish  to  make  the 
gutta-percha  adhere  to  the  cup,  or  wish  it  to  part  from  the  sides  of  the 
cup,  as  it  shrinks  on  cooling.  In  the  first  case,  soften  in  water  heated  to 
180^-200^  Fahrenheit;  dry  off  the  water;  hold  for  a  few  moments 
over  a  flame,  and  press  into  a  warm  cup  ;  keep  the  fingers  wet,  to  pre- 
vent the  gutta-percha  from  sticking,  but  do  not  let  water  get  between 
it  and  the  cup.  In  the  second  case  keej)  the  surface  of  the  gum  wet, 
and  introduce  it  into  a  cold  and  wet  cup.  When  the  cup  is  filled,  place 
again  in  water  at  180°  ;  then  press  it  somewhat  into  shape  and  intro- 
duce into  the  mouth.  Pressure  must  be  more  gentle  than  for  wax  ;  it 
must  be  kept  longer  in  the  mouth,  and  ice  should  be  used  to  cool  it. 
Be  very  careful,  in  partial  cases  where  there  is  much  undercut  or  a 
dovetail  space  between  teeth,  not  to  make  the  gutta-percha  too  hard, 
else  it  will  be  almost  impossible  to  get  it  out  of  the  mouth. 

Gutta-percha  copies  surfaces  with  all  the  accuracy  of  plaster ;  but, 
although  harder  than  wax,  it  is  more  apt  than  plaster  to  change  its 
shape  upon  withdrawing  it  from  the  mouth.  Its  characteristic  pecu- 
liarity is  contraction  on  cooling ;  but  this  is  controlled,  when  required, 
by  the  directions  above  given  for  making  it  adhere  to  the  cup.  It  is 
less  easily  manipulated  than  wax,  and  not  so  generally  useful ;  but  its 
property  of  contraction  admirably  adapts  it  to  certain  cases  in  which 
plates,  otherwise  accurate,  fail  because  too  large  and  loose. 

Gutta-percha  for  impressions  is  supplied  in  convenient  form  by  the 
depots.  The  native  color  is  dark,  and  calculated  to  repel  fastidious 
patients.  For  this  reason,  also  to  give  it  body,  it  is  incorporated  with 
about  its  own  weight  of  white  oxide  of  zinc,  magnesia  or  chalk,  and 
a  pinkish  color  given  by  vermilion.  Thus  prepared,  it  is  less  sticky 
■when  softened,  and  becomes  harder  when  cool,  than  the  crude  article. 

Plaster —  Gypsum,  Sulphate  of  Lime,  or  Plaster  of  Paris,  consists  of  28 
parts  lime,  40  of  sulphuric  acid,  and  18  of  water ;  the  first  its  minera- 
logical  name,  the  second  its  chemical,  the  third  its  commercial.  A 
beautiful  translucent  variety  of  gypsum  is  known  as  alabaster;  the 
transparent  crystalline  variety  is  called  selenite.  That,  how^ever,  used 
in  agriculture  and  for  calcining  is  in  amorphous  masses  of  a  grayish  or 
bluish-white  color.  When  exposed  to  a  heat  between  300°  and  400° 
i'ahrenheit,  most  of  the  water  of  the  gypsum  escapes.    It  is  then  known 


544  PLASTER. 

as  calcined  plaster,  plaster  of  Paris,  or  simply  plaster.  After  being 
properly  calcined  and  pulverized,  if  mixed  with  water  to  the  consistence 
of  thin  batter  or  cream,  it  hardens  in  a  few  minutes,  and  acquires  great 
solidity.  Tiic  plaster  lias  chemically  reunited  with  a  portion  of  the 
water,  while  another  portion  is  mechanically  held  in  the  porous  mass, 
and  may  be  driven  off  by  drying.  During  the  process  of  consolidation 
it  expands,  in  consequence  of  the  absorption  of  the  water  by  the  par- 
ticles of  plaster.  If  the  plaster  is  very  fine-grained,  this  absorption 
takes  place  quickly,  and  the  expansion  occurs  while  the  plaster  is  soft. 
But  coarse-grained  plaster  sets  before  the  particles  become  thoroughly 
saturated  ;  hence  it  continues  to  expand,  more  or  less,  for  some  time 
after  solidification.  There  is  a  great  difference  in  the  quality  of  plas- 
ter. That  used  for  taking  imjjressions  of  the  mouth  (and,  in  fact,  for 
all  dental  purposes)  should  be  of  the  best  description,  well  calcined, 
finely  pulverized,  and  passed  through  a  sieve  of  bolting-cloth  previ- 
ously to  being  used.  The  idea  of  taking  impressions  for  full  sets  of 
teeth  with  plaster  originated,  we  believe,  almost  simultaneously  with 
Drs.  Westcott,  Dunning,  and  Bridges,  by  whom,  and  the  profession 
generally,  it  has  been  regarded  as  adapted  almost  exclusively  to  full 
impressions.  Prof.  Austen  introduced  a  method  of  using  it  in  connec- 
tion with  gutta-percha  cups,  which  makes  it,  in  the  hands  of  a  careful 
manipulator,  universally  applicable  to  every  case  in  which  a  dental 
appliance  is  called  for.  He  would,  however,  by  no  means  recommend 
such  universal  application,  claiming  only  that  the  gutta-percha  cup 
will  give  with  plaster  a  correct  impression  of  partial  cases  of  greatest 
irregularity,  wliere  the  use  of  wax  or  gutta-percha  would  be  impossible. 

For  plaster  impressions  in  ordinary  full  cases,  upper  or  lower,  select 
a  Britannia  cup  about  one-eighth  of  an  inch  larger  than  the  alveolar 
ridge,  and,  in  case  of  a  deep  upper  arch,  build  up  with  wax,  so  as  to 
give  support  to  the  soft  plaster ;  also  supply  with  wax  any  deficiency 
■  in  the  size  of  the  cup  at  the  back  part  or  around  the  outside  edge.  In 
exceptional  cases,  requiring  a  special  cup,  a  gutta-percha  one  will  be 
found  to  be  much  easier  made  than  a  swaged  or  cast  metallic  cup. 
If  properly  shaped,  it  will  fully  answer  the  pui'pose. 

The  late  Dr.  Bean's  practice  was  to  take  a  wax  impression,  make 
model  and  dies,  and  swage  a  plate ;  then  solder  a  strip  from  ridge  to 
ridge  to  hold  a  stick,  which  was  to  act  as  a  handle  in  removing  the 
impression.  He  then  heated  the  plate,  and  coated  the  palatine  surface 
with  shellac,  pressing  a  lump  of  raw  cotton  against  the  adhesive  resin. 
The  cotton  fibres  caused  the  plaster  to  adhere  firmly  to  the  plate,  thus 
avoiding  the  great  annoyance  when  scales  of  plaster,  so  thin  as  in  this 
kind  of  cup,  break  ofi".  The  process  is  troublesome,  but  the  results 
very  satisfactory. 


PLASTER.  545 

To  take  a  plaster  impression,  place  the  patient  in  a  common  chair, 
and  after  the  cup  is  introduced,  incline  the  head  forward,  holding  it 
in  place  with  a  gentle  but  steady  pressure  upon  the  centre  of  the  cup. 
The  plaster  should  be  very  fine-grained  and  mixed  rather  thin,  to  get 
rid  of  air-bubbles.  If  necessary,  a  little  salt  or  sulphate  of  potash 
should  be  added  to  quicken  slow-setting  plaster.  The  necessity  for  salt 
and  quantity  to  be  used  should  not  be  left  to  conjecture ;  hence  the 
importance  of  setting  aside  in  a  well-closed  vessel  a  quantity  of  "  impres- 
sion j)laster."  Also,  if  the  plaster  is  "  slow,"  set  aside  a  large  bottle 
of  salt  "water  of  the  exact  strength  required  to  make  that  plaster  set 
properly.  There  will  in  this  way  be  no  danger  of  the  plaster  setting- 
too  quickly  or  too  slowly.  If  made  to  set  too  rapidly,  it  hurries  tin 
operator  and  increases  the  risk  of  failure ;  if  it  sets  too  slowly,  both 
patient  and  operator  become  "wearied  before  it  is  hard  enough  to  re- 
move.  It  should  require  about  three  minutes  to  harden  after  it  is 
introduced  into  the  mouth,  "which  must  be  done  when  it  is  stiff  enough 
to  allow  the  plaster  to  be  moulded  into  some  shape,  and  yet  soft  enough 
to  permit  no  sharp  points  or  angles  on  its  surface.  If  softer  than  this, 
the  slightest  pressure  forces  it  out  of  the  cup,  to  run  sometimes  out  of 
the  mouth,  sometimes  on  the  tongue  and  the  fauces.  This  also  is  apt  to 
occur  if  an  excess  of  plaster  is  used.  These  unnecessary  accidents  are 
"well  calculated  to  prejudice  patients  against  plaster  and,  perhaps, 
against  the  operator. 

The  hardness  of  plaster  in  the  mouth  can  be  ascertained  by  the 
"watch,  when  the  exact  time  required  for  setting  is  kno"wn,  or  by  testing 
some  of  the  plaster  remaining  in  the  bowl.  As  soon  as  it  breaks  with 
a  sharp  fracture,  it  should  be  removed.  To  keep  it  in  much  longer 
than  this  is  apt  to  give  unnecessary  pain  and  difficulty  in  removal, 
owing  to  the  absorbing  property  of  the  hardened  plaster,  which  causes, 
it  to  cling  with  great  tenacity  to  the  mucous  membrane. 

Full  lower  impressions  are  generally  easy  to  withdraw ;  but  some 
full  upper  ones  adhere  very  tenaciously.  Raising  the  cheek  on  one 
side  or  in  front,  and  depressing  the  cup,  will  detach  most  cases.  This 
can  be  done,  in  case  of  plaster,  "^vithout  risk  of  injuring  the  shape  of 
the  impression.  Where  there  is  much  undercut,  the  plaster  will  break; 
but  it  can  readily  be  replaced.  Sometimes  the  action  of  the  cheeks 
and  lips,  or  of  the  soft  palate,  will  loosen  the  impression  ;  or  an  instru- 
ment may  be  used  to  press  up  the  palate,  and  thus  cause  air  to  pass  in. 
at  the  back,  when  it  may  be  easily  removed.  Complicated  modifica- 
tions of  the  cup  to  facilitate  removal  are  of  little  value,  and  make  an 
unnecessary  multiplicity  of  apparatus. 

■     In  partial  cases,  the  outer  rim  (which  for  this  purpose  is  made  elastic, 
or  else  in  sections)  is  first  detached,  and  the  central  portion  then  loosened 
35 


546  PLASTER. 

by  an  instrument  inserted  into  the  back  part  of  the  gutta-percha  cup. 
If  there  should  be  many  broken,  detaclied  fragments,  either  loose  oi" 
caught  in  dovetail  spaces  between  teeth,  these  must  be  very  carefully 
removed  ;  and  when  the  surface  moisture  has  dried  off,  they  must,  with 
the  utmost  nicety,  be  replaced  in  the  impression.  This  is  sometimes  a 
tedious  and  difficult  operation  ;  but  it  is  not  trouble  misapplied,  since 
it  is  the  only  way  in  which  perfect  impressions  of  difficult  partial  cases 
can  be  obtained.  Should  the  detached  plaster  be  from  a  very  irregu- 
lar surface,  its  readjustment  is  made  much  easier  by  touching  the 
gutta-percha  at  that  point  with  a  camel's-hair  brush  dipped  in  very 
hot  water.  The  fragments  being  all  adjusted  and  the  outside  ones 
secured  by  a  little  resinous  cement,  should  there  be  much  broken  sur- 
face on  the  inside,  it  is  best  to  varnish  heavily  with  sandarach,  to 
cement  the  pieces ;  otherwise,  let  the  surface  be  prepared,  as  in  full 
sets,  for  preventing  the  plaster  of  the  model  from  adhering. 

Wax  and  gutta-percha  require  nothing  for  this  purpose,  or,  at  most, 
a  very  thin  layer  of  oil.  Plaster  impressions  may  be  rendered  separ- 
able :  1,  by  an  alcoholic  varnish  of  sandarach  or  shellac,  or  a  diluted 
solution  of  soluble  glass,  Avith  a  little  oil  upon  the  varnished  surface 
when  dry ;  2,  by  saturating  it  with  as  much  oil  as  it  will  take  up  with- 
out standing  upon  its  surface ;  3,  by  coating  the  surface  with  a  dilute 
soap  mixture.  The  varnish  is  best  applied  with  a  small  bristle  brush  ; 
the  oil  and  soap-water  with  a  camel's-hair  brush  or  a  stiff,  pointed 
feather.  The  varnish  must  be  kept  well  stopped,  or  from  time  to  time 
diluted,  so  as  not  to  become  thick.  The  soap  mixture  needs  occa- 
sional renewal,  as  the  plaster  gradually  neutralizes  its  oil  and  renders 
it  unfit  for  use. 

Some  dentists  take  plaster  impressions,  in  certain  cases,  thus :  First, 
a  wax  impression,  as  usual ;  then  enlarge,  by  pressure  or  by  cutting  out, 
the  depressions  formed  by  teeth  or  a  prominent  alveolar  ridge  ;  lastly, 
they  pour  in  a  thin  layer  of  plaster,  and  repeat  the  irajDression.  Others 
surround  certain  teeth  with  a  collar  of  wax,  preparatory  to  taking  a 
l^laster  impression. 

The  last  is  a  troublesome  method,  very  apt  to  fail,  from  the  slipping 
of  the  wax  collars  ;  nor  has  it  any  superiority  over  a  wax  impression, 
to  compensate  the  trouble.  The  first  is  a  method  of  doubtful  utility, 
which  must  not  be  confounded  with  the  swaged  cups  of  Dr.  Bean,  or 
the  gutta-percha  cups  of  Prof.  Austen.  It  is,  in  fact,  little  else  than  a 
saving  of  trouble,  in  the  making  of  special  cups,  for  cases  where  there 
is  no  undercut  to  cause  breaking  of  the  plaster.  It  is  evident  that,  in 
cases  of  hatchet-  (or  club-)  shaped  teeth,  or  dovetail  spaces,  or  under- 
cut ridge,  the  plaster  will  often  bed  itself  in  the  wax ;  which  wax  is 
changed  in  shape,  in  the  act  of  withdrawal,  at  those  very  points  where 


CHOICE    OF    MATERIALS,  547 

it  is  the  purpose  of  this  kind  of  impression  to  give  accuracy.  And 
since  the  wax  is  inelastic,  it  is  impossible  to  restore  small,  thin  por- 
tions of  the  broken  plaster  to  their  exact  place.  Hence,  we  decidedly 
prefer  impressions  all  wax  or  all  plaster,  to  this  conibination  of  the 
two,  which  is  not  calculated  to  develop  the  excellences  of  either. 
Prof.  Austen  thus  sums  up 

THE   COMPARATIVE   VALUE 

of  the  three  impression  materials — wax,  gutta-percha,  plaster  —  which 
can  only  be  determined  by  a  careful  study  of  (1)  their  distinctive 
peculiarities ;  (2)  the  special  requirements  of  different  mouths ; 
(3)  the  kind  of  base-plate,  and  manner  of  its  construction.  The 
exclusive  use  of  one  is  as  reprehensible  as  the  indiscriminate  use  of 
all.  No  one  is  best ;  nor  can  any  be  disj^ensed  with.  Disregard  of 
this  most  important  fact  is  a  fruitful  source  of  failure  in  impressions  — 
failures  arising  neither  from  defect  in  the  material  nor  lack  of  skilful 
manipulation  in  the  ojjerator,  but  from  want  of  philosophical  selection 
of  resources. 

(1.)  Wax  demands  strong  pressure,  and  is  inelastic ;  also,  it  neither 
expands  nor  contracts  on  cooling.  It  copies  a  hard  gum  accurately, 
although  it  never  gives  the  fine  tracery  of  gutta-percha  or  plaster.  It 
also  copies  a  soft  gum ;  but  not  until  the  gum  is  either  compressed  or 
thrown  out  of  shape  by  the  strong  pressure  required.  —  Gutta-Percha 
requires  moderate  pressure ;  is  slightly  elastic :  also  has,  as  its  marked 
peculiarity,  very  decided  contraction  on  cooling,  which,  however,  is 
under  control,  as  previously  explained.  Slight  undercuts  it  will  take, 
without  dragging,  as  wax  does ;  but,  on  the  other  hand,  it  will  occa- 
sionally pass  into  very  narrow  interdental  spaces  and  injure  the  impres- 
sion in  the  effort  to  withdraw  therefrom.  — Plaster  permits  only  gentle 
pressure,  taking  impressions  of  softest  tissues  in  natural  position.  It 
slightly  expands  in  setting  ;  but,  in  a  rigid  cup,  this  makes  no  ap- 
preciable increase  in  the  size  of  the  model.  It  sets  so  hard  that  it  will 
break  before  leaving  the  smallest  undercut ;  but,  by  virtue  of  the  same 
quality,  it  can  be  used  in  the  most  marked  cases  of  dovetail,  or  alveolar 
undercut. 

(2.)  Alveolar  and  palatine  surfaces,  and  their  investing  membranes, 
have  a  great  variety  of  conditions.  These  must  be  carefully  examined 
with  reference  to  the  properties,  just  named,  of  the  impression  materials. 
We  have  large  or  small  arches;  deep  or  flat  ones;  irregular  or  smooth 
ridges.  The  mucous  surfaces  may  be  uniformly  hard  or  soft ;  the  ridge 
hard  and  palate  soft,  or  the  more  difficult  combination  of  soft  ridge 
and  hard  palate^  or  the  ridge  may  be  irregularly  hard  and  soft.  No 
one  material  can  possibly  be  equal  to  these  varying  conditions. 


548 


CHOICE    OF    MATERIALS. 


(3.)  The  mode  of  constructing  the  plate  will  often  determine  the 
choice  of  an  impression  material.  A  plate  swaged  upon  a  zinc  die  is 
smaller  by  the  shrinkage  of  the  die.  Here — apart  from  shape  or 
hardness  of  the  parts  —  plaster  would  be  best,  wax  next,  gutta-percha 
the  worst.  A  vulcanite  plate  is  larger  than  the  mouth,  by  the  expan- 
sion of  the  model.  Here,  the  contraction  of  gutta-percha  will  often 
prove  a  very  valuable  compensation  ;  also  the  compression  of  tissue, 
made  by  the  pressure  of  wax, — special  considerations  must  determine 
which  of  these  to  choose;  but,  as  a  rule,  plaster  is  not  best  for  full  vul- 
canite sets.  On  the  other  hand,  plaster  is  best  for  all  partial  vulcanite 
work,  and  is  the  only  material  in  difficult  cases  worthy  of  any  reliance. 
It  may  safely  be  asserted,  that  the  operator  who  cannot  take  an  accu- 
rate plaster  impression  of  any  partial  case,  however  difficult,  has  a  very 
imperfect  idea  of  the  value  of  hard  rubber.  For  the  majority  of  partial 
cases,  where  swaged  work  is  used,  wax  will  give  ample  accuracy. 
Where,  however,  the  undercut,  and  consequent  dragging  of  wax,  is 
very  great,  plaster  must  be  employed. 

Large,  or  hand,  or  irregular  mouths  are  best  copied  in  plaster;  great 
deviations  from  normal  size,  or  sha^^e,  requiring  special  cups.  A  gum 
of  medium  softness,  but  uniform,  may  be  taken  equally  well  in  any 
material.  This  class  of  mouths  have  a  wonderful  adaptation  to  any 
thing :  variations  in  size  or  form  must  determine  the  selection  of  the 
material.  A  gum  of  extreme  softness,  yet  uniform,  will  give  better 
results  sometimes  with  one  material,  sometimes  with  another.  It  is 
often  very  difficult  to  determine  beforehand  ;  but,  in  case  of  failure, 
let  the  second  impression  be  taken  always  with  a  different  material. 
This  is  especially  true  of  lower  sets,  where  the  gum  behind  is  soft  and 
flexible :  it  is  hard  to  say  whether  the  pressure  of  Avax  or  the  softness 
of  plaster  leaves  the  ridge  in  best  condition ;  gutta-percha  is  often 
very  useful  in  these  cases. 

Irregularity  of  texture  in  the  mu- 
cous tissues  is  a  fruitful  source  of 
trouble.  A  hard  ridge,  with  a  soft 
palatine  surface,  is  easily  fitted,  and 
any  impression  material  may  be  used. 
But  the  reverse  condition  will  often 
require  the  firm  pressure  of  wax  upon 
the  ridge ;  also  in  all  cases  of  inequal- 
ity of  texture  in  the  ridge  itself.  As 
a  rule,  subject  to  exceptions,  wax  is  the 
best  for  these  mouths,  and  occasionally 
(especially  for  vulcanite)  the  contrac- 
tion of  gutta-percha  is  useful.     The 


MODELS.  .549 

old-fashioned  shape  of  upper  plates  (Fig.  220)  will  often  give  the 
best  adhesion  and  most  useful  plates,  when  the  central  palate  is 
very  hard.  It  is  firmer  than  a  vacuum  cavity,  and  much  more  agree- 
able to  the  patient.  Of  course,  it  must  be  made  of  thick  plate,  to  give 
requisite  strength  ;  doubling  the  plate,  as  far  as  the  bicuspids,  may 
suffice. 

It  is  evident  that  an  enumeration  of  all  the  complications,  which 
call  for  exercise  of  judgment  in  the  selection  of  impression  materials,  is 
impossible.  By  suggesting  a  few  varieties,  we  hope  to  direct  attention 
to  a  much  neglected  point,  in  our  judgment  of  utmost  importance. 
Routine  practice,  which  inquires  into  the  reason  of  nothing,  and  the 
one-idea  system,  with  its  "practice  makes  perfect"  motto,  are  equally 
at  fault.  The  future  may  reveal  some  new  material ;  but  the  three  we 
now  have  are  alike  important  and  indispensable. 

MODELS. 

The  model  is  made  of  calcined  plaster,  mixed  with  water  so  as  to 
have  the  consistence  of  cream;  too  much  water  making  the  model 
fragile,  whilst  too  little  will  prevent  the  escape  of  the  air  contained 
in  the  plaster,  and  the  model  will  be  porous.  This  last  condition  also 
greatly  endangers  the  full  flowing  of  the  plaster  into  the  inequalities 
of  the  impression. 

The  model,  for  convenience  of  description,  is  said  to  have  a  face, 
back,  body,  and  sides — terms  scarcely  requiring  explanation.  The 
i'ace,  corresponding  with  the  mouth  to  be  fitted,  requires  greatest  care ; 
and  the  same  directions  answer  for  it  in  all  models.  The  body  of  the 
model  has  different  shape  and  size  according  to  the  use  to  be  made  of 
it.  The  back  should  be,  in  all  cases,  parallel  with  the  face.  The 
,'^ides  are  to  be  either  vertical  or  slanting,  according  to  its  uses. 

In  making  models,  we  require  a  plaster  table,  with  a  rim  to  prevent 
scattering  of  waste  plaster ;  having  at  least  two  drawers  in  front,  a 
shelf  at  the  back,  also  an  opening  for  escape  of  Avaste  plaster  into 
a  refuse  box ;  a  tight  plaster  can  and  a  bucket  of  water  will  complete 
the  outfit  of  the  table.  The  implements  are  two  or  three  strong 
bowls,  a  plaster  scoop,  a  spatula,  an  iron  spoon,  a  plaster  knife,  a 
scraper,  a  sponge,  and  some  camel's-hair  brushes  or  wing-feathers  of 
poultry.  Sometimes  a  marble  slab  or  slate  is  used  for  shaping  the 
back  of  the  model  upon ;  but  if  the  table  is  kept  clean  and  smooth 
with  the  scraper,  this  is  not  essential ;  since,  in  any  case,  a  piece  of 
wet  paper  should  be  laid  down,  to  permit  the  ready  removal  of  the 
model,  for  the  purpose  of  shaping,  whilst  yet  rather  soft.  Running  water 
and  waste  pipes  "are  apt  to  become  more  a  nuisance  than  an  advantage 
to  a  plaster  table ;  because  the  latter  are  so  apt  to  become  closed  by 


550 


MODELS. 


the  careless  use  of  plaster.  A  bucket  of  water,  changed  daily,  is 
eijually  good,  and  has  the  merits  of  simplicity  and  universal  applica- 
bility. 

The  most  troublesome  models  are  the  thick  ones  for  sand  moulding. 
The  surface  of  the  impression  being  prepared  as  above  directed,  the 
cup  is  surrounded  -with  a  rim  of  wax,  waxed  cloth,  sheet  lead,  or  tin 
foil,  fitting  closely  to  prevent  escape  of  plaster,  and  about  two  inches 
deep.  The  rims  should  be  slightly  curved,  to  give,  when  placed 
around  the  cup,  the  requisite  flare.  Models  made  in  such  rims  need 
trinmiing  with  the  knife.  To  avoid  this,  and  also  to  give  greatest 
possible  smoothness  and  regularity  to  the  sides,  flaring  rings  of  sheet 
tin  may  be  used  as  follows.  Set  the  impression  level  on  the  table,  and 
surround  with  some  soft  plastic  material  (wet  newspaper  made  into  a 
pulpy  mass  is  perhaps  the  most  convenient),  and  into  this  set  a  ring 
of  such  size  as  will  give  a  proper  shoulder  to  the  model.     Fig.  221 

FiQ.  221. 


sho"ws  such  a  ring  arranged  for  making  such  a  cheoplastic  model. 
For  a  sand  model,  the  ring  should  flare,  should  conform  more  to  the 
shape  of  the  cup,  and  be  smaller.  For  the  dipping  process  of  making 
counter-dies  and  dies,  the  model  needs  no  specially  nice  trimming. 
For  the  fusible-metal  process,  the  model  should  be  cylindrical,  and  not 
flaring.     Tliese  are  the  three  forms  of  thick  or  deep  model. 

The  shallow  models  are  usually  made  without  rims.  The  impression 
is  filled,  then  turned  down,  when  the  plaster  has  set  sufiiciently  to 
permit  it,  on  the  remaining  plaster,  and  poured  on  a  strip  of  wet  paper. 


MODELS.  551 

"Whilst  plastic,  it  is  shaped  with  the  spatula.  If  for  vulcanite  or 
other  plastic  work,  it  is  taken  up  while  soft  enough  to  dress  with  the 
sponge.  But  if  the  shallow  model  is  to  be  used  in  sand  moulding,  or 
in  Dr.  Gunning's  process,  it  is  allowed  to  harden,  and  is  then  trimmed 
with  the  knife.  In  vulcanite  models  it  will  save  time,  and  insure 
greater  accuracy  in  articulation,  to  extend  the  model  at  once  and 
make  the  articulating  portion;  as  will  be  fully  explained  when 
describing  the  process  of  articulation.  The  sides  of  vulcanite  models 
need  no  shaping,  except  such  as  neatness  and  convenience  in  handling 
require;  since  they  are  subsequently  set  into  the  flask  ;  but  they  should 
be  no  larger  or  thicker  than  strength  requires. 

When  rims  are  used,  the  impression  should  rest  upon  the  plaster 
table ;  if  set  level,  the  back  will  necessarily  be  parallel  with  the  face, 
since  the  thin  plaster  poured  into  the  rim  finds  its  level.  In  making 
shallow  models,  the  impression  is  held  in  the  hand,  thus  permitting 
the  flow  of  the  plaster  to  be  aided  by  moving  or  tapping  it.  As 
before  stated,  wax  and  gutta-percha  need  no  oiling;  plaster  may  be 
oiled  or  soaped,  or  else  varnished  and  oiled ;  it  must  also  be  saturated 
with  water  just  before  pouring  the  model. 

Calcined  plaster  for  models  should  not  set  too  rapidly,  as  this  will 
cause  haste,  with  its  attendant  dangers.  Coarse  plaster  makes  a  stronger 
model,  but  it  has  greater  expansion.  Gum-water,  or  size,  retards  the 
setting,  but  makes  the  model  very  hard ;  salt  quickens  the  setting, 
but  should  not  be  used  for  any  models  w^hich  are  to  be  kept  as  per- 
manent records  of  the  case.  It  is  best  to  add  the  plaster  to  the  water, 
than  the  reverse ;  it  makes  smoother  work  by  permitting  the  escaj)e 
of  the  air ;  it  also,  by  the  amount  of  unsaturated  water,  permits  the 
operator  to  gauge  the  stiffness  of  the  batter.  Yet  practised  operators 
may  with  equal  success  add  water  to  the  plaster. 

In  all  cases  the  face  of  the  model  is  the  part  first  made.  The  thin, 
freshly  mixed  plaster  is  first  to  be  carefully  run  into  the  depressions 
of  the  teeth  or  their  ridges.  A  brush  or  feather  is  necessary  when  the 
cup  is  stationary ;  when  in  the  hand,  motion  or  tapping  will  cause  the 
plaster  to  flow  as  desired.  Perhaps  the  surest  way  to  prevent  defects 
on  the  face,  from  confined  air,  is  to  have  a  little  surplus  water  in  the 
cup.  The  plaster  (which  in  this  case  must  not  be  too  thin)  settles  at 
once  into  the  smallest  crevice  under  the  water,  and,  if  not  stirred,  it 
will  not  be  made  thin  and  rotten  by  it. 

The  impression  once  filled,  the  formation  of  the  body  is  easy.  For 
deep  models,  the  remaining  plaster  should  be  poured  at  once,  that, 
while  thin,  it  may  form  a  smooth  and  level  back.  For  shallow  models 
the  plaster  miist  slightly  stiffen,  lest  the  weight  of  the  impression 
should  make  it  settle  too  much  into  the  plaster  on  the  table.   The  sponge 


552 


MODELS. 


is  very  useful  in  dressing  up  a  model :  it  cuts  more  or  less  according 
to  the  state  of  the  plaster.     It  may  be  used  to  trim  vulcanite  models 
directly  after  the  spatula,  or  to  give  finish  to  other  models  after  the 
use  of  the  knife.     But  when  plaster  is  fully  hardened  it  has  no  effect. 
Figs.  222  and  223  represent  upper  and  lower  models  suitable  for 


Fig.  222. 


Fig.  223. 


Fig.  224. 


sand  moulding ;  the  same  may  be  used  for  dipping.  Fig.  224  repre- 
sents a  shallow  model  in  the  moulding-flask,  show- 
ing how  the  body  of  the  die  is  formed  by  the  zinc- 
half  of  the  flask.  The  same  figure  may  be  taken 
to  represent  the  position  of  the  thin  model  at  the 
bottom  of  an  iron  cup,  in  the  process  of  making 
the  counter-die  by  Dr.  Gunning's  method. 

Difficulties  arising  from  undercuts,  on  the  outside 
of  the  upper  ridge  and  on  the  inside  of  the  lower, 
may  be  overcome  :  (1)  by  filling  up  the  undercut  with  wax  or  plaster 
in  all  places  where  it  is  unnecessary  or  impracticable  to  carry  the 
metallic  plate;  (2)  by  using  a  peculiarly  constructed  flask  for  mould- 
ing, such  as  the  one  invented  by  Dr.  G.  E.  Hawes  (Figs.  230,  231)  ; 
(3)  by  filling  the  undercut  with  movable  pieces  of  plaster,  technically 
known  as  "false  cores,"  They  should  be  shaped  so  as  to  admit  of  being 
drawn  from  the  sand;  at  the  same  time  they  must  have  a  decided 
angle,  so  as  to  mark  distinctly  the  place  in  the  sand  for  their  replace- 
ment. A  small  nail  or  tack  in  the  sand,  above  the  core,  will  keep 
it  in  place  whilst  the  metal  is  being  poured.  (4)  By  making  a  sec- 
tional model  (Fig.  225),  as  suggested  by  Dr.  A.  Westcott.  It  may 
be  made  by  filling  the  central  third  of  the  wax  impression  with  the 
plaster,  keeping  it  from  the  lateral  thirds  by  a  temporary  use  of  clay 
or  putty.  This  is  removed  and  trimmed,  leaving  the  back  wider  than 
the  face  (Fig.  225)  ;  then  replaced  in  the  impression,  and  filled  up  on 
each  .side  with  plaster;  the  model  is  then  removed,  properly  trimmed, 
and  varnished. 


MODELS. 


553 


Dr.  Bean's  method  of  making  a  model  in  two  parts  (for  his  Alu- 
minum Process)  is  equally  applicable  to  making  models  in  three  parts, 


Fig.  225. 


Fig.  226. 


and  is  perhaps  better  than  the  foregoing.  He  thus  describes  it.  "  To 
secure  a  division  in  the  model  itself,  the  best  plan  is  to  set  up  in  the 
impression  a  septum  of  thin  sheet  lead,  forming  a  vertical  plane  in  the 
median  line  of  the  palate,  and  fitted  somewhat  to  the  inequalities  of 
the  impression.  This  plate  should  have  two  or  three  small  projections 
struck  up  on  one  side,  by  means  of  a  small  conical  punch,  and  the 
opposite  side  has  some  cotton  fibre  attached  with  shellac,  in  the 
manner  described  for  preparing  impression  cups.  Fig.  226  represents 
the  shape  of  this  plate  (one-half  the  size),  and  shows  the 
side  on  which  are  the  projections.  Its  proper  position 
will  be  readily  understood  when  applied  to  an  impres- 
sion of  one  of  those  deep  palates  now  under  considera- 
tion. The  side  having  the  projections  is  oiled,  the  cotton 
on  the  other  side  wet  with  water,  and  while  filling  up  the 
impression,  this  plate  is  set  up  in  the  middle,  along  the 
median  line,  so  that  when  the  model  is  trimmed  to  proper 
size  and  shape,  it  may  be  carefully  broken  apart  and 
placed  together  again,  in  the  same  position." 

Much  time  may  be  wasted  in  the  efibrt  to  overcome 
difiiculties  of  undercut  in  sand  moulding.  The  dexterous  removal  of 
shallow  models  will  suffice  for  most  cases  of  front  undercut ;  and  of 
all  others,  it  may  be  said  that  no  undercut,  on  the  die,  is  of  any  service 
into  which  the  plate  cannot  be  swaged,  or  in  removal  from  which  the 
plate  is  apt  to  be  bent. 

Removing  the  impression  is  a  fruitful  source  of  vexation,  because 


554  MODELS. 

of  tlie  frequent  breaking  of  prominent  parts  of  the  model,  and  other 
annoying  accidents.  But  these  are  in  every  case  the  result  of  haste, 
carelessness,  or  forgetfulness.  First,  the  model  must  have  time  to 
harden ;  then  the  impression,  if  of  wax  or  gutta-percha,  must  bo 
thoroughly  softened.  The  common  practice  of  setting  the  model  on 
the  stove  is  bad  ;  the  smell  of  burning  wax  is  often  the  first  warning 
of  a  softening  which  has  gone  too  far,  injuring  the  model  by  the  ab- 
sorption of  melted  wax.  It  is  far  better  to  place  it  in  water  at  140^ 
and  loO''  Fahrenheit,  leaving  it  long  enough  for  the  entire  mass  of 
wax  to  soften  :  at  this  temperature  the  wax  does  not  melt,  yet  is  so  soft 
that  it  cannot  injure  the  most  delicate  point  of  the  model.  If  over 
ISO"^,  some  portions  may  adhere  to  the  model,  and  give  trouble  in 
removing.  Gutta-percha  impressions  must  be  thoroughly  softened  in 
water  at  200°;  if  over  this  temperature,  portions  of  gutta-percha  are 
apt  to  adhere  to  the  surface.  In  partial  cases,  it  is  a  good  plan  to  first 
remove  the  cup,  then  turn  up  the  edges  of  softened  wax  or  gutta-percha, 
till  it  is  free  from  the  teeth,  and  then  remove  the  entire  mass. 

Plaster  impressions  require  a  different  treatment.  If  the  cup  is 
wholly  or  j)artly  of  wax  or  gutta-percha,  these  must  first  be  softened 
and  removed :  a  Britannia  cup  is  loosened  by  light  strokes  of  the 
plaster  knife  handle.  The  impression  is  then  broken  away  piecemeal. 
Dipping  in  hot  water  makes  it  rotten,  and  facilitates,  at  times,  its  re- 
moval. It  is  often  necessary  to  cut  nearly  through  the  impression  in 
places;  in  doing  which,  the  knife,  or  graver,  must  be  held  so  as  to 
guard  against  injury  to  the  model  beneath.  Another  safeguard  is  to 
coat  the  impression,  before  pouring,  with  oil  colored  byalkanet;  or, 
better  still,  to  tinge  the  plaster  with  which  the  impression  is  taken 
with  vermilion  or  Brandon  red ;  it  gives  the  dry  plaster  a  faint  pinkish 
tinge;  does  not,  in  this  small  proportion,  injure  its  setting  qualities; 
and  it  makes  a  very  distinct  contrast  with  the  pure  white  of  the  model. 

Few  impressions  can  be  used  twice ;  those  taken  in  wax  or  gutta- 
percha cups  never.  Partial  impressions  of  all  kinds  are  necessarily 
sacrificed  to  the  integrity  of  the  first  model.  But  plaster  impressions, 
in  a  smooth  Britannia  cup,  may,  with  proper  care,  be  replaced  in  the 
cup,  and  used  again  so  as  to  give  a  model  quite  equal  to  the  first. 
Some  of  these  will  come  from  the  model  entire ;  but  often  it  is  neces- 
sary to  cut  a  groove  over  the  alveolus,  and  break  off  the  outer  rim  in 
two  or  three  sections. 

Models  are  mostly  trimmed  before  removing  the  impression  ;  but  it 
is  always  necessary  afterward  to  trim  the  shoulder.  Usually  this  is 
done  by  merely  taking  off  the  rough  edges,  following  the  outline  of 
Hie  edge  of  the  impression;  but  for  striking  up  a  plate  with  the  outer 
edge  turned  up,  a  flange,  or  shoulder,  about  the  fourth  of  an  inch  wide, 


MODELS.  555 

}s  formed  around  the  outside  of  the  plaster  model,  -svhere  it  is  designed 
that  the  edge  of  the  base-plate  shall  terminate  on  the  alveolar  border. 
It  may  be  shaped  either  in  wax  or  plaster,  and  should  stand  off  from 
the  ridge  at  an  angle  of  about  90°  or  100^,  the  angle  of  the  rim  being 
completed  with  pliers  after  swaging.  A  i:)late  swaged,  with  such  a  rim 
is  used  in  mounting  gum  or  block  teeth  and  in  continuous  gum  work  ;  it 
is  stronger  than  a  simple  plate,  and  is  susceptible  of  a  more  beautiful 
finish.  For  a  lower  set  of  block  teeth,  the  edge  of  the  plate  may 
also  be  turned  up  all  the  way  round.  An  objection  to  a  swaged  rim 
is  the  occasional  difficulty  of  determining  just  how  far  over  the  ridge 
the  plate  should  extend  ;  for  any  change  is  impossible,  without  destroy- 
ing the  rim.  Hence  the  more  common  practice,  except  in  continuous- 
gum  work,  is  to  solder  a  gold  band  or  wire,  after  adaptation  of  the 
plate  to  the  mouth,  as  hereafter  explained. 

The  model,  if  it  is  to  be  used  in  sand  moulding,  should  have  several 
coats  of  shellac  or  sandarach  varnish  applied  with  a  small  bristle 
brush,  to  give  it  a  smooth,  hard,  and  polished  surface.  This  will  pro- 
tect it  from  injury  by  use,  render  it  more  pleasant  to  handle,  and  cause 
the  sand  to  part  easily  from  it.  The  gum-shellac  varnish  may  be  pre- 
pared by  dissolving  five  ounces  of  shellac  in  one  quart  of  alcohol.  In 
using  this  varnish  on  a  damp  impression,  be  careful  not  to  apply  a 
second  coat  until  the  first  is  hard ;  else  it  will  cause  the  first  to  peel, 
and  injure  the  smoothness  of  the  surface.  Sandarach  varnish  is  pre- 
ferable to  shellac,  as  it  is  harder;  it  is  also  more  transparent,  and, 
consequently,  does  not  color  the  plaster.  It  may  be  made  in  the  fol- 
lowing manner :  Take  six  ounces  of  gum-sandarach,  one  ounce  of  elemi, 
digest  in  one  quart  of  alcohol,  moderately  warm,  until  dissolved;  or 
the  sandarach  alone  may  be  used.  This  is,  perhaps,  as  good  a  varnish 
as  can  be  used  for  plaster  models.  It  is  easily  prepared  :  but  the  alcohol 
should  be  warmed  in  a  sand-bath  or  hot  water,  to  prevent  it  from  taking 
fire.  To  make  the  finest  varnish,  the  sandarach  should  be  of  best 
quality,  and  washed  in  water  before  being  put  into  the  alcohol.  Some, 
however,  prefer  a  coating  of  charcoal  dust  or  plumbago  for  sand  models. 

Models  for  dipping,  or  pouring,  or  the  fusible-metal  process,  should 
have  no  kind  of  varnish  upon  them.  Vulcanite  and  other  plastic-work 
models  may  have  a  protecting  coat  of  dilute  soluble  glass  (nine  parts 
water  to  one  part  of  the  glacial  syrup) ;  but  if  too  much  or  too  strong 
a  solution  is  used,  it  will  do  more  harm  than  good. 


556  DIES    AND    COUNTER-DIES. 


CHAPTER  IX. 

DIES   AND    COUNTER-DIES  —  SWAGING    PLATES. 

YARIOUS  methods  have  been  adopted  for  jirocuring  metallic  dies 
and  counter-dies.  The  three  following  are  all  which  the  author 
deems  it  necessary  to  describe.  The  first  of  these  consists  in  fouring 
melted  metal  into  a  mould  or  matrix,  made  in  sand  with  the  plaster 
model :  by  this  means  the  die  is  formed,  and  the  counter-die  is  obtained 
by  pouring  metal  upon  it.  Tlie  second  consists  in  making  the  counter- 
die  first,  eitlier  by  immersing  the  plaster  model  in  metal,  or  pouring 
metal  upon  it;  the  die  is  formed  by  pouring  metal  into  this. 

The  third  consists  in  pouring  the  metal,  for  the  metallic  die,  directly 
into  the  impression.  A  very  ingenious  set  of  flasks  for  this  purpose, 
the  invention  of  Dr.  F.  Y.  Clark,  of  Savannah,  can  be  had  at  the 
dental  depots.  The  same  maybe  done,  less  conveniently  perhaps,  with 
the  usual  Britannia  cups  and  moulding-rings.  Take  a  piece  of  copper 
or  brass  gauze,  and  fit  into  the  cup  before  taking  the  impression.  Set 
the  impression,  thus  strengthened,  into  a  batter  (asbestos  or  sand  three 
parts,  plaster  one  part),  poured  into  a  narrow  iron  ring  (sheet  iron  will 
answer)  ;  carefully  work  the  batter  around  the  edges  of  the  impression, 
then  place  upon  it  the  zinc-half  of  Bailey's  flask 
Fig.  2-7.  (Fig.  227).    If  the  impression  is  thoroughly  di'ied, 

the  first  metallic  die  will  be  perfect,  no  matter  how 
much  undercut  there  may  be.  A  second  or  third 
may  then  be  taken,  more  or  less  defective,  but  very 
useful  for  the  first  stages  of  the  swaging  process. 
Zinc  is  the  metal  used  by  Dr.  Clark  for  the  die. 
In  this  process  the  impression  may  be  plaster,  or  plaster  and  felspar; 
but  the  investing  batter  should  have  only  enough  plaster  to  bind  the 
asbestos  or  sand  together.  Dr.  Clark  uses  a  copper  impression  cup, 
which  Prof  Austen's  process  dispenses  with.  The  flask  and  impression 
must  be  perfectly  dry,  and  heated  nearly  or  quite  up  to  the  fusion- 
point  of  the  metal  used. 

The  second  method  admits  of  three  modifications:  1.  The  fusible 
metal  process ;  in  which  the  model  is  surrounded  Avith  thick  paper,  and 
fusible  metal  in  a^  semifluid  state  is  dashed  over  it  with  a  spoon,  the 
model  being  cold,  so  as  to  rapidly  chill  the  metal.  While  still  warm, 
the  paper  is  removed,  and  the  counter-die  trimmed  with  a  knife ;  for  at 


DIES    AND    COUNTER-DIES.  557 

this  temperature  it  can  be  cut  as  readily  as  cheese.  The  counter-die, 
"when  cold,  is  then  smoked  or  coated  with  whiting,  surrounded  with 
paper,  and  semifluid  fusible  metal  dashed  on  it,  to  make  the  die.  This 
process  is  repeated,  until  from  two  to  six  dies  are  made,  according  to  the 
irregularity  of  the  case.  The  model  should  be  made  in  a  ring  of  nearly 
circular  shape  and  cylindrical ;  it  should  also  be  at  least  a  half  inch 
larger  than  the  alveolar  ridge,  that  the  counter-die  may  have  sufiicient 
metal  to  force  up  the  plate. 

2.  The  dipping  process  consists  in  pouring  melted  lead,  type-metal, 
or  pewter  into  a  sheet-  or  cast-iron  cup  or  box,  three  and  a  half  or 
four  inches  in  diameter,  and  three  or  four  inches  deep,  until  it  is 
more  than  half  full ;  then,  stirring  the  fluid  mass  with  gradually  in- 
creasing rapidity  until  it  begins  to  granulate,  quickly  brush  off"  the 
surface  dross,  and  at  once  immerse  the  plaster  model  more  or  less  deeply, 
as  the  palate  is  a  deep  or  shallow  one,  and  hold  it  there  until  the  metal 
congeals.  To  prevent  accident  from  air  confined  in  the  palatine  arch, 
a  small  hole  should  be  drilled  through  the  plaster  model.  It  is  then 
removed,  and  the  whole  upper  surface  of  the  counter-die  covered  with  a 
thin  coating  of  whiting  or  lamp-smoke  as  before  directed.  After  this  has 
become  perfectly  dry,  melted  block  tin,  type-metal,  or  soft  solder,  at  a 
temperature  so  low  that  it  will  not  char,  or  even  discolor  white  paper, 
is  poured  in,  until  the  cup  is  filled.  If  the  counter-die  is  so  deep  that 
the  die  has  not  sufficient  thickness,  it  may  be  deepened  by  placing  on 
the  freshly-poured  metal  the  zinc- half  of  a  Bailey  flask,  and  continu- 
ing to  pour ;  the  metal  in  the  two  flasks  will  unite  and  form  one  die. 
When  cold,  the  castings  are  removed  from  the  iron  cup,  separated,  and 
are  then  ready  for  use. 

3.  Dr.  Gunning's  method,  called  also  the  "pouring  process,"  in  which 
a  very  thin  model  (made  of  plaster  two  parts,  and  sand  or  felspar 
one  part)  is  placed  in  the  bottom  of  an  iron  box,  three  and  a  half  to 
four  inches  in  diameter,  and  about  two  inches  deep.  It  is  fastened 
there  by  a  thin  layer  of  plaster  and  sand,  then  thoroughly  dried  by 
gradually  raising  box  and  all  to  the  temperature  of  the  melted  metal, 
which  is  next  poured  in,  and  the  box  set  in  a  shallow  vessel  of  water 
to  cool  it  rapidly  from  the  outside.  To  delay  the  cooling  in  the  centre 
until  the  last  moment,  and  so  prevent  contraction  at  that  place,  a  very 
hot  pointed  iron,  somewhat  similar  in  shape  and  size  to  a  tinner's 
soldering-iron,  is  placed  upon  the  centre  of  the  model  before  the  metal 
is  poured.  When  cold,  this  is  removed,  and  the  conical  space  filled 
with  metal.  The  counter-die  is  thus  made  of  lead,  alloyed  with  tin 
or  type-metal.  The  die  is  made  by  placing  over  this  a  stout  wrought- 
iron  ring,  and" pouring  in  fusible  metal.  Dr.  Gunning  uses  from  three 
to  eight  dies,  according  to  the  sharpness   of  the  prominences  of  the 


558 


DIES    AND    COUNTER-DIES. 


model.  The  method  gives,  in  his  hands,  very  accurately  fitting 
plates. 

When  metallic  dies  are  to  be  obtained  by  the  first  method,  mould- 
ing-fhusks  and  sand  aj-e  required.  Flasks  may  be  of  wood  or  iron. 
The  moulding-box  of  wood  should  be  about  six  inches  square.  This  is 
to  be  filled  with  fine  sand,  such  as  is  used  by  brass  founders,  in  the 
following  manner:  The  deep  or  shallow  plaster  model  is  placed  on 
the  moulding-table  exactly  in  the  centre  of  the  box,  with  its  face 
upward.  Sand  is  then  firmly  packed  around  the  sides  of  the  model. 
Sand  should  then  be  sifted,  covering  the  face  of  the  model,  to  the 
depth  of  a  half  inch,  the  box  then  filled,  and  the  whole  rammed  with 
a  fii-mness  proportioned  to  the  coarseness  or  dryness  of  the  sand  — 
damp  or  very  fine  or  strong  (i.  e.  with  large  percentage  of  clay)  sand 
not  permitting  so  much  compression  as  sand  possessing  the  opposite 
qualities,  because  it  would  become  too  compact  to  permit  the  escape 
of  the  vapors  formed  during  the  process  of  pouring.  But  the  finest 
sand,  rich  in  clay  and  quite  moist,  may  be  used,  if  it  is  dried  before 
pouring. 

The  box  is  then  turned  over  and  gently  tapped  several  times  with 
some  light  instrument  or  hammer,  for  the  purpose  of  starting  or 
detaching  it  a  little  from  the  matrix,  and  then  carefully  removed. 
Great  care  is  necessary  that  this  tapping  does  not  depress  first  one 
side  and  then  the  other ;  this  would  make  the  die  too  deep  in  the 
centre,  and  perhaps  cause  the  plate  to  rock.  The  model  may  be 
loosened  laterally,  by  holding  an  excavator  firmly  upon  the  centre 
of  the  die  and  tapping  it  on  the  side.  If  the  model  be  composed  of 
three  pieces,  the  middle  section  is  first  removed,  and  afterward  the 
two  others.  There  are  two  ways  of  drawing  the  model :  first,  by 
screwing  into  it  an  excavator  or  gimlet,  and  carefully  di'awing  it  out; 
second,  by  throwing  it  out  with  a  dexterous  jerk  of  the  matrix.    The 


Fig.  228. 


Fig.  228  represents  the  two  ends  of  a  double  spatula,  ■which  will  be  found  very 
useful  in  sand  moulding. 


DIES    AND    COUNTER-DIES. 


559 


last  is  best ;  the  excavator  is  apt  to  break  through  the  centre  of  the 
thin  model,'  and  the  thick  one  falls  out,  by  its  own  weight,  better  than 
it  can  be  drawn. 

If  the  deep  model  is  used,  the  matrix  is  now  ready  for  pouring ; 
but  first  remove  all  loose  sand,  and  make  a  groove  at  the  back  part 
of  the  matrix  to  receive  the  first  flow  of  the  metal.  If  the  thin  model 
is  used,  a  ring  must  be  set  upon  the  sand  after  the  model  is  drawn,  to 
give  the  additional  size  which  the  die  requires  to  prevent  cracking 
under  the  swaging-hammer. 

The  mould  being  prepared,  the  metal  to  be  employed  for  the  casting 
should  be  put  into  a  tolerably  thick  wrought-  or  cast-iron  ladle,  and 
melted  in  a  common  fire  or  furnace.  If  brass  is  used,  the  latter  will 
be  required  to  melt  it ;  but  if  zinc,  block  tin,  or  lead,  a  common  fire 
will  afford  sufficient  heat.  As  soon  as  the  metal  has  become  thoroughly 
melted,  it  is  poured  into  the  furrow  formed  in  the  sand,  whence  it  will 
flow  into  the  back  part  of  the  mould.  It  is  necessary  to  convey  the 
melted  metal  into  the  mould  in  this  way  to  prevent  the  injury  which 
the  surface  of  the  sand  might  sustain  by  pouring  directly  upon  it. 

There  have  been  quite  a  number  of  moulding-flasks  devised  to  super- 
sede the  wooden  one  just  described,  or  the  common  cart-wheel  box, 
wliich  was  once  much  used.  Some  of  these  are  worse  than  useless  ; 
others  are  very  convenient,  and  have  the  advantage  of  requiring  only 
a  small  quantity  of  sand  ;  also  of  permitting  the  sand  to  be  dried, 
which  cannot  be  well  done  in  the  wooden  box.  The  simplest,  and 
perhaps  best,  flask  is  that'  invented  by  Dr.  E.  N.  Bailey.  Fig.  229 
represents  the  shape  and  working  of  this  flask. 

Fig. 229 


c 

LEAD 

'     c^£-IZ^:::r^ 

~B\ 

V  ;      ZINC 

Half-flask  B  is  placed,  joint  edge  downward,  over  a  thin  model,  and 
firmly  packed  with  sand.  It  is  then  turned;  the  sand  compressed 
around  the  edge  of  the  model ;  then  trimmed  so  that  the  model  may 
be  easily  drawn  (a  properly  shaped  model  renders  much  sand  trimming 
unnecessary) ;  the  model  is  then  lightly  tapped  and  thrown  out.  All 
operations  on  the  thin  model  must  be  conducted  with  great  care,  for 
it  is  easily  displaced  in  its  matrix,  so  as  to  destroy  the  accuracy  of  the 
latter.  Next,  pour  zinc  into  the  mould,  and  at  once  place  on  half- 
flask  A,  and  complete  the  pouring.     When  cool,  remove  the  sand,  in- 


560 


DIES    AND    COUNTER-DIES. 


vert  the  flask,  witli  zinc  die  contained,  and  pour  the  lead  (C)  upon  the 
zinc  for  the  counter-die. 

In  cases  of  moderate  undercut  in  front,  the  thin  model  can  gener- 
ally be  drawn  by  a  dexterous  backward  movement.  But  for  a  deeper 
undercut  in  front,  also  for  those  at  the  side,  the  moulding-flask  of  Dr. 
Hawes  (Figs.  230,  231,  232)  will  be  found  useful. 

The  manner  of  using  it  is  thus  described  by  Dr.  C.  C.  Allen : 
"  If  the  model  be  considerably  smaller  than  the  space  between  the 
flanges  projecting  inward,  small  slips  of  paper  may  be  placed  in  the 
joint,  extending  to  the  sides  of  the  model,  so  as  to  part  the  sand  when 
opening  the  flask  for  the  removal  of  the  pattern.  The  sand  may 
now  be  packed  around  the  model  up  to  the  most  prominent  part  of 
the  ridge.  It  should  be  finished  smoothly  around  it,  slightly  descend- 
ing toward  the  model,  so  as  to  form  a  thick  edge  of  sand  for  the  more 


Fig.  230. 


Fig.  232. 


Fig.  231.  Fia.  230.— The  lower  section  of  the  flask  slightly 

opened  to  show  joints.  Fig.  231. — The  upper  sec- 
tion. Fig.  232. — The  lower  section  closed,  and 
confined  by  a  pin,  with  the  plaster  model  placed 
in  it. 

perfect  parting  of  the  flask.  The  sand  and 
face  of  the  model  must  now  be  covered  with 
dry  pulverized  charcoal  sifted  evenly  over 
the  whole  surface.  When  this  is  done,  the  upper  section  of  the  flask 
is  placed  over  the  loAver,  and  carefully  filled  with  sand.  It  is  then 
rai.sed  from  the  lower  one,  which  may  now  be  parted  by  removing  the 
long  pin,  and  the  model  gently  taken  away.  When  closed,  and  the 
two  put  together  again  and  inverted,  it  is  ready  to  receive  the  melted 
metal."  After  the  metal  has  cooled,  it  may  be  removed  and  turned 
over,  so  that  the  face  of  the  die  shall  be  upward,  while  the  remainder 
is  buried  in  the  sand.  Thus  placed,  it  is  encircled  with  the  ring  (Fig. 
231),  and  the  metal  for  the  counter-die  poured  upon  it. 

The  metals  most  commonly  used,  when  metallic  dies  are  made  by 
sand  moulding,  are  zinc  and  lead.  For  many  reasons,  these  are,  per- 
haps, the  best  metals  for  general  use  that  can  be  employed.  Zinc  is 
the  hardest  metal  that  the  dentist  can  conveniently  melt.     In  case  of 


DIES    AND    COUNTER-DIES. 


661 


deep  or  large  arches,  and  for  mouths  where  the  mucous  membrane  is 
very  hard,  should  its  shrinkage  prevent  the  close  adaptation  of  the 
plate,  a  finishing  die  may  be  made  of  block  tin,  type-metal,  soft  solder, 
or  Babbit's  metal  (a  patented  alloy  of  copper,  tin,  and  antimony,  which 
can  be  obtained  at  any  machine-shop),  which  last  is  nearly  as  hard  as 
zinc,  and  has  decidedly  less  shrinkage.  When  a  metal  softer  than  zinc 
is  used,  several  dies  will  be  necessary  to  complete  the  swaging. 

Prof  Austen,  by  careful  experiment,  found  that  an  average-sized 
zinc  die,  measuring  two  inches  transversely,  contracts  27-lOOOths  of  an 
inch  from  outside  to  outside  of  the  alveolar  ridge,  being  equivalent  in 
thickness  to  three  ordinary  book-leaves.  He  remarks :  "  In  the  firsf 
case,  (upper  jaw,)  the  plate  would  'bind,'  and  if  the  ridge  were  coverec 
by  an  unyielding  mucous  membrane,  it  would  prevent  accuracy  of 
adaptation.  In  the  second  case,  (under  jaw,)  the  plate  would  have 
too  much  lateral  'play,'  and  consequently  lack  stability.  Again,  in  a 
moderately  deep  arch,  say  a  half  inch  in  depth,  the  shrinkage  between  the 
level  of  the  ridge  and  the  floor  of  the  palate  will  be  nearly.  7-lOOOths  — 
rather  more  than  one  leaf.  In  the  deepest  arches,  this  shrinkage  may 
give  trouble,  except  where  the  ridge  is  soft,  and  then  it  becomes  a  posi- 
tive advantage.  In  the  shallower  cases,  it  is  not  of  much  moment,  as 
there  is  no  mouth  so  hard  as  not  to  yield  the  1  or  2-lOOOths  of  an  inch." 

A  counter-die  should  be  soft.  Lead  is  decidedly  the  best  metal  for 
this  purpose ;  tin  may  be  used  if  the  die  is  made  of  zinc.  It  is  desirable,, 
if  practicable,  that  the  metal  last  poured  (in  sand  moulding,  this  is  the- 
counter-die)  should  melt  at  a  lower  temperature  than  the  other.  la 
this  respect,  zinc  and  lead  are  admirably  suited  —  zinc  melting  at  770° 
and  lead  at  600°.  Tin  melting  at  440°  might  be  supposed,  in  this  re- 
spect, better  than  lead  ;  but  such  is  not  the  fact,  owing  to  the  tendency 
of  tin  and  zinc  to  form  alloys,  whilst  lead  and  zinc  have  no  such  affinity. 

In  a  paper  on  metallic  dies,  published  in  the  fourth  volume  of  the  Am.. 
Journal  of  Dental  Science,  Prof  Austen  gives,  as.  the  result  of  careful 
experiment,  the  following  tabular  view  of  the  fusible  alloys —  zinc  being, 
introduced  for  the  purpose  of  comparison : 


Con- 

Melting 

tractil- 

Hard- 

Beittie- 

Point. 

ity. 
■01366 

ness. 

ness. 

1.  Zinc  ...... 

770° 

•018 

5 

2.  Lead,  2 ;  tin,  1    . 

440° 

00633 

•050 

3 

3.  Lead,  1 ;  tin,  2         .              .             .             . 

340° 

00500 

•040 

3 

4.   Lead,  2;   tin,  3;   antimony,  1     . 

420° 

00433 

•026 

I 

•5.  Lead,  5;  tin,  6;  antimony,  1 

320° 

00566 

•035 

6 

6.  Lead,  5 ;  tin,  6  ;  antimony,  1  ;  bismuth,  3 

300° 

■00266 

•030 

9 

7.  Lead,  1  ;  tin,  1 ;   bismuth,  1 

250° 

00066 

•042 

7 

8.  Lead,  5;  tin,  3";  bismuth,  8     .. 

200° 

00200 

•045 

8 

9.  Lead,  2 ;  tin,  1 ;  bismuth,  8 

200° 

■00133 

•048 

7 

36 


662  DIES    AND    COUNTER-DIES. 

The  last  column  contains  an  approximate  estimate  of  the  relative  brit- 
tleness  of  the  samples  given.  As  in  the  other  columns,  the  low  numbers 
represent  the  metals,  so  fiir  as  this  property  is  concerned,  most  desirable. 
Those  marked  below  5  are  malleable  metals ;  those  above  5  are  brittle; 
zinc,  marked  5,  separates  these  two  classes,  and  belongs  to  one  or  the 
other,  according  to  the  way  in  which  it  is  managed. 

In  all  cases  of  melting,  it  is  a  safe  rule  to  pour  the  metals  at  the 
lowest  temperature  at  which  they  will  flow.  It  is  prudent,  also,  to 
coat  the  metal,  on  which  other  metal  is  poured,  with  a  mixture  of 
alcohol  and  whiting,  to  prevent  all  chance  of  adhesion.  One  more 
very  important  caution  in  the  melting  of  zinc  and  lead  is  invariably 
to  use  separate  ladles ;  for  any  lead,  left  from  a  previous  melting, 
flows  from  the  ladle  with  the  last  portions  of  the  zinc,  and,  being 
heavier  (in  the  proportion  of  11  to  7)  and  more  fluid,  falls  at  once  to 
the  bottom  of  the  matrix,  making  the  alveolar  ridge,  more  or  less,  of 
a  soft  metal,  thus  totally  destroying  its  usefulness. 

The  elastic  vapor  generated  by  the  contact  of  the  Avater  in  the  sand 
with  the  hot  metal  sometimes  collects  under  or  rises  through  the  metal, 
and  renders  the  casting  more  or  less  imperfect.  This  may  be  prevented : 
1,  by  drying  the  sand ;  2,  by  using  coarse  or  loosely-jDacked  sand,  and 
avoiding  too  much  moisture ;  3,  by  mixing  the  sand  with  oil  instead 
of  water.  The  slightest  moisture  on  one  metal,  previous  to  the  pouring 
of  another  metal  upon  it,  will  make  the  latter  imperfect. 

In  making  metallic  dies  for  partial  cases,  about  three-fourths  of  the 
crowns  of  the  teeth  should  be  cut  from  the  plaster  model  before  using 
it  for  moulding.  The  plate  can  thus  be  fitted  more  easily  and  perfectly 
than  can  be  done  when  the  teeth  remain  on  the  plaster  model  and  zinc 
die ;  for,  in  the  former  case,  the  plate  need  not  be  cut  to  fit  the  teeth 
until  it  has  been  swaged ;  while  in  the  latter,  this  must  be  done  first ; 
consequently,  in  striking  it  up,  it  will  be  drawn  to  a  greater  or  less 
distance  away  from  them.  There  is  also  danger  of  splitting  the  plate, 
in  swaging  it  into  the  spaces  between  the  teeth,  if  these  are  left  on  the 
metallic  die. 

We  shall  conclude  the  section  on  metallic  dies  by  giving  some  prac- 
tical suggestions  by  Prof  Austen,  on  the  properties  and  uses  of  the 
metals  and  alloys  employed  for  this  purpose. 

Many  of  the  properties  of  these  metals,  though  most  interesting,  are 
not  practically  useful  to  the  dentist;  but  there  are  some  points,  for 
which  he  usually  refers  to  his  memorandum -book,  that  should  be 
printed  on  the  page  of  his  memory.  The  following  tables  present  two 
properties  of  certain  metals  in  a  form  convenient  for  memorizing ;  al- 
though not  absolutely  accurate,  they  are  quite  enough  so  for  use  in  the 
■dental  laboratory : 


DIES    AND    COUNTER-DIES. 


563 


Ordek  of  Fusibility. 

Order  op  Specific  Gravity. 

Copper        .         .         .  2000° 

Lead         .         .         .     11-5 

Antimony        .         .         900° 

Bismuth       .          .           10- 

Zinc  ....     770° 

Cadmium           .         .       8-5 

Lead       .         .         .         600° 

Tin        .         .         .          7-5 

Bismuth     .         .         .     500° 

Zinc          .         .         .       7- 

Tin  and  cadmium  .         440° 

Antimony      .         .           6  "5 

In  the  fusibility  table,  copper  is  given  to  show  how  unsuited  it  is 
for  laboratory  use.  Remembering  that  900°  is  red  heat,  the  next  four 
numbers  may  be  easily  memorized.  In  the  specific  gravity  table,  cop- 
per 9"  and  iron  8*  are  omitted,  so  as  to  present  the  table  in  a  form 
easily  remembered. 

The  only  pure  metals  suitable  for  a  die  are  zinc  and  tin;  for  a  coun- 
ter-die, tin  and  lead :  zinc  makes  the  best  die,  lead  the  best  counter-die. 
Copper  is  too  hard  to  fuse;  antimony  and  bismuth  are  too  brittle;  cad- 
mium is  too  expensive.     All  other  metals  used  in  swaging  are  alloys. 

Zinc  and  lead  are  valuable  because  :  They  are  so  unlike  that  they 
are  not  easily  mistaken  for  each  other ;  a  very  common  error  when 
alloys  are  used.  They  have  no  such  disposition  to  alloy  as  zinc  and  tin 
or  tin  and  lead  have.  Zinc  is  so  hard,  one  die  will  suffice  for  many 
cases ;  three  are  sufficient  for  the  most  difficult.  The  brittleness  may  be 
corrected  by  the  size  of  the  die.  Its  shrinkage  is  often  a  decided 
advantase ;  and  in  some  cases,  where  it  makes  the  plate  bind  on  the 
alveolus,  the  contraction  may  be  anticipated  by  coating  these  parts  on 
the  model  with  one  or  two  layers  of  very  thin  plaster.  Zinc,  after  re- 
peated use,  becomes  defective ;  hence,  a  supply  of  new  metal  should 
always  be  kept. 

No  metal  equals  lead  as  a  counter-die.  Its  weight  and  softness  are  in 
its  favor  for  this  purpose.  A  counter-die  cannot  be  too  large  or  heavy  ; 
convenience,  of  course,  limits  its  size.  A  difficult  plate  cannot  be  swaged 
with  a  small  counter-die,  unless  the  work  is  nearly  completed  by  partial 
counters,  hammers,  etc.,  before  using  it.  As  regards  softness,  the  greater 
the  disparity  between  die  and  counter,  the  less  will  be  the  change  in 
the  die  by  the  act  of  swaging.  The  plate  is  forced  by  the  counter  into 
the  depressions  of  a  die,  not  so  much  by  its  hardness,  as  by  its  vis 
inertia  under  the  swaging-blows.  The  little  disparity  in  the  hardness 
of  the  two  dies  is  one  serious  objection  to  the  use  of  the  second  class 
of  operations.  It  is  a  common  practice  to  use  several  counters,  and 
perhaps  only  one  die.  One  die  may  in  a  few  cases  suffice  ;  two  are  bet- 
ter, and  often  three ;  but  good  swaging  never  demands  more  than  one 
counter-die,  where  that  is  properly  made. 

"With  zinc,  lead,  and  one  fusible  alloy  (lead,  tin,  and  bismuth,  equal 
parts),  all  swaging  operations  may  be  completed  when  the  dies  are 


564 


DIES    AND    COUXTER-DIES. 


made  by  sand  moulding,  or  by  pouring  zinc  into  the  impression. 
But  since  many  prefer  other  methods  of  making  dies,  it  is  important 
to  understand  the  subject  of  aHoys.  Experiment  is  here  the  only  basis 
of  knowledge,  for  no  a  priori  reasoning  could  deduce  the  singular 
changes  caused,  and  new  properties  developed,  by  alloying. 

The  alloy  of  two  brittle  metals  is  always  brittle,  and  a  brittle  metal 
usually  imparts  this  property  to  a  tough  one  nearly  in  proportion  to 
its  percentage.  But  that  two  tough  metals  can  make  a  brittle  alloy  is 
remarkable.  Malleable  copper,  with  half  its  weight  of  brittle  zinc, 
gives  hard  brass,  which,  though  less  tough  than  copper,  is  not  brittle. 
But  malleable  copper,  with  malleable  tin  in  the  same  proportions, 
makes  speculum  metal — the  most  brittle  alloy  known.  A  similar 
instance  is  that  of  lead,  the  softest  of  metals,  which  will,  in  minute 
quantities,  make  gold,  the  most  malleable  of  all  metals,  very  brittle. 

Another  remarkable  property  of  all  alloys  is  fusibility.  Alloys  fuse 
below  the  average  melting-point  of  their  constituents.  Ternary  com- 
pounds exhibit  this  more  strikingly  than  binary.  The  following  table, 
in  illustratiou  of  this  property,  will  be  found  practically  useful  to  the 
dentist  in  the  selection  of  alloys. 

Allots  of  Bismuth,  Lead,  and  Tin. 


BiSSICTH, 

500°. 

Lead,  600°. 

Tin,  440°. 

F.^HREKHEIT. 

1 

10 

1 

540° 

2 

5 

1 

510° 

3 

2 

1 

440° 

4 

1 

1 

370° 

5 

2 

3 

335° 

6 

1 

2 

340° 

7' 

1 

5 

380° 

8 

1 

4 

4 

320° 

9 

1 

2 

2 

290° 

10 

1 

1 

1 

2G0° 

11 

2 

1 

1 

220° 

It  will  be  noticed  that  two  pounds  of  lead  do  not  make  one  pound 
of  tin  harder  to  melt;  whilst  a  half  pound  reduces  its  fusion-point 
100°.  Also,  Nos.  6  and  7,  though  containing  more  tin  than  'No.  5,  are 
harder  to  melt.  Again,  a  pound  of  bismuth  added  to  alloy  No.  4 
reduces  its  melting-point  110°.  No.  11  and  all  alloys  containing  much 
bismuth  are  brittle.  The  alloys  of  this  table  vary  somewhat  in  hard- 
ness, but  all  are  harder  than  tin. 

The  "  alloying  metals  "  of  the  dental  laboratory  are  copper,  antimony, 


DIES    AND    COUNTER-DIES.  565 

and  bismuth.  Copper  gives  hardness  to  zinc  and  tin,  and  is  sometimes 
combined  with  alloys  of  the  two.  But  the  high  fusion-point  of  copper 
renders  it  less  useful  to  the  dentist  than  the  other  two  metals.  The 
alloy  01  copper,  antimony,  and  tin  (Babbit's  metal)  is  perhaps  the 
only  one  of  practical  interest.  Its  advantage  over  zinc,  in  being  less 
liable  to  contract,  is  perhaps  set  off  by  the  tendency  of  most  alloys  to 
change  their  composition  by  frequent  melting ;  and  the  danger  of  mix- 
ing different  alloys,  from  absence  of  those  distinctive  marks,  such  as 
separate  zinc  and  lead. 

Antimony  is  a  more  valuable  alloying  metal.  It  hardens  tin,  but 
its  chief  use  in  the  laboratory  is  to  harden  lead,  making  type-metal. 
Small  types  composed  of  lead  4,  antimony  1,  are  too  brittle  ;  and  large 
types,  lead  6,  antimony  1,  are  scarcely  fit  for  laboratory  use.  In  the 
proportion  of  9  to  1,  antimony  corrects  the  excessive  contraction  of 
lead,  and  hardens  it ;  yet  leaves  it  tough,  so  as  to  resist  the  blows  of 
swaging.     It  is  suitable  only  for  counter-dies. 

The  very  common  opinion  that  antimony  causes  lead  to  expand  on 
cooling  is  erroneous.  The  alloy  has  a  slight  expansion  at  the  moment 
of  solidification ;  but  after  that,  it  obeys  the  universal  law  of  all 
metals,  and  contracts  as  it  cools.  Actual  contraction  depends  upon 
the  ratio  of  contraction  and  the  fusion-point ;  thus  lead  contracts  more 
than  zinc  because  its  high  ratio  of  contraction  more  than  compensates 
its  lower  fusion-point. 

Another  common  error  is  that  a  zinc  die  poured  very  hot  is  smaller 
than  if  poui-ed  at  its  fusion-point.  Of  course,  contraction  begins  the 
moment  cooling  begins  ;  but  so  long  as  the  metal  is  fluid,  it  necessarily 
fills  the  matrix,  and  contraction  causes  simply  subsidence  of  the  metal. 
No  die  begins  to  leave  the  walls  of  the  matrix  until  it  solidifies; 
hence  the  amount  of  contraction  is  the  same  in  all  cases.  Very  hot 
zinc  copies  minutely  the  sand  surface,  and  thus  has  not  that  bright, 
smooth  appearance  of  cooler  zinc,  which  sets  before  penetrating  the 
sand  interstices ;  but  both  are  equally  good.  Another  difference  is  in 
the  greater  depth' in  the  cavity  on  the  back  of  the  hot-poured  die. 
But  this  is  not  as  objectionable  as  many  think;  no  good  mechanic 
strikes  directly  upon  the  die,  but  upon  some  ovoid  or  conical  piece  of 
metal  covering  this  cavity  in  the  back. 

Bismuth  is  perhaps  the  most  valuable,  to  the  dentist,  of  the  three 
alloying  metals.  Antimony  gives  hardness,  but  not  much  fusibility ; 
bismuth  gives  fusibility,  but  no  great  hardness.  The  table  above 
given  shows  the  marked  effect  of  this  metal.  It  is  seldom  used  as  a 
binary  alloy,  because  its  fluxing  qualities  are  more  fully  brought  out 
in  ternary  combination;    also  because  of  its  expensiveness,  and   its 


566 


SWAGING    PLATES. 


tendency  to  impart  brittleness.     Type-metal  is  rendered  more  fusible 
by  the  addition  of  "05  per  cent,  of  bismuth. 

Bismuth,  antimony,  and  zinc  are  readily  distinguished — bismuth 
by  its  great  weight  and  characteristic  pinkish  color;  antimony  by  its 
peculiar  crystallization  and  its  excessive  brittleness.  But  the  alloys 
of  these  metals  with  tin  and  lead  have  such  a  general  resemblance, 
that  they  must,  with  much  care  and  system,  be  kept  apart  in  properly 
labelled  boxes ;  otherwise,  if  more  than  one  alloy  is  used,  the  annoy- 
ance caused  by  using  one  for  another  will  more  than  offset  their 
utility ;  in  fact,  such  negligence  defeats  their  usefulness. 

SWAGING. 

A  die  and  counter-die  having  been  obtained,  a  piece  of  sheet  lead  is 
adapted  to  the  former,  and  the  dimensions  of  the  plate  marked  upon 
it.  Paper  is  sometimes  used  for  this  purpose,  but  is  not  so  good  as  thin 
sheet  lead  or  heavy  tin  foil.  The  pattern  thus  made  is  cut  out,  flat- 
tened, and  laid  upon  the  gold  plate,  and  its  outline  marked  upon  it. 
The  plate  should  be  cut  a  little  too  large,  to  allow  for  trimming  and 
any  accidental  slipping  upon  the  die.  In  partial  cases,  the  pattern 
should  be  carried  partly,  or  fully,  over  the  excised  teeth,  and  no  at- 
tempt made  to  fit  it  accurately  around  the  necks  of  the  teeth  until  the 
swaging  is  nearly  or  quite  completed.  With  a  pair  of  strong  shears 
or  snips  (Figs.  233,  234),  the  portion  of  plate  thus  marked  is  cut  out. 
Fig.  233  represents  a  pair  of  Stubb's  plate-shears ;  Fig,  234,  a  pair  of 

Fig.  233. 


Fig.  234. 


diflferent   construction,  with   longer   and    more   conveniently  -  shaped 

handles.  The  blades  of  some  shears 
are  curved  laterally ;  but  this  form 
is  not  desirable.  A  fine  watch-spring 
saw  should  be  used  for  curves  which 
the  straight  shears  will  not  cut ;  for 
very  short  curves,  around  teeth  for 
instance,   a   pair  of  cutting  forceps, 

shaped  as  in  Fig.  235,  will  be  found  useful. 


SWAGING    PLATES. 


567 


Cutting  plates  to  shape  before  swaging  is,  however,  not  only  unne- 
cessary, but  is  in  many  cases  a  positive  disadvantage.  Swaging  the 
square  plate  is  greatly  preferable  in  the  lower  jaw,  since  it  permits 
working  from  the  centre  outward.  And,  in  both  upper  and  lower 
plates,  the  two  triangular  pieces  outside  the  ridge  help  to  prevent 
plaiting,  or  doubling  of  the  plate.  Purchased  plates  are  ordered  to 
pattern,  on  the  score  of  economy;  but  the  difference  is  trifling,  since 
good  plate-scrajD  has  nearly  the  same  value  as  the  original  plate,  and 
every  careful  operator  separates  his  plate-scrap  from  his  solder-scrap 
and  filings.  After  swaging  is  nearly  completed,  with  partial  counters 
and  hammers,  the  square  plate  may  be  quickly  trimmed  to  shape  by 
means  of  a  jeweller's  saw. 

Fig.  235. 


The  plate  must  next  be  well  annealed,  and  partially  fitted,  by  wooden, 
horn,  or  leaden  hammers,  to  that  part  of  the  die  inside  the  ridge. 
There  is  no  better  hammer  for  this  purpose  than  lead  ;  but,  of  course, 
the  plate  must  be  thoroughly  cleansed  of  all  trace  of  the  lead  before 
annealing.  The  swaging  is  continued  by  the  use  of  partial  counter- 
dies  ;  these  are  made  by  placing  a  rim  of  clay  or  putty  around  the 
ridge  and  back  part  of  the  metallic  die,  and  pouring  on  it  fusible 
metal.  In  this  way,  the  plate  should  be  perfectly  fitted  so  far  as  the 
ridge.  Then,  clamping  the  plate  between  the  die  and  the  partial 
counter,  the  edge  is  to  be  gradually  carried  over  the  top  and  outside  of 
the  ridge  with  hammers  and  small  wooden  or  ivory  stakes.  The  plate 
may  be  clamped  .in  a  vice,  or  by  means  of  a  string  passing  over  the  die 
and  under  the  foot ;  but  a  much  more  convenient  method  is  found  in 
the  use  of  Dr.  T.  H.  Burras's  clamps.  Fig.  236.  Of  the  two  forms  here 
given,  the  sliding-arm  (No.  2)  is  preferable  to  the  long  screw  (No.  1). 
The  application  of  the  clamp  is  so  plainly  shown  in  No.  1,  that  any 
description  is  unnecessary. 

It  is  the  practice  of  some  to  cut  out  V-shaped  pieces  from  the  front 
or  back  part  of  the  plate,  to  prevent  the  plaiting  of  the  metal.     This 


568 


SWAGING    PLATES. 


is  very  bad  practice,  and  is  never  called  for,  if  due  care  is  used  in 
swaging,  and  the  metal  is  of  proper  fineness.  To  avoid  plaits,  or  folds, 
anneal  often,  and  in  deep  arches  carry  the  plate  down  very  gradually ; 
also  take  care  in  such  cases  that  the  plate  be  thick,  to  allow  for  stretch- 
ing or  drawing.  In  swaging  over  the  ridge,  it  is  a  very  common  mis- 
take to  hammer  down  the  outside  before  fully  striking  up  (with  ham- 
mer and  stakes)  the  parts  nearest  the  partial   couuter-die.     Always 


Fig.  236, 


No.  2. 


make  it  a  rule,  in  carrying  the  plate  over  the  ridge,  to  swage  from  the 
centre  outward,  carrying  the  plate  "  home"  as  you  proceed.  In  deep 
arches,  irregular  alveolar  ridges,  and  in  prominent  lower  ridges,  swag- 
ing must  be  done  slowly  and  with  great  care. 

All  forms  of  bending  forceps  are  worse  than  useless.  They  bruise 
the  plate,  as  will  any  steel  or  hard  metal  instruments.  There  is  no 
shape  of  arch  or  of  plate  which,  by  the  above  simple  process,  cannot 
be  perfectly  fitted  with  a  twenty-carat  plate.  The  elaborate  forms  of 
a  window-cornice,  or  a  jelly-mould,  should  teach  any  dentist  how  poor 
a  mechanic  he  is,  when  he  complains  of  the  difiiculty  of  swaging  so 
highly  malleable  a  metal  as  gold  into  and  over  the  irregularities  of 
any  mouth.  And  when,  to  save  his  skill,  he  pleads  want  of  time,  he 
exposes  a  graver  deficiency  —  dishonesty. 

The  fitting  of  the  plate  being  thus  almost  completed  by  hammers  and 
partial  counters,  it  should  be  trimmed  to  its  exact  shape,  and  then 


SWAGING    PLATES.  569 

placed  between  a  fresh  die  and  the  full  counter-die,  and  carried  "home  " 
by  several  firm  blows  of  the  hammer  given  directly  over  the  centre  of 
the  die.  The  hammer  should  not  weigh  more  than  three  pounds,  with 
a  handle  about  a  foot  long.  It  is  a  great  mistake  to  use  a  very  heavy 
or  a  very  long-handled  hammer.  The  striking  block  may  be  an 
anvil,  or  a  large  wooden  block  set  in  sund,  or  on  a  cushion,  and  the  base 
of  the  counter-die  must  rest  steadily  upon  it.  It  greatly  facilitates 
swaging,  and  makes  one  independent  of  any  striking  block,  to  have  a 
very  thick  and  heavy  lead  counter.  As  there  is  always  a  hollow  in  the 
back  of  a  zinc  die,  a  conical  piece  of  iron,  steel,  or  other  hard  metal, 
should  be  placed  upon  it  to  centralize  the  blow  of  the  hammer.  An 
egg-shell,  filled  with  plaster,  is  useful  for  making,  at  the  time  of  mould- 
ing the  die,  several  zinc  blocks  for  this  purpose.  To  a  disregard  of 
these  precautions  is  due  much  of  the  diflSculty,  so  often  complained  of, 
in  the  tilting  or  rocking  of  plates  and  dies. 

Throughout  the  entire  process  of  swaging,  the  plate  must  be  fre- 
quently annealed.  It  may  be  suddenly  cooled  after  all  except  the 
final  annealing;  when  the  cooling  must  be  very  gradual,  so  as  to  avoid 
warping  or  springing.  The  malleability  of  gold  plate  will  permit  a 
great  deal  of  swaging  without  annealing ;  yet  the  neglect  of  this  simple 
operation  is  unsafe.  One  broken  or  cracked  plate  gives  more  trouble 
than  the  annealing  of  a  dozen.  The  plate,  after  final  swaging,  must 
be  taken  from  the  counter  very  carefully,  to  avoid  change  of  shape. 
Thin  paper  in  the  counter-die  makes  removal  easier ;  it  is  also  easier, 
when  only  one  counter  is  used.  Too  much  swaging  gives  the  plate  a 
loose  fit. 

When  block-tin,  lead,  or  fusible -metal  dies  or  counter-dies  are  used 
in  swaging  the  plate,  any  portion  of  these  metals  which  may  adhere  to 
it  should  be  removed  before  annealing ;  as  their  fusion  upon  its  sur- 
face alloys  them  with  the  gold,  and  will  render  it  brittle,  and  impair 
its  ductility ;  or  else  eat  holes  in  the  plate  at  the  spot  where  the  par- 
ticles of  baser  metal  form  an  alloy,  fusible  at  the  annealing  heat. 
This  is  done  either  by  mechanical  or  chemical  means.  If  acid  is  used, 
it  should  be  dilute  nitric,  since  sulphuric  will  not  dissolve  lead ;  but 
be  .very  careful  that  the  nitric  acid  contains  no  hydrochloric,  else  the 
plate  will  be  acted  upon.  The  liability  of  the  tin  or  lead  to  adhere  to 
the  gold  may  be  measurably  prevented  by  oiling  the  plate  before  it  is 
struck  up. 

Figs.  237,  238,  represent  the  general  forms  of  upper  and  lower 
plates  after  the  swaging  process  is  completed.  In  the  upper  plate  is 
represented  the  proper  size  and  position  of  a  vacuum  cavity,  whenever 
it  may  be  thought  proper  to  use  one.  The  question  of  the  cavity  will 
be  elsewhere  discussed. 


570  SWAGING    PLATES. 

If,  on  trial  of  tlie  plate  iu  the  mouth,  it  does  not  fit  properly,  the 
operator  must  proceed  to  ascertain  the  cause  of  failure.  And,  first, 
whether  it  is  temporary  or  permanent.  A  plate  which  falls,  because  it 
rocks  over  a  hard  palate,  will  never  improve ;  if,  because  it  fails  to  go 
fully  into  the  palate,  it  may  daily  improve,  and  ultimately  adhere  with 
great  firmness.  Most  plates,  made  soon  after  extraction,  fit  badly  until 
the  alveolar  prominences  are  pressed  down  by  wear.  Some  very  hard 
mouths  will  not  retain  the  plate  until  it  has  been  worn  for  a  time; 
especially  if  the  mouth  is  very  flat.  Deep  arches,  or  uniformly  soft 
mouths,  should  retain  the  plate  firmly  from  the  first. 

Fig.  237.  Fig.  238. 


The  use  of  pliers,  except  for  bending  the  edge  into  some  alveolar 
undercut,  is  an  evidence  of  bad  work.  The  back  margin  of  upper 
plates,  so  often  adjusted  in  this  way,  is  much  better  fitted  by  scraping 
the  model  at  the  place  where  the  plate  should  bind  ;  this  should  be 
done  to  a  depth  proportioned  to  the  softness  of  the  membrane. 

Much  judgment  is  demanded  in  deciding  upon  the  necessity  for  a 
new  plate.  The  impression  may  have  been  badly  taken,  or  with  a 
material  not  adapted  to  the  mouth.  The  dies  may  have  been  carelessly 
made,  or  the  swaging  imperfectly  done.  Trial  of  the  plate  is  essential 
to  ascertain  all  these  points,  that  the  articulation,  soldering,  etc.,  may 
not  be  so  much  additional  labor  in  vain. 

The  different  forms  of  plates,  full  and  partial,  will  hereafter  be  con- 
sidered. They  are  retained  in  the  mouth  by  clasps  or  stays ;  by  the 
adhesion  of  contact  or  by  the  vacuum  cavity,  the  retaining  force  being 
atmospheric  pressure ;  by  spiral  springs.  These  will  be  taken  up  in  a 
subsequent  chapter,  and  their  relative  merits  discussed.  We  pass  now 
to  the  step  which,  in  swaged  work,  comes  next  in  order  to  the  fitting' 
of  the  plate — the  means  for  securing  its  exact  relation  to  the  natural 
teeth;  or,  in  double  sets,  its  relation  to  the  opposing  plate.  These 
processes  come  under  the  technical  head  of  Articulation. 


AKTICULATION.  571 


CHAPTER  X. 

ARTICULATION. 

THE  term  Articulation,  as  used  in  Dental  Mechanics,  comprehends 
several  distinct  operations,  implied  in  the  use  of  the  terms  (1) 
Articulating  impressions,  (2)  Articulating  jjlates,  (3)  Articulating 
models. 

In  many  partial  sets  it  is  best,  after  fitting  the  swaged  plate  to  the 
mouth,  to  take  a  wax  impression  with  the  plate  in  situ.  This  gives 
the  precise  relation  of  the  plate  to  the  adjacent  teeth  ;  and,  upon  appli- 
cation of  a  model  of  the  lower  jaw,  it  gives  the  relation  of  the  plate 
to  the  antagonist  teeth.  This,  and  all  other  impressions  of  the  relation 
of  plates  to  the  teeth,  or  to  each  other,  in  the  mouth,  we  call  articu- 
lating impressions. 

A  base-plate  becomes  an  articulating  plate  when  the  articulating  rim 
is  attached  which  has  the  impress  of  its  opposite  rim  or  teeth.  In 
swaged  work,  it  is  the  gold  plate  itself;  in  plastic  work,  it  is  some  tem- 
porary plate  of  tin,  lead,  or  gutta-percha. 

The  articulating  models  make  up  what  is  technically  called  an 
"  Articulator,"  of  which  there  are  many  forms ;  all,  however,  compre- 
hended under  three  varieties,  (a.)  Those  made  wholly  of  plaster 
poured  into  the  articulating  plates,  (b.)  Those  in  which  the  model 
portion  is  poured  into  the  articulating  plates ;  but  the  back,  or  hinged 
portion,  is  metallic,  (c.)  Those  in  which  the  original  models  are  set 
into  the  articulating  plates,  and  some  complicated  metallic  articulator 
adjusted  to  them.  Each  of  these  classes  have  special  advantages 
adapting  them  to  various  exigencies  of  practice. 

Whenever,  in  partial  cases,  there  are  three  points  of  contact  suffi- 
ciently apart  to  give  firm  antagonism.  Prof.  Austen's  plan  is  to  take 
an  impression  of  the  lower  teeth  :  this  gives  a  model  which  antagonizes 
perfectly  with  the  upper  model,  and  makes  the  articulator  without 
further  trouble.  This  plan,  specially  applicalDle  to  vulcanite  work,  is 
adapted  to  swaged  work  by  taking  the  articulating  impression  de- 
scribed in  the  second  paragraph  of  this  chapter.  Such  articulators 
require  no  backward  extension  or  hinge,  because  the  articulation  is 
determined  by  the  articulating  cusps  of  the  teeth. 

In  partial  cases  where  there  are  only  one  or  two  points  of  antago- 
nism, and  where,  consequently,  the  opposition  of  the  corresponding 
teeth  would  be  uncertain,  the  necessity  exists  for  some  third  point  of 


572 


ARTICULATION, 


support.  This  is  best  given  by  a  backward  extension  of  the  model,  so 
as  to  permit  motion  of  the  two  halves  of  the  articulator,  somewhat 
resembling  that  of  the  natural  jaws;  though  many  partial  cases  do 
not  require  such  an  extension.  In  putting  this  wax  rim  on  the  plate, 
it  is  better  in  all  cases  to  trim  it,  as  is  done  for  full  upper  sets ;  but 
where  there  are  remaining  teeth,  the  antagonism  of  these  determines 
the  proper  closure  of  the  mouth,  and  this  is  not  essential.  The  plate 
and  adherent  wax  are  placed  in  the  mouth;  the  patient  is  then  re- 
quested to  close  the  mouth  naturally,  imbedding  the  teeth  of  the  lower 
jaw  in  the  wax.  While  the  mouth  is  thus  closed,  the  wax  on  the  out- 
side of  the  teeth  and  alveolar  ridge  is  pressed  closely  against  them. 

This  done,  the  plate  and  wax  impression  are  carefully  removed, 
filled  with  plaster,  and  placed  on  a  piece  of  wet  paper,  with  the  wax 
downward.  The  upper  side  of  the  plate  is  then  oiled.  As  the  plaster 
stiffens,  it  may  be  applied  until  it  is  raised  half  an  inch  above  the  plate, 
and  extended  back  of  it  on  the  paper  an  inch  and  a  half  or  two  inches. 
As  soon  as  the  plaster  has  set,  its  edges  may  be  neatly  trimmed ;  and  at 
the  back  of  the  surface  next  the  paper  a  deep  transverse  or  T-shaped 
groove  should  be  cut,  to  serve  as  a  mould  for  the  formation  of  a  cor- 
responding ridge  on  the  half  model  with  which  this  is  to  antagonize. 
This  grooved  surface  must  be  coated  with  oil,  or  soap-water,  or  varnish, 
or  covered  with  a  layer  of  tin  foil  or  thin  paper.  Then  partly  fill  the 
space  inclosed  by  the  wax  rim  w'ith  clay,  putty,  or  wet  paper,  and 
pour  on  plaster  to  form  the  other  half  model.  In  running  plaster 
into  the  wax  impressions  of  the  teeth,  be  very  careful  to  avoid  air- 
bubbles  and  flaws,  and  do  not  oil  the  wax.  After  the  plaster  has  set, 
it  may  be  trimmed  as  before  directed. 

Another  and  often  more  convenient  method  is  to  take  a  strip  of  sheet 
lead  one  and  a  half  inches  wide,  and  bend  it  to  the  required  outline 
of  the  articulator.     Pour  this  partly  full  of  plaster,  and  set  the  plate, 

previously  filled  with  plas- 
ter, upon  it.  Cut  the 
grooves  as  before  de- 
scribed, and  pour  the 
other  half  of  the  articu- 
lator. The  lead  rim  saves 
much  manipulation  and 
trimming,  which,  in  the 
other  case,  the  plaster  re- 
quires. When  the  half 
last  made  has  become  suf- 
ficiently hardened,  the  two 
pieces  may  be  separated, 


Fig.  239. 


ARTICULATION.  573 

after  softening  the  wax  in  warm  water,  and  the  wax  carefully  removed. 
The  model  is  then  varnished  for  greater  comfort  in  handling,  and 
when  put  together  may  present  an  appearence  exhibited  in  Fig.  239. 

The  artist  has  failed  in  this,  and  in  other  designs  of  the  plaster 
articulator,  to  represent  the  tapering  shape  which  it  is  best  to  give  to 
the  back  half  of  the  models,  for  greater  convenience  of  holding  them 
while  adapting  the  teeth.  The  fault  of  many  plaster  articulators  is 
that  they 'are  too  large  and  clumsily  shaped.  In  any  given  case,  the 
proper  distance  of  the  groove  or  hinge  is  the  distance  from  the  patient's 
external  auditory  meatus  to  the  line  of  the  front  teeth  or  alveolar  ridge. 
The  width  and  thickness  of  the  articulator  must  vary  with  the  size  or 
depth  of  the  mouth,  avoiding  any  excess  of  plaster  not  necessary  to 
give  requisite  strength. 

For  a  full  upper  set,  or  where  two  or  more  remaining  molars  have 
no  antagonism,  it  is  a  very  common  practice  to  place  on  the  plate  a 
roll  of  wax  sufficiently  large  to  receive  the  imprint  of  the  lower  teeth, 
and  to  prevent  these  from  closing  too  far  by  the  insertion  of  a  piece 
of  wood  buried  in  the  wax,  and  projecting  at  the  median  line.  The 
closure  is  better  arrested  by  two  lumps  of  sealing-wax  attached  oppo- 
site the  bicuspids,  and  trimmed  to  the  required  length  before  putting 
on  the  wax.  But  the  articulation  ought  to  determine  other  points 
besides  the  single  one  of  space.  Hence  the  antagonizing  plate  should 
be  made  by  adjusting  a  rim  of  wax  corresponding  in  width  to  the 
length  proposed  for  the  artificial  teeth,  and  trimming  it  until  all  the 
teeth  in  the  lower  jaw  touch  it  at  the  same  instant.  Instead  of  wax,  a 
rim  of  gutta-percha  may  be  used  to  represent  the  required  length  and 
external  fulness  of  the  teeth.  When  this  is  satisfactorily  adjusted,  a 
small  rim  of  soft  wax  is  placed  upon  the  wax  or  gutta-percha,  and  the 
mouth  closed  as  naturally  as  possible  until  the  teeth  touch  the  latter. 
The  gutta-percha  can  be  readily  trimmed  with  a  sharp  knife.  Eims 
thus  shaped  give  opportunity  to  ascertain,  by  the  effect  on  the  expres- 
sion of  the  lips,  &c.,  exactly  what  length  "and  fulness  of  tooth  suits  the 
particular  case.  Gutta-percha  is  better  than  wax  in  arresting  the 
closure  of  the  teeth,  and  is  decidedly  best  for  the  temporary  articula- 
ting plates  of  plastic  work  ;  but  the  latter  is  more  easily  attached  to  a 
gold  plate,  and  is  more  easily  trimmed.  By  making  the  wax  cold,  or 
by  imbedding  a  small  block  of  wood  opposite  the  bicuspids  on  each 
side,  the  wax  rim  offers  a  firm  resistance. 

There  is  a  tendency  on  the  part  of  the  patient  to  close  the  mouth  to 
one  side,  and  too  far  forward ;  it  is  impossible  to  close  it  behind  the 
natural  articulation.  The  simplest  method  for  regulating  this  is  to 
keep  the  body  erect,  and  throw  the  head  backward,  so  as  to  make  as 
tense  as  possible  the  throat-muscles,  which  thus  act  as  a  bridle,  and 


574  ARTICULATION. 

almost  compel  a  correct  closure  of  the  mouth.     It  may  also  be  done 
by  careful  observation  of  repeated  closures  made  by  the  patient  while 

sitting  in  an  erect  natural  i)o.sition. 

FiQ.  240.  m  .  ^         •  1  • 

The  operator  must  avoid  impressing 

upon  his  patient  the  necessity  for 
an  easy  natural  closure;  such  di- 
rections invariably  defeat  their  ob- 
ject. Of  course  these  trials  are  to 
be  made  before  attaching  the  soft 
wax  which  receives  the  impress 
upon  the  final  closure.  A  vertical 
median  line,  traced  on  the  wax,  is 
of  service  in  observing  the  articula- 
tion, and  in  the  subsequent  adjustment  of  the  artificial  teeth.  Fig. 
240  represents  such  a  rim  with  its  original  fulness  cut  away. 

For  a  double  set  of  artificial  teeth,  the  following  method  of  articu- 
lation is  often  adopted.  After  having  accurately  fitted  both  plates,  a 
rim  of  soft  beeswax  is  placed  between  them,  about  an  inch  and  a 
quarter  in  width.  A  piece  of  wood,  exactly  corresponding  in  width  to 
the  proposed  length  of  the  upper  and  lower  central  incisors,  is  passed 
through  the  wax  between  the  plates  at  the  median  line ;  or,  still 
better,  one  piece  on  each  side  between  the  bicuspid  part  of  the  plates. 
The  whole  is  now  placed  in  the  mouth,  and  each  plate  accurately 
adjusted  to  the  alveolar  border.  The  patient  is  then  directed  to  close 
the  mouth  until  the  plates  are  brought  in  contact  with  the  edges  of 
the  interposed  piece  of  wood.  This  done,  the  plate,  wax,  and  wood 
are  together  removed  from  the  mouth. 

But  a  far  better  method  consists  in  placing  a  rim  of  wax  or  gutta- 
percha on  each  plate,  giving  the  length,  outline,  and  fulness  respec- 
tively designed  for  the  teeth  of  each  jaw.  The  two  plates  are  put  in 
the  mouth,  and  the  jaw^s  are  carefully  closed;  if  the  rims  of  wax  touch 
at  any  one  point  sooner  than  another,  the  plates  are  removed  and  the 
wax  trimmed ;  this  operation  is  repeated  until  the  two  rims  of  wax 
meet  all  the  way  round  at  the  same  instant,  and  give  the  proper  con- 
tour to  the  cheeks  and  lips.  The  median  line  is  then  marked,  and  the 
final  closure  of  the  mouth  made  with  the  utmost  care,  so  that  there 
shall  be  no  lateral  or  forward  deviation.  The  exact  position  being 
secured,  the  low'er  jaw  is  to  be  held  with  the  left  hand,  while,  with  the 
right,  some  six  or  eight  oblique  indentations  are  made  with  a  wax-knife 
across  the  line  of  contact  between  the  two  rims.  Some  fasten  them 
together  by  a  warm  wax-knife,  or  by  pins,  or  by  small  slips  of  brass 
plate  warmed  and  forced  into  the  wax.     The  pieces  are  removed  jointly 


AETICULATION. 


575 


or  separately  from  the  mouth  ;  if  separately,  they  can,  by  the  aid  of 
these  marks,  be  accurately  readjusted. 

From  these  articulating  plates  a  plaster  articulator  is  made  substan- 
tially in  the  manner  described  for  a  partial  case.  The  lead  rim  for 
shaping  the  models  will  often  have  to  be  two  inches  broad.  If  the 
precaution  is  taken  to  fill  the  space  within  the  wax  rims  and  between 
the  plates  with  paper  pulp,  it  is  not  material  which  half  is  filled  first. 
Usually  the  lower-jaw  model  will  be  thickest,  and  in  this,  made  first, 
it  is  best  to  cut  the  grooves.     Fig.  241  represents  a  plaster  articulator 

Fig.  241. 


with  the  plates  removed,  in  which  figure,  from   neglect  of  this  point, 
the  thin  upper  half  is  much  weakened  by  the  V-shaped  cut. 

Partly  to  save  plaster, 
but  chiefly  to  permit  modi- 
fication of  the  articulation, 
where  inaccuracy  is  sus- 
pected, quite  a  number  of 
metallic  articulators  have 
been  recommended.  One 
of  the  first  contrived  for 
this  purpose  was  by  Dr. 
Thomas  Evans,  of  Paris, 
and  made  of  heavy  brass 
wire. 

Fig.  242  represents  a 
very  convenient  form  of 
metallic  articulator.  But 
in  using  this,  and  every 
similar  contrivance,  the  operator  should  remember  that  facility  of 


576 


ARTICULATION. 


changing  the  articulation,  after  the  guiding  wax  rims  are  removed,  \a 
a  very  questionable  advantage.  It  tempts  to  carelessness  in  articu- 
lating. Moreover,  if  the  width  of  space,  or  other  relation  of  the  parts, 
is  such  as  leads  to  suspicion  of  inaccuracy,  any  change  of  articulation 
is,  at  best,  a  sort  of  random  guess-work.  The  most  certain  correction 
of  surmised  error  is,  undoubtedly,  to  take  the  articulation  anew. 
Hence  our  preference  is  for  the  old-fashioned  plaster  articulator,  with 
its  unaccommodating  fixedness,  that  neither  offers  a  premium  on  care- 
lessness, nor  puts  the  careful  workman  at  the  mercy  of  some  loose  joint 
or  screw. 

There  is  another  class  of  articulators  more  complicated  than  the 
above,  which  are  very  useful  in  those  cases  where  the  original  models 
are  used,  instead  of  special  models  cast  in  the  articulating  plates. 

Fig.  243. 


Fig.  243  is  a  very  excellent  one  for  this  purpose,  combining  all  the 
advantages  of  metallic  articulators,  with  a  peculiar  lateral  movement 
closely  resembling  that  of  the  natural  jaw. 

The  subject  of  articulation  cannot  be  dismissed  without  a  few  words 
upon  the  great  importance  of  extreme  accuracy  in  all  its  details.  It 
is  a  very  remarkable  fact  that  some  of  the  most  painstaking  dental 
mechanicians  practise  methods  of  articulating  in  which  there  can  be 
no  certainty,  and  for  constant  errors  in  which  the  emery  wheel  is  re- 
sorted to,  in  order  to  save  them  the  mortification  of  making  their  work 
anew.  In  fact,  there  is  no  better  evidence  of  the  guess-work  character 
of  an  immense  number  of  articulations  than  the  habitual  attempts  at 
correction  by  the  equally  guess-work  shifting  of  movable  articulators. 


SOLDERING.  577 

We  assert,  without  hesitation,  that  any  articulation — whether  with  gold 
plate  or  with  the  temporary  plates  of  vulcanite  and  other  forms  of 
plastic  work — can  betaken  in  such  manner  as  not  to  require  the  slightest 
change  in  the  relation  of  the  articulating  models.  We  shall  not  insult 
the  profession  by  attempting  to  prove  that,  if  it  can  be  done,  it  should 
be  done.  Next  in  importance  to  accuracy  of  the  impression  is  correct- 
ness of  articulation.  Defects  in  either  are  damaging  to  one's  reputa- 
tion. But  there  is  this  difference :  that  in  the  former  the  error  may 
often  be  detected  on  trial  of  the  plate,  while  in  the  latter  case  the  fin- 
ished work  alone  reveals  the  failure. 

Defective  articulation  is  a  prolific  source  of  the  disgraceful  short- 
coming of  Vulcanite  Dentistry.  By  these  terms  we  specialize  thai 
art,  and  its  accompanying  science,  which  begins  with  Hard  Rubber 
and  ends  with  a  Vulcanizer ;  which  knows  nothing  of  the  uses  of  gold 
save  as  a  circulating  medium,  recognizing  no  quality  in  a  dental  mate- 
rial so  highly  as  its  cheapness,  no  merit  in  a  process  so  valuable  as  it? 
rapidity.  So  long  as  such  principles  rule  in  the  dental  laboratory, 
carelessness  in  articulation  is  of  little  consequence.  But  older  practi- 
tioners, who  are  accustomed  to  handle  the  royal  metal  with  a  care 
worthy  of  its  high  character,  will  fully  appreciate  the  great  import- 
ance of  a  rigorously  exact  articulation. 


CHAPTER  XI. 

PRINCIPL.ES   AND   APPLIANCES   OF  SOLDERING. 

SOLDERING  is  the  union  of  two  metallic  surfaces;  either  by  slightly 
fusing  the  surfaces  themselves  (technically  termed  sweating,  or 
autogenous  soldering),  as  in  the  union  of  a  plate  of  silver  to  a  block 
of  copper  preparatory  to  rolling  it  into  Shefiield  plate;  or  by  the  fusion 
of  an  alloy  which  melts  more  readily  than  the  metals  to  be  soldered. 
The  conditions  of  successful  soldering,  as  given  by  Prof.  Austen, 
are :  1.  A  freely  flowing  solder.  2.  Absence  of  oxide  from  the  surface 
over  which  the  solder  is  to  flow.  3.  Proper  amount  and  direction  of 
heat  in  flowing  the  solder.  The  first  condition  requires  good  solder; 
of  this  we  have  elsewhere  spoken.  The  second  calls  for  the  use  of 
borax,  the  specific  action  of  which,  as  a  flux,  is  —  first,  the  removal  of 
existing  oxide  by  virtue  of  its  powerful  affinity  for  it;  secondly,  the 
prevention  of  further  oxidation  by  the  exclusion  of  the  oxygen  of  the 
air.  The  third  condition  demands  a  skilful  management  of  the  blow- 
37 


578 


SOLDERING. 


pipe  flame;  this  is  the  principal  difficulty  with  most  beginners,  and, 
indeed,  with  not  a  few  old  practitioners. 

The  borax  should  be  used  in  the  lump,  and  rubbed  with  pure  (dis- 
tilled or  rain)  water  upon  a  coarsely-ground  glass  slab  until  a  creamy 
paste  is  formed.  Into  this  the  pieces  of  solder  may  be  placed,  and  also 
some  of  it  applied,  with  a  small  brush  or  feather,  to  the  surfaces  over 
which  the  solder  is  required  to  flow.  Hard  water  and  the  common 
practice  of  rubbing  borax  on  a  slate  make  it  impure,  and,  to  some 
extent,  interfere  with  soldering.  Too  much  borax  is  objectionable, 
and  gold  requires  less  than  silver. 

In  fulfilling  the  third  condition  —  the  management  of  the  heat  — 
the  following  points  demand  attention:  (a)  To  raise  the  heat  very 
gradually  until  the  water  of  crystallization  of  the  borax  is  slowly 
driven  ofl";  for  if  this  is  done  rapidly,  the  borax  puffs  up  and  throws 
off*  the  solder ;  rapid  heating  at  the  outset  is  apt  also  to  crack  the  teeth. 
(6)  To  diffuse  the  heat,  when  using  the  blow-pipe,  so  that  the  solder 
shall  not  become  melted  before  the  metallic  surfaces  are  hot  enough  to 
unite  with  it ;  else  it  will  roll  into  a  ball,  or  flow  with  an  abruptly- 
defined  edge ;  whereas  it  should  unite  so  smoothly  with  the  plate  that, 
except  for  the  diffei-ence  in  color,  its  line  of  termination  cannot  be 
detected,  (c)  To  manage  the  fine  point  of  the  blow-pipe  flame  so  as  to 
be  able  to  direct  the  flow  of  the  solder  to  any  given  point ;  the  rule 
being,  that,  unless  prevented,  solder  will  flow  toward  the  hottest  point. 
There  are  two  kinds  of  flame  given  by  the  blast  of  the  blow-pipe :  1. 
The  broad,  heating-up,  or  oxidizing  flame ;  this  is  produced  by  holding 
the  tip  a  little  behind  or  at  the  edge  of  the  flame.  2.  The  pointed, 
soldering,  Or  deoxidizing  flame ;  this  is  produced  by  passing  the  tip 
more  or  less  into  the  flame.  A  very  general  mistake  is  to  use  too  strong 
a  blast. 

The  apparatus  required  for  soldering  includes  a  lamp  to  give  a  suflB- 

ciently  hot  flame ;  a  blow-pipe  to  give 
intensity  and  direction  to  the  flame  ; 
borax,'brush,  glass,  slate,  solder,  and 
solder -tongs;  investing  materials 
and  clamps,  to  protect  the  teeth, 
also  to  hold  the  parts  in  relation  to 
each  other  until  soldered ;  a  recep- 
tacle to  retain  or  give  additional  heat 
during  the  process  of  soldering  ;  an 
acid  (sulphuric)  bath  to  remove  the 
glass  of  borax. 

The  simplest  form  of  lamp  is  shown 
in  Fig  244,  holding  about  a  pint,  and  having  a  wick  three-fourths  of 


Fig.  244. 


SOLDEEING. 


579 


For  all  purposes 


Fig.  246. 


an  inch  or  one  inch  in  diameter.  As  accidents  sometimes  occur  from 
the  flame  communicating  with  the  explosive  mixture  of  air  and  alco- 
holic vapor  in  the  body  of  the  lamp,  it  is  prudent  to  make  a  safety- 
lamp  by  connecting  the  wick-tube  with  the  body  of  the  lamp  by  a 
small  tube,  which  shall  be,  under  all  circumstances,  full  of  alcohol. 
Fig.  245  represents  such  a  lamp.  If  the  wick  is  not  permitted  to  run 
below  the  shoulder  above  the  horizontal  tube,  this  tube  Avill  remain 
always  filled  with  alcohol.  The  top  of  the  wick-tube  should  be  bevelled 
off"  in   a  direction  just  the 

reverse  of  that  shown  in  the  ^^^-  ^^'^• 

drawing,  so  as  to  permit  the 
downward  projection  of  the 
flame.  Fig.  246  is  a  very 
ingenious  modification  of  the 
safety -lamp,  made  by  Dr. 
B.  W.  Franklin,  so  con- 
structed as  to  retain  the  al- 
cohol uniformly  at  the  same 
level. 

The  fluid  used  in  these  lamps  is  usually  alcohol, 
of  dental  soldering,  alcohol  gives  a  suf- 
ficient degree  of  heat,  and  is  much  more 
cleanly  than  the  carboniferous  flame  of 
ethereal  oil,  sperm  oil,  coal  oil,  or  gas. 

To  give  intensity  and  proper  direction 
to  the  heat  of  the  lamp,  a  blow-pipe  is 
necessary.     The  simplest  is  a  tapering 
tube,  fifteen  to  eighteen  inches  long,  and 
curved  at  the  smaller  end  (Fig.  247). 
At  this  end  the  bore  for  the  last  half 
inch  should  ho. perfectly  cylindrical,  and 
about  as  large  as  a  medium-sized  knit- 
ting-needle.    This  may  be  modified  in 
several  ways,  and   made  more  useful. 
First,  by  cutting  it  within  three  inches  of  the  flame-end,  and  inserting 
8;  small  hollow  ball   or  cylinder  to  receive  the  condensed  moisture, 
which,  in  the  plain  blow- 
pipe, often  interrupts  the  ^^^-      '■ 
blast.      Secondly,   by  at- 
taching a  flattened  mouth- 
piece, which    it   is    much    . 
less  fatiguing  to  the  lips  to  grasp.     Thirdly,  by  connecting  the  flame- 
end  to  the  mouth-piece  by  from  six  to  twelve  inches  of  flexible  tubing. 


580 


SOLDERING. 


The  flame-end  otifrht  to  be  ptvaifrht,  and  from  four  to  six  inches  long: 
a  cigar-holder  makes  an  excellent  mouth-piece.  A  bulb  or  enlarge- 
ment in  the  tube  might  be  serviceable  in  retaining  condensed  moisture; 
but  it  is  less  liable  to  accumulate  in  rubber-tubing  than  in  the  metal 
pipes.  There  are  many  forms  of  moutli  blow-pipes,  and  some  quite  ex- 
pensive ones ;  but  the  pipe  with  flexible  tube,  as  here  described,  will 
be  found  altogether  the  most  convenient  for  the  laboratory. 

The  moutli  blow-pipe  requires  in  its  use  a  peculiar  management  of 
the  muscles  of  the  chest,  cheeks,  and  palate,  by  virtue  of  whicb  an 
uninterrupted  and  regular  current  of  air  is  thrown  from  the  lungs 
througlv  the- pipe.  The  simplest  way  to  learn  how  to  do  this,  is  to  first 
practise  blowing  exclusively  during  uispiration  :  this  calls  into  action 
the  cheek-muscles,  and  involuntarily  closes  the  opening  between  mouth 
and  fauces.  Then  use  the  pipe  solely  during  ea:piration  :  this  teaches 
control  of  the  chest-nuLscles  in  the  emission  of  a  steady,  gentle  blast. 
The  art  of  using  the  blow-pipe,  without  fatigue,  consists  in  alternating 
the  action  of  these  two  set&  of  muscles:  the  art  of  giving  a  perfectly 
steady,  uninterrupted  blast  implies  complete  control  over  these  muscles, 
and  the  ability  to  pass  from  one  set  to  the  other  at  the  moment  of 
opening  or- closing  the  entrance  to  the  fauces.  After  persevering  prac- 
tice of  the  two  methods  of  blowing,  the  art  of  connecting  them  will 
come  almost  unconsciously :  when  once  learned,  it  is  never  forgotten. 
Those  who  are  too  indolent  to  master  the  first  difficulty  of  learning  it, 
become  the  slaves  to  mechanical  appliances,  which,  however  useful  for 

Fig.  248. 


many  purposes,  can  never  supply  the  place  of  this  simplest  and  best  of 
all  blow-pipes. 

Blow-pipes  working  by  artificial   blast   may  be  divided  into  four 
classes:  1.  Alcoholic  or  self-acting  blow^-pipes ;  2.  Mechanical  or  bel- 


SOLDERING. 


581 


Fig.  249. 


lows  blow-pipes  ;  3.  Hydrostatic  blow-pipes  ;  4.  Oxy-hydrogen  or  aero- 
hydrogen  blow-pipes.  Of  each  of  these  we  shall  give  an  example. 
To  enumerate  all  the  forms  that  inventive  talent  has  devised  would  fill 
too  much  of  our  space. 

The  SELF-ACTING  blow-pipcs  derive  the  force  of  their  blast  from  the 
vapor  of  hot  alcohol,  which,  igniting  as  it  passes  through  the  flame, 
adds  to  the  intensity  of  the  heat.  A  somewhat  complex,  but  very 
complete,  l)low-pipe  of  this  class,  invented  by  Dr.  Jahial  Parmly,  is 
shown  in  Fig.  248. 

The  lamp  G,  supplied  from  the  reservoir  D  D,  heats  the  alcohol  in 
globe  I,  supplied  from  the  reservoir  J,  through  the  pipe  N.  The  elas- 
tic vapor  escapes  at  the  jet  P,  giving  intensity  to  the  large  flame  L, 
which  receives  its  supply  of  alcohol  from  reservoir  M  J.  Both  upper 
and  lower  wick-tubes  have  movable  cylinders  for  regulating  the  flame. 
A  small  charcoal  furnace,  R,  may  be  brought  in  range  of  the  flame  for 
melting  purposes. 

Smaller  and  more  portable  lamps  are  made,  of  which  quite  a  num- 
ber of  different  patterns  are  to  be 
found  in  the  depots.  The  principle 
and  general  plan  of  construction  are 
very  clearly  shown  in  Fig.  249,  de- 
signed by  Dr.  S.  S.  White.  All  al- 
coholic blow-pij^s  give  intensity  of 
heat,  but  are  greatly  inferior  to  the 
Tnouth  blow-pipe  in  the  control  which 
the  operator  has  over  the  force  and 
direction  of  the  jet. 

The  different  forms  of  the  me- 
chanical blow-pipe  are  almost  infi- 
nite. The  principle  of  construction 
is  either  that  of  the  bellows  or  the 
force-pump  combined  with  a  reser- 
voir of  air  to  give  uniformity  to  the  blast,  which  would  otherwise  issue 
in  jets. 

A  common  house-bellows,  secured  to  the  floor,  will  form  a  simple 
and  good  arrangement.  A  spring  should  separate  the  handles,  the 
upper  one  of  which  forms  a  treadle.  An  India-rubber  pipe  should 
pass  from  the  nozzle  to  an  air-tight  box,  from  which  a  second  tube 
comes  out  and  is  attached  to  the  blow-pipe.  If  the  bellows  is  made 
double,  like  a  blacksmith's,  the  upper  half  forms  the  air-chamber,  in 
place  of  the  air-tight  box. 

Fig.  250,  taken  from  S.  S.  White's  illustrated  catalogue,  represents 
a  foot-bellows  and  regulating  air-vessel,  applicable  to  the  spray  appa- 


682 


SOLDERING, 


Fig.  250. 


ratus.     It  may  also  be  used  in  the  laboratory  for  soldering,  and  comes 
in  this  class  of  blow-jjipes. 

In  Fig.  251  is  shown  a  double  -  cylinder 
bellows,  ten  inches  in  diameter,  moved  by  a 
treadle  attached  to  the  rod  d  f,  which  passes 
under  the  soldering -table.  In  the  drawing 
it  is  combined  with  an  alcohol  blow-pipe,  as 
designed  by  Dr.  W.  H.  Elliot,  of  Montreal ; 
but  it  may  be  used  independently  by  attach- 
ing a  flexible  tube,  with  bras^s  point,  to  the 
air-pipe  a  a.  The  following  remarks  by  Dr. 
Elliot,  upon  this  combination,  will  be  found 
very  instructive. 

"  The  fact  that  the  centre  of  the  flame  of 
the  self-acting  blow-pipe  contains  no  oxygen 
is  well  known  to  every  enlightened  dentist, 
and  may  be  proved  by  placing  a  rod  of  pol- 
ished metal  in  the  flame  for  a  few  seconds,  in 
which  case  it  will  be  seen  that  the  surface  of 
that  portion  of  the  rod  occupying  the  centre 
of  the  flame  does  not  unite  with  oxygen,  how- 
ever great  the  degree  of  heat  may  be ;  but  if 
a  jet  of  atmospheric 
air  be  thrown  into 
the  flame  upon  the 
rod,  it  will  oxidize  as 
readily  as  if  heated 
by  any  other  means. 
This  little  experi- 
ment proves  not  only 
the  want  of  oxygen 
in  the  flame,  but  it 
leads  to  the  very  im- 
portant conclusion 
that,  without  oxy- 
gen, the  burning  of 
the  vapor  must  be  gradual  and  imperfect.  In  consideration  of  this 
fact,  the  writer  was  led  to  make  the  experiment  of  producing  a  more 
perfect  combustion  by  throwing  into  the  flame  one  of  its  supporters. 
This  may  be  done  in  several  ways  ;  but  the  simplest  and  most  conve- 
nient is  atmospheric  air,  thrown  in  by  means  of  a  bellows.  The  air 
from  the  lungs  will  not  do  as  well,  inasmuch  as  it  not  only  contains 


SOLDERING. 


583 


Jess  oxygen,  but  also  contains  a  large  portion  of  carbonic  acid,  which 
just  so  far  renders  it  unfit  for  the  support  of  combustion. 

"  The  air-pipe  should  pass  along  by  the  vapor-pipe,  and  discharge 
about  an  inch  and  a  half  beyond  it  in  the  very  centre  of  the  flame, 
and  in  precisely  the  same  direction.     The  calibre  of  the  air-pipe  at  its 


Fig,  251. 


apex  must  be  equal  to  that  of  the  vapor-pipe.  It  must  be  made  as 
small  as  possible  without  being  enlarged  at  the  end,  as  any  enlarge- 
ment there  would  derange  the  vapor-flame.  It  must  also  be  con- 
structed of  platina,  as  that  is  the  only  metal  which  will  resist,  for  any 
length  of  time,  the  heat  of  the  burning  vapor. 

"  The  air-pipe  appears  to  throw  out  a  pale  blue  flame,  about  two 
inches  in  length,  small  and  pointed.  At  the  very  point  of  this  flame, 
the  oxygen  being  all  consumed,  the  greatest  amount  of  heat  is  pro- 
duced, and  the  fusion  of  the  solder  takes  place  without  oxidation  ;  but 
within  the  blue  flame,  where  oxygen  prepondei-ates,  oxidation  of  the 
solder  goes  on  rapidly.  The  extra  heat  gained  by  the  introduction  of 
the  air-pipe  is  nearly  all  concentrated  at  the  apex  of  the  blue  flame, 
which  may  be  brought  to  bear  upon  the  point  to  be  soldered,  while  the 
vapor-flame  keeps  up  the  temperature  of  the  whole  work." 

Dr.  R.  Somerby,  of  Louisville,  has  constructed  a  combined  furnace 
and  blow-pipe,  which  will  be  found  very  convenient  and  useful  in  the 
laboratory  (Fig.  252).  The  double  bellows  o,  worked  by  the  treadle 
r,  sends  its  blast  —  which  may  be  increased  by  the  weighty?  —  up  the 
pipe  n,  either  to  the  furnace  i,  or  through  the  blow-pipe  d,  into  the 
flame  of  the  lamp  h,  which  rests  on  a  sliding-ring  /  attached  to  the 
movable  stand  h.     The  frame  is  of  cast-iron,  the  pipes  of  brass,  the  lamp 


584 


SOLDERING. 


of  copper,  and  the  entire  apparatus  admirably  made,  and  of  the  best 
maierial.  When  the  furnace  is  used,  a  hood,  resting  against  the  flange 
a,  carries  off  the  smoke,  and  a  pan  j  receives  the  ashes.  If  desirable, 
the  fire  may  be  started  by  the  blast,  and  then  continued  by  simple  draft 

'Fio.  252. 


through  the  door  h ;  this  can  be  made  of  any  required  intensity  by  a 
pipe  set  directly  over  the  top  of  the  furnace.  The  process  of  soldering 
is  rendered  more  easy  by  this  blow-pipe  than  by  the  usual  method, 
and  is,  therefore,  valuable  to  those  of  the  profession  who  are  stationary, 


SOLDERING.  585 

and  occupy  themselves  much  in  mechanical  dentistry.  The  furnace 
attached  to  it  answers  all  the  purposes  of  melting  gold,  solder,  and 
metallic  casts. 

The  THIRD  class  of  blow-pipes  is  sometimes  combined  with  the  second 
to  regulate  the  blast,  or  with  the  first  to  intensify  it.  In  its  uncom- 
bined  form  it  consists  essentially  of  a  blow-pipe  point  attached  by  a 
flexible  tube  to  an  air-chamber,  from  w^hich  the  air  is  forced  by  the 
steady  pressure  of  water.  When  once  set  in  operation,  it  is  self-acting, 
and  in  this  respect  has  great  advantage  over  the  second  class.  This, 
with  the  perfect  regularity  of  the  blast,  makes  a  properly-constructed 
hydrostatic  blow-pipe,  much  the  best  of  all  substitutes  for  the  lungs 
and  mouth  blow-pipe. 

The  gasometer  of  the  nitrous  oxide  gas  apparatus  makes  a  very 
excellent  hydrostatic  blow-pipe.  Its  form,  and  the  manner  of  using 
it,  are  so  familiar  to  dentists  as  to  render  any  illustration  or  description 
unnecessary.  Any  required  force  of  blast  may  be  given  by  detaching 
the  counterpoise,  or  by  adding  weights  to  the  descending  cylinder. 

Prof.  Austen  gives  the  following  description  of  a  simple  and  inex- 
pensive apparatus  suitable  for  laboratories  where  no  pressure  can  be 
had,  as  in  cities,  from  public  water-works.  "  Place  in  convenient  posi- 
tion a  strong  ten-gallon  water-tight  oak-cask,  two  feet  from  the  floor. 
Over  this,  and  two  feet  above  it,  place  a  second  of  the  same  size,  with 
a  movable  cover,  so  that  water  may  be  conveniently  poured  into  it. 
Connect  the  casks  by  a  tube  running  nearly  to  the  bottom  of  the  lower 
cask,  and  having  a  stop-cock  a  between  the  casks.  Into  the  top  of 
the  lower  cask  insert  a  stop-cock  h,  to  which  attach  the  blow-pipe 
tube,  and  into  the  bottom  a  larger  stop-cock  e  for  drawing  off  the 
water.  It  is  prepared  for  operation  thus  :  close  all  the  stop-cocks,  and 
fill  the  upper  cask  to  within  an  inch  of  the  top  (if  too  full,  it  might 
chance  to  overflow  the  lower  cask  and  force  water  out  of  the  blow-pipe 
upon  the  flame  and  work) ;  then  open  stop-cocks  a,  h,  and  the  jet  will 
issue  with  a  force  proportioned  to  the  height  of  the  water.  If  too  strong, 
it  may  be  regulated  by  pressure  upon  the  elastic  tube,  or  by  partly 
closing  the  stop-cock.  Ten  gallons  of  air  will  suffice  for  any  ordinary 
case  of  soldering ;  but  the  process  is  easily  renewed  by  closing  stop  a 
and  drawing  off  the  water  by  stop  e  from  the  lower  cask,  and  emptying 
into  the  upper.  This  can  be  more  rapidly  done  if  stop  h  is  left  open, 
so  as  to  admit  air  freely  while  drawing  off  the  water." 

Another,  but  more  expensive  form,  is  shown  in  Fig.  253,  made  of 
copper  or  boiler-iron,  and  connected  by  lead  pipes  with  the  public 
water-works,  in  towns  and  cities  thus  supplied.  The  drawing,  taken  in 
connection  with  the  previous  description,  makes  any  explanation  un- 
necessary. 


686 


SOLDERING. 


Fig.  253. 


j--'J|l|l'i  ..l.l'-v.T-^- 


The  fourth  class  of  blow-pipes  is  analogous  in  its  operation  to  the 
oxy-hydrogen  blow-pipe.  The  point  is  double,  consisting  of  a  tube, 
through  which  comes  the  sui)porter  of  combustion  (oxygen  or  com- 
mon air),  surrounded  by  a  cylinder,  through  which  comes  the  com- 
bustible (alcoholic  vapor,  illuminating  gas, 
or  hydrogen).  In  Count  Richmont's  aiiro- 
hydrogen  blow-pipe,  the  hydrogen  is  gener- 
ated in  a  vessel  by  the  action  of  dilute  sul- 
phuric acid  upon  zinc,  and  the  air  forced 
through  the  centre  tube  either  with  a  bellows 
or  from  the  lungs.  The  heat  is  less  intense 
than  that  of  the  oxy-hydrogen  blow-pipe,  but 
is  too  great  for  most  laboratory  purposes. 
The  gas  blow-pipe  is  a  very  convenient  in- 
strument: the  principle  is  similar,  and  the 
heat  very  great. 

Fig.  254  represents  Macomber's  gas  blow- 
pipe. The  direction  of  the  point  1  is  regu- 
lated by  the  joint  3,  and  the  supply  of  gas 
controlled  by  the  stop-cock  2.  The  air  is 
supplied  from  the  lungs,  or  from  some  form 
of  mechanical  or  hydrostatic  blow  -  pipe, 
through  the  flexible  tube. 
In  the  operation  of  soldering,  the  parts  to  be  united  must  be  held 
together  in  their  exact  relative  position.     This  can  sometimes  be  done 

by  simply  laying  them  together ;  but 
usually  they  must   be  held  in  place, 
either    by    iron    wire    bound    around 
them,  or  by  small  clamps  of  iron  wire, 
or  by  rivets ;  or  else  by  some  investing 
material,  which,  in  dentistry,  is  always 
plaster   mixed   with   some    substances 
that   will   counteract   its   tendency  to 
shrink  and  crack  under  soldering  heat. 
\    This  substance  may  be  coal  ashes,  soap- 
""\  stone  dust,  felspar,  clean  sand,  or  as- 
bestos.  The  two  latter  are  the  best,  and 
may  be  mixed  in  proportions  varying 
from  two  to  six  parts  sand  or  asbestos 
to  four  of  plaster.     As  a  rule,  the  less 
plaster,  the   less   shrinkage ;   but   a  very  small  quantity  makes  the 
investment  too  friable. 

A  common   mistake  is  to   use  too  large  a  quantity  of  investixi^ 


Fig.  2.54. 


SOLDEEING. 


587 


material.  This  almost  invariably  results  in  the  warping  of  the  plate ; 
for,  as  all  investments  have  some  degree  of  permanent  contraction,  and 
all  metal  must  expand,  if  the  latter  is  bound  by  a  rigid,  unyielding 
mass,  it  will  inevitably  warp.  Hence,  as  a  rule,  use  no  more  investing 
material  than  is  necessary  to  keep  the  parts  to  be  soldered  in  their 
position,  and  to  protect  the  porcelain  surfaces  from  direct  contact  with 
the  flame.  This  subject  will  be  further  considered,  when  speaking  of 
the  soldering  of  teeth  to  the  plate. 

In  selecting  a  suitable  receptacle  for  the  work  to  be  soldered,  it  is 
important  to  retain  the  heat,  especially  when  using  the  mouth  blow- 
pipe. A  funnel-shaped  mat  made  with  scraps  of  woven  iron-wire ;  or 
a  large  lump  of  pumice-stone ;  or  one  of  close-grained  charcoal,  with 
the  outside  coated  over  with  a  thin  layer  of  plaster,  form  very  simple 
and  convenient  receptacles  for  smaller  pieces  of  work.  For  larger  work, 
or  for  very  high  temperatures,  it  is  important  to  receive  additional 
heat  from  ignited  charcoal,  for  which  purpose  the  soldering-pan  (Fig. 
255)  is  a  very  admirable  contrivance.  The  movable  lid  remains  during 
the  beating  up  and  the  cooling  off",  but  is,  of  course,  removed  during 
the  act  of  soldering. 

Fig.  255. 


After  soldering,  the  work  should  cool  gradually,  unless  it  is  to  be 
re-swaged.  If  there  is  any  porcelain  attached,  the  cooling  must  be 
very  gradual.  When  cold,  it  may  be  placed  in  dilute  sulphuric  acid 
and  slowly  raised  to  the  boiling-point,  kept  there  for  a  few  moments, 
and  then  slowly  cooled.  This  dissolves  the  glass  of  borax,  which  is 
so  hard  that  it  injures  the  edge  of  files  and  scrapers. 


588  SOLDERING. 

A  few  general  considerations  may  be  of  service  in  the  use  of  the 
above  described  appliances  for  soldering.  It  is  an  operation  regarded 
by  many  as  attended  with  much  risk  ;  and  by  students  generally  it  is 
considered  the  Pons  Asinorwn  of  dentistry.  Whereas,  there  is  no  pro- 
cess in  dental  prosthesis  in  which  the  desired  result  can  be  with  more 
certainty  obtained,  provided  such  care  and  skill  are  exercised  as  alone 
can  give  success  in  any  department  of  the  art. 

Plates  warp  from  want  of  support  when  heated,  or  from  excess  of 
investing  batter :  they  are  burnt,  blistered,  or  melted,  from  careless  or 
ignorant  use  of  the  blow-pipe.  Teeth  are  broken  from  rapid  heating 
or  cooling;  they  are  displaced  by  the  shrinking  of  an  ill-judged  invest- 
ment. Solder  is  condemned  because  it  will  not  bridge  a  chasm  one- 
eighth  inch  wide,  will  not  run  over  plaster,  will  not  attach  itself  to  an 
oxidized  surface,  or  will  obstinately  roll  up  into  a  ball,  rather  than  flow 
over  a  surface  too  cold  to  receive  it.  These,  and  all  other  vexations 
of  soldering,  are  the  result  of  haste,  ignorance,  or  want  of  skill. 

In  soldering  two  surfaces,  as  in  the  doubling  of  lower  or  shallow 
upper  plates,  the  borax  must  contain  no  particles  preventing  contact 
of  the  plates  ;  also  the  heat  must  be  directed  on  the  side  opposite  the 
pieces  of  solder,  so  that,  when  melted,  it  may  flow  between  the  plates 
from  one  side  to  the  other.  Clamps  are  preferable  to  plaster  batter 
for  holding  parts  together,  whenever  practicable,  as  in  soldering  a  wire 
or  band  around  plates  ;  but  when  the  relation  must  be  preserved  with 
utmost  accuracy,  as  in  clasps,  the  plaster  investment  is  essential.  It  is 
also  necessary  for  the  protection  of  porcelain  from  the  direct  action  of 
flame. 

In  soldering  teeth  to  a  plate,  the  batter  must  have  such  proportion 
of  plaster  with  asbestos  or  sand  as  to  admit  of  being  used  in  small 
quantity,  and  yet  be  so  strong  when  heated  that  it  will  not  crack,  and 
endanger  the  position  of  the  teeth.  Backings  and  clasps  must  fit  accu- 
rately wherever  they  are  to  be  fastened.  There  should  be  no  trace  of 
plaster  on  a  surface  where  solder  is  to  flow  ;  or,  in  fact,  substances  of 
any  kind  except  borax,  and  not  too  much  of  that.  Borax  must  be 
pure  and  clean,  and  used  with  soft  water,  and  the  heating  must  be 
gradual,  in  view  of  its  liability  to  throw  off"  the  solder.  Solder  must 
be  of  good  quality  and  carefully  placed,  never  putting  two  pieces 
where  the  position  will  allow  the  proper  quantity  to  lie  in  one  piece. 
It  is  a  very  common  practice  to  cut  solder  into  very  small  pieces,  under 
the  idea  that  it  will  flow  more  evenly  ;  but  if  a  plate  is  properly  heated 
and  the  blow-pipe  flame  skilfully  managed,  the  large  pieces  melt  in- 
stantly, and  flow  into  their  proper  position. 

It  is  quite  possible,  by  careful  observance  of  these  directions,  and  by 
expertness  in  the  management  of  the  blow-pipe,  to  solder  any  set  of 


ADJUSTMENT    OF    TEETH.  589 

teeth  so  that  there  shall  be  no  roughness  or  abrupt  edges  requiring 
the  use  of  files  and  scrapers.  In  fact,  these  tools  are  never  needed  to 
give  finish  to  a  perfectly-soldered  joint :  the  natural  flow  of  the  solder 
takes  a  shape  which  cannot  be  improved. 


CHAPTER  XII. 


ADJUSTMENT  OF  POKCELAIN  TEETH   TO  THE   PLATE  —  FINISHINa 

PROCESS. 

WHERE  vacancies  between  natural  teeth  are  to  be  filled,  it  is 
highly  important  that  the  artificial  teeth  should  correspond 
in  shade  and  color  with  the  natural  organs ;  for  in  proportion  as  they 
are  whiter  or  darker,  will  the  contrast  be  striking,  and  their  artificial 
character  apparent.  Of  the  two  faults,  it  is  better  that  they  should  be 
a  little  darker  than  any  Avhiter.  They  should  also  resemble  in 
shape  those  which  have  been  lost,  so  far  as  it  is  possible  to  ascertain 
this.  Minute  accuracy  as  to  shades  of  color,  involves  the  necessity  of 
a  large  assortment,  unless  one  is  located  near  a  depot  or  agency.  But 
the  facilities  of  mail  and  express  greatly  lessen  this  necessity,  provided 
there  is  time  to  send  for  the  tooth  or  teeth  required.  It  is  desirable,  in 
view  of  this  method  of  matching  shades  of  color  to  keep  all  refuse  or 
broken  teeth,  to  be  used  as  samples  in  sending  orders. 

The  manufacturer  supplies  three  varieties  of  plate -teeth, —  plain, 
gum,  and  sections.  The  latter  have  the  advantage  of  showing  few 
joints,  but  are  less  easily  repaired,  and  are  not  applicable  to  so  wide 
a  range  of  cases.  Gum  teeth  or  sections  are  applicable  only  Avhere 
there  has  been  sufiicient  absorption  to  permit  the  extra  fulness  of  the 
artificial  gum.  Many  mouths  are  deformed  by  a  foolish  craving  on  the 
part  of  the  patient,  which  the  dentist  is  equally  foolish  in  yielding  to, 
whenever  plain  teeth  are  more  appropriate.  In  point  of  strength, 
durability,  and  facility  of  repair,  plain  teeth  are  superior  to  the  others  ; 
they  are  also  more  readily  adapted  to  the  plate. 

The  manufacture  of  gum  teeth,  in  sections  of  two,  three,  or  four 
teeth,  has  been  brought  to  such  perfection  that  comparatively  few 
single  gum  teeth  are  now  used  ;  especially  since  new  methods  of  at- 
taching these  sections  to  the  plate  have  rendered  unnecessaiy  that  exact 
fitting  of  blocks  which  was  one  objection  to  their  use.  This  perfection 
of  manufacture  has  also  done  away  with  the  necessity,  on  the  part  of 
the  dentist,  of  devoting  to  the  making  of  block  teeth  the  very  large 


590 


ADJUSTMENT    OF    TEETH, 


proportion  of  his  time  formerly  detnanded  by  this  difficult  process. 
Whenever  special  cases  demand  blocks  or  sections  made  to  order,  it 
will  be  found  more  satisfactory  to  send  proper  models  and  descriptions, 
and  have  such  teeth  made  by  those  who  are  thus  constantly  occupied, 
than  to  incur  the  disappointments  and  delays  inevitably  attendant 
upon  infrequent  and  irregular  attempts  at  block  work. 

For  the  proper  shaping  of  models  or  articulators  to  accompany  such 
orders,  directions  will  hereafter  be  given.  These  blocks,  when  received, 
do  not  need  much,  if  any,  grinding.  But  all  plain  teeth,  single  gum 
teeth,  and  ordinary  sections  or  block  teeth  require,  after  selection,  to 
be  more  or  less  accurately  fitted  to  the  base-pUite.  For  this  purpose 
they  must  be  ground  on  emery-  or  corundum-wheels  until  accurately 
fitted,  and  must  be  so  arranged,  in  full  cases,  as  to  meet  the  teeth  with 
which  they  are  intended  to  antagonize  at  the  same  instant  around  the 
entire  arch:  in  partial  cases,  the  natural  teeth  should  touch  their 
antagonists  more  decidedly  than  the  artificial  ones.     A  correct  articu- 


FiG.  256. 


"^P 


lation  will  enable  the  dentist  to   antagonize   the  teeth  with  perfect 
accuracy. 

In  arranging  an  entire  set  for  the  upper,  or  for  both  jaws,  the  molars 
should  be  so  adjusted  that  the  inner  or  palatine  tubercles  come  together 
before  the  outer  ones.  This  precaution  is  necessary  in  antagonizing 
single  as  well  as  block  teeth.  If  the  outer  tubercles  strike  first,  the 
pressure  there  will  spring  and  loosen  the  plate.     For  the  same  reason 


ADJUSTMENT    OF    TEETH. 


591 


Fig.  258. 


upper  molars  and  bicuspids  should  not  be  set  so  that  the  force  of 
mastication  falls  outside  of  the  ridge.  A  small  space  should  be  left 
between  the  last  tooth  of  the  upper  and  of  the  lower  jaw,  in  those  eases 
where  the  crown  of  the  lower  molar  looks  forward,  its  posterior  edge 
being  a  little  higher  than  the  anterior. 

It  is  often  necessary  to  cut  away  a  considerable  portion  of  a  tooth  in 
order  to  make  it  fit  accurately  to  the  plate.  This  makes  the  process  of 
grinding  very  tedious,  unless  the  operator  has  a  number  of  sharp- 
cutting  corundum-wheels,  varying  from  half  an  inch  to  three  or  four 
inches  in  diameter. 

These  wheels  may  be  attached  to  one 
of  the  hand- lathes  on  pages  509,  510,  or 
to  Coy's  noiseless  hand-lathe,  Fig.  258. 
The  foot-lathe  is,  however,  far  more  con- 
venient for  laboratory  use,  where  much 
grinding  is  to  be  done.  Of  these,  the  depots 
furnish  some  excellent  varieties.  Fig.  258 
represents  an  admirable  lathe  for  dental 
purposes ;  wdiile,  in  Fig.  257,  we  have  a 

larger,  stronger,  and  more  powerful  lathe,  capable  of  very  rapid  mo- 
tion; also  adapted  to  the  making  of  small  instruments,  handles, 
etc. 

Figs.  259,  260  represent  a  piece  of  cabinet  furniture  combining  lathe, 
work-table,  and  drawers  for  implements,  materials,  etc.,  specially  de- 


Fig.  259. 


Fig.  260. 


592 


ADJUSTMENT    OF    TEETH 


signed  for  those  vho,  having  laboratory  and  office  iu  one  room,  may 
>vish  to  unite  utility  and  ornament. 

The  lathe  of  Dr.  Lawrence,  with  detached  driving-wheel  and  head, 
that  can  be  attached  to  any  convenient  board,  shelf,  or  table,  (Fig. 
261,)  has  advantages  that  will  make  it  very  desirable  to  many. 

Fig.  261. 


Wheels  may  either  be  set  at  intervals  on  a  long  spindle  (Fig.  257), 
or  screwed  singly  on  the  end  of  the  mandril  (Fig.  256).  In  the  latter 
case  they  should  be  fixed  with  a  screw-chuck  in  the  centre,  so  as  to  be 
quickly  changed  from  coarse  to  fine,  or  from  large  to  small.  In  grind- 
ing, the  wheel  should  revolve  toward  the  operator,  and  be  kept  con- 
stantly wet  with  a  sponge  held  either  in  a  sponge-holder  or  between 
the  ring-finger  and  little  finger  of  the  left  hand. 

The  thumb  and  forefinger  of  each  hand  must  be  free  to  hold  the 
tooth,  the  right  wrist  being  steadily  supported  on  the  hand-rest.  Two 
faults  are  very  common  in  grinding :  one  is,  revolving  the  wheel  too 
rapidly  ;  the  other,  bearing  the  tooth  too  heavily  against  the  wdieel. 
The  first  hinders  rather  than  helps  grinding;  the  second  is  very  apt  to 
throw  the  tooth  from  the  fingei's,  and  destroys  the  delicacy  of  touch 
necessary  for  accurate  grinding. 

In  grinding  blocks  and  gum  teeth,  and  often  in  plain  teeth,  very 
small  wheels  are  required  to  make  them  fit  the  curves  of  the  plate. 
Thin. edges  of  gum  teeth  and  blocks  must  be  ground  with  very  fine- 
grained wheels;  in  jointing  them,  a  three-inch  wheel  should  be  used, 
perfectly  flat  on  its  outer  side,  and  running  very  true.  Wheels,  when 
worn  down  to  small  size,  increase  in  value  because  they  grind  out 
curves  inaccessible  to  larger  ones.  In  warm  weather,  large  and  thin 
wheels,  when  not  in  use,  should  rest  on  a  flat  surface ;  such  wheels  are 
often  warped  by  the  softening  of  the  shellac  as  they  lie  carelessly 
among  other  wheels.     Wheels  running  on  the  end  of  a  mandril,  and 


ADJUSTMENT    OF    TEETH.  593 

attached  by  a  screw-chuck,  can  be  made  to  run  true  by  warming  the 
mandril  with  a  spirit-lamp,  and  at  the  same  time  revolving  the  wheel 
rapidly. 

The  accuracy  of  fit  necessary  depends  upon  the  kind  of  work  and 
mode  of  attachment  to  the  base-plate.  In  general  terms,  it  may  be 
stated  that  whenever  any  permanent  plastic  material  is  in  contact  with 
the  base  of  the  teeth,  or  forms  the  bond  of  union  between  the  teeth 
and  plate,  grinding  is  much  simplified.  It  is  sometimes  better,  in  such 
cases,  to  have  a  moderate  space  between  the  base  of  the  tooth  and  the 
plate  or  the  model,  than  to  have  actual  contact  But  in  all  cases  the 
lateral  jointing  of  block  or  single  gum  teeth  requires  care. 

The  order  of  grinding  a  set  of  teeth  is  usually  to  fit  the  central 
incisors,  then  the  laterals,  next  the  bicuspids,  and  so  on ;  in  case  of 
sections,  in  the  same  order.  This  order  will  be  found  most  conducive 
to  uniformity  of  arrangement ;  of  course,  it  may  be  modified  to  any 
desired  extent.  In  case  of  a  double  set,  there  is  much  diversity  of 
practice.  Some  adapt,  first,  the  entire  upper  set,  others,  the  entii'e  lower ; 
some,  again,  adjust  the  two  sets  of  incisors,  then  the  bicuspid  blocks 
of  both  pieces,  lastly,  the  molars.  Whichever  method  is  adopted,  when 
all  or  part  of  one  of  the  articulating  rims  is  removed,  the  antagonizing 
rim  must  be  retained,  to  guide  in  the  adjustment  of  the  teeth. 

During  the  process  of  grinding,  the  teeth  are  temporarily  attached 
to  the  plate  in  several  ways.  Either  the  articulating  rim  is  cut  away 
sufficiently  to  receive  the  tooth  (Fig.  262), 
or  the  rim  is  entirely  removed,  and  its  place 
supplied  with  a  mass  of  wax  covering  the 
plate  to  the  top  of  the  ridge,  and  to  which 
the  teeth  are  severally  attached  as  they  are 
ground ;  others  fasten  the  teeth  to  the  plate 
with  cement. 

Definite  rules  of  arrangement,  or  wood- 
cuts illustrating  various  forms  of  teeth  and 

manner  of  setting  them  in  the  arch,  are  not  all  that  is  necessary. 
This  branch  of  dental  aesthetics  must,  of  necessity,  be  worked  out  by 
every  one  for  himself  He  will  succeed  or  fail  just  in  proportion  as  he 
has  the  ability  to  observe  the  hundreds  of  models  which  are  perpetually 
before  him;  and  as  he  has  the  further  and  rarer  ability  to  apply  his 
observations  to  the  special  cases  that  are  in  his  laboratory. 

Imitation  of  nature  is  the  rule.  Limitations  of  art,  and  individual 
incapacity,  make  exact  observance  of  this  rule  comparatively  rare. 
We  replace  the  sixteen  teeth  with  only  fourteen,  and  often  make  them 
shorter  and  every  way  smaller  than  the  natural  organs.  We  do  not 
make  the  grinding  surfaces  interlock  with  such  deep  cusjds  as  in  nature.. 
38 


594;  ADJUSTMENT    OF    TEETH. 

At  one  time  we  cannot  avoid  an  unnatural  fulness  of  artificial  gum; 
at  other  times,  the  contraction  of  the  absorbed  arch  compels  the  set- 
ting of  molar  teeth  nearer  the  median  line  than  the  original  teeth. 

Notwithstanding  these  and  many  other  disadvantages,  the  perfection 
of  the  deuto-ceramic  Art  is  such  that  a  skilled  artist,  who  is  quick  to 
observe  what  nature  requires,  can,  in  the  majority  of  cases  falling 
under  his  care,  supply  the  lost  dental  organs  with  great  accuracy,  and 
preserve  that  higher  order  of  beauty  which  grows  out  of  the  harmony 
of  his  work  with  the  expression  of  the  face  and  entire  person.  But 
no  dentist  can  give  to  his  work  this  kind  of  beauty  who  does  not  sys- 
tematically study  the  natural  organs  as  they  daily  present  themselves 
in  the  operating-chair.  Few  patients  would  object  to  the  pressure  of  a 
roll  of  wax  (two  inches  long  and  about  a  half  inch  thick)  against  the 
closed  teeth.  A  model  from  this  impression  would  give  the  size,  form, 
arrangement,  and  articulation  of  all  except  the  molar  teeth.  A  well- 
matched  porcelain  tooth  (more  than  one  might  be  required)  would  add 
to  these  data  the  color  of  teeth  and  gum.  To  this  add  also  the  age, 
sex,  physical  characteristics  of  the  face,  and  the  physical  temperament. 
If  the  dentist  would  have  a  case  and  book  for  the  registration  of  one 
such  carefully  made  observation  every  week,  he  would,  at  the  end  of 
two  years,  have  a  collection  which,  as  a  practical  guide  in  the  selec- 
tion and  arrangement  of  artificial  teeth,  would  prove  of  incalculable 
value.  These  fixed  records  of  minute  details  are  made  still  more  use- 
ful by  a  habit  of  close  observation  in  society.  In  this  way  a  set  style, 
or  mannerism,  may  be  avoided,  which  so  often  stamps  dental  work 
with  meaningless  uniformity  of  expression. 

Artificial  teeth  should  imitate  the  natural  organs  ;  yet  there  is  a 
perfection  of  form  and  arrangement  which  it  is  not  advisable  to  imitate. 
To  disarm  suspicion  as  to  their  artificial  character,  it  is  often  desirable 
to  impart  a  measure  of  irregularity.  An  overlapping  lateral,  a  missing 
bicuspid,  a  worn  canine,  an  incisor  bicuspid  or  molar  apparently  de- 
cayed and  filled  with  gold,  au  exposed  neck  from  absorption  of  the 
alveolus,  are  among  the  legitimate  devices  of  the  skilful  mechanician 
who  has  the  "  art  to  conceal  his  art."  If  there  are  any  defective  natu- 
ral teeth  remaining  to  be  matched,  still  higher  art  is  required.  A  per- 
fect porcelain  incisor  is  no  fit  companion  for  one  that  is  partly  broken, 
decayed,  and  discolored ;  and  since  no  art. can  make  the  defective  tooth 
perfect,  and  yet  the  patient  retains  it,  there  is  no  alternative  but  to 
give  so  much  imperfection  to  the  artificial  one  as  shall  take  away  that 
striking  contrast  which  so  painfully  offends  our  aesthetic  sense  of 
fitness. 

In  this  class  of  operations  a  "diamond  drill"  is  of  great  value;  in 
fact,  so  very  useful  is  it  in  many  ways,  that  we  regard  it  as  an  abso- 


ADJUSTMENT    OF    TEETH.  595 

lutely  indispensable  instrument  in  the  laboratory.  Cutting  away  parts 
of  teeth  or  blocks  inaccessible  to  wheels  ;  changing  the  shape  of  teeth 
near  the  gum ;  drilling  cavities  to  be  filled  with  gold,  or  holes  for  the 
repair  of  broken  blocks,  these  are  some  of  the  operations  which  the 
diamond  drill  wall  accomplish  as  no  other  instrument  can. 

The  selection  and  grinding  of  artificial  teeth  requires,  first,  a  high 
order  of  aesthetic  culture ;  secondly,  great  patience  and  skilful  manip- 
ulation. The  latter  are  often  taxed  to  the  utmost  to  make  a  set  of 
blocks  answer  the  requirements  of  a  given  case ;  especially  when  the 
blocks  must  be  closely  fitted  to  a  gold  plate  preparatory  to  attachment 
by  soldering.  Single  gum  teeth  are  more  easily  fitted  to  the  plate ;  but 
there  are  more  joints;  hence  it  is  doubtful  if  much  time  is  saved. 
The  principal  advantage  of  single  gum  teeth  is,  that  a  single  tooth,  if 
broken,  may  be  replaced  without  interfering  with  the  adjoining  ones. 
Another  reason  why  many  prefer  them  is,  that  a  small  stock  of  teeth, 
in  this  form  is  adapted  to  a  larger  variety  of  cases  than  blocks 
would  be. 

We  think,  however,  that  dentists  living  at  a  distance  from  the 
manufacturer  should  depend  upon  a  great  variety  of  samples  rather 
than  upon  duplicates  of  certain  forms,  however  desirable.  It  is  a 
matter  of  some  surprise  that  manufacturers  have  not  long  ago  recog- 
nized the  advantage  of  preparing  "sample  cards,"  numbered  and  let- 
tered ;  so  that  any  desired  size,  shape,  and  color  of  teeth  may  be 
ordered  by  mail  or  express,  as  they  are  required.  These  samples 
should  be  so  made,  however,  that  the  "card"  could  not  be  injured  by 
the  temptation  to  use  them  in  practice. 

In  jointing  a  set  of  blocks  or  single  gum  teeth,  one  point  must  be 
remembered  which  has  been  already  alluded  to.  In  soldering,  the 
metal  expands,  Avhile  the  teeth  held  in  the  investment  ai'e  brought 
closer  together  by  its  contraction,  and  in  this  slightly- altered  position 
they  are  soldered  to  the  plate.  The  contraction  of  the  plate  on  cool- 
ing is  irresistible,  and  may  result  in  one  or  both  of  two  accidents  — 
chipping  off  the  brittle  edges  of  the  teeth  thus  brought  too  closely 
together,  or  warping  the  plate  because  of  the  resistance  which  the  teeth 
or  blocks  offer  to  the  contraction  of  the  plate.  Thin  letter-paper 
slipped  between  the  side-joints  will  suffice  to  prevent  these  accidents. 

Fig.  263  gives  an  external  view  of  a  full  upper  set  of  single  gum 
teeth,  arranged  on  a  gold  plate,  preparatory  to  the  operations  which 
precede  soldering,  or  other  modes  of  fastening  them  to  the  base.  Fig. 
264  is  a  similar  view  of  a  set  of  blocks,  with  a  soldered  rim  covering 
the  upper  edge. 

Usually,  in  first  or  temporary  pieces,  and  sometimes  after  the  alveo- 
lar absorption  is  completed,  the  fulness  of  the  gum  is  such  as  to  forbid 


596  ADJUSTMENT    OF    TEETH. 

the  addition  of  arj  artificial  gum  to  the  ten  incisors,  canines,  and  bicus- 
pids. In  such  cases  the  phite  must  be  cut  away  from  the  front  of  the 
ridge  as  far  as  the  first  or  second  bicuspid,  and  the  teeth  ground  with 
great  accuracy  to  fit  the  gum  itself  Single  plain  teeth  will  usually  be 
best  adapted  to  such  cases ;  but  an  excellent  effect  can  sometimes  be 

Fig.  2G3.  Fig.  2G4. 


produced  by  grinding  a  block,  when  the  shade  of  gum  is  well  matched, 
to  fit  directly  upon  the  natural  gum.  In  partial  cases  the  tooth  or 
block  must  invariably  be  fitted  to  the  gum ;  no  plate  should  be  seen 
above  or  at  the  side.  In  fitting  directly  to  the  plaster  model,  this 
should  be  scraped  (after  the  tooth  is  ground),  so  that  it  may  press 
firmly  on  the  corresponding  gum. 

The  teeth  or  blocks  being  now  arranged  and  fitted  to  the  plate,  the 
next  step,  preparatory  to  soldering,  is  to  get  access  to  the  pins  on  the 
inside,  for  the  purpose  of  backing  them.  Set  the  articulating  model 
on  the  table  with  the  teeth  upward ;  bend  a  strip  of  lead  (an  inch 
wide)  outside  the  arch  and  about  a  half  inch  from  the  teeth  ;  then  fill 
the  space  with  plaster,  itiserting  a  strip  of  tin  foil  opposite  the  median 
line,  so  that  the  plaster  rim  will  readily  break  at  that  point  when 
removed.  In  a  double  set  do  the  same  with  each  half  of  the  articu- 
lator. "When  the  plaster  has  set,  remove  all  w^ax  or  cement  from  the 
teeth  and  plate,  and  proceed  to  examine  the  pins,  also  the  relations  of 
the  teeth  or  blocks  to  the  plate  and  to  each  other.  This  temporary 
plaster-baud  we  regard  as  essential  in  every  case,  except  a  few  varieties 
of  partial  sets.  It  is  equally  essential  in  vulcanite  and  other  forms  of 
plastic  work,  as  will  be  hereafter  explained.  It  is  a  common  but  not 
good  practice,  where  the  teeth  are  soldered,  to  substitute  for  this  tem- 
porary baud  the  soldering  investment. 

Fig.  265  will  give  an  idea  of  the  shape  of  this  rim,  except  that, 
being  here  designed  for  a  different  purpose,  it  does  not  show  the  im- 
press of  the  teeth.  Fig.  266  represents  the  inner  surface  of  a  set  of 
blocks  with  the  wax  removed,  which  we  may  suppose  just  withdrawn 
from  the  plate  in  preceding  figure.  Blocks  or  sections  are  readily 
replaced  in  their  proper  positions ;  but  single  teeth  are  sometimes  so 
similar,  especially  bicuspids,  that  they  are  apt  to  be  misplaced.  To 
prevent  such  accidents,  have  a  circular  wooden  block,  four  inches  in 


ADJUSTMENT    OF    TEETH. 


597 


diameter,  with  twenty-eight  cups  or  depressions  so  marked  that  each 
tooth  can  be  instantly  put  into  and  taken  from  its  proper  cup. 

The  teeth  being  thus  arranged,  a  gold-plate,  or  backing  large  enough 
to  cover  the  entire  width,  and  from  eight-  to  nine-tenths  of  the  height 
of  the  posterior  surface  of  each,  is  fitted  to  them  in  the  following  man- 
ner.   Each  tooth  has  securely  fixed  in  the  back  part  of  it  two  platina 


Fig.  265. 


Fig.  266. 


rivets  for  the  purpose  of  connecting  it  to  the  backing.  Each  backing, 
therefore,  should  have  two  holes  punched  through  it  by  means  of  a 
pair  of  punch-forceps,  as  represented  in  Fig.  267,  large  enough  to 
admit  the  rivets  of  the  teeth.     After  having  punched  one  hole,  a  rivet 


Fig.  267. 


is  inserted ;  then,  by  moving  the  strip  of  gold  plate  two  or  three  times 
to  the  right  and  left,  a  mark  will  be  left  upon  it,  indicating  the  dis- 
tance the  rivets  are  apart.  But  previously  to  this  the  rivets  should  be 
made  parallel  (being  very  careful  not  to  strain  them  in  the  tooth),  and 


598 


ADJUSTMENT    OF    TEETH. 


the  ends  filed  off  level.  Otherwise  the  pins  will  not  go  into  the  holes 
punched,  and  there  will  be  an  uncertainty  as  to  which  side  of  the  pin 
the  mark  on  the  plate  corresponds. 

Dr.  Samuel  Mallet  has  very  ingeniously  invented  a  punch  which 
will  save  much  trouble  in  finding  the  proper  position  of  the  second 
hole.  (Fig.  268.)     After  straightening  the  pins,  one  is  placed  in  the 

Fig.  268. 


hole  i,  at  the  head  of  the  punch,  the  other  pin  pressing  out  the  mova- 
ble punch  e  (which  works  by  the  spring  g),  until  it  slij^s  into  the  slot 
h ;  the  two  punches  /,  e,  then  make  the  holes  at  the  exact  distances 
apart  to  receive  the  pins. 

A  simple  form  of  punch,  and  one  not  liable  to  accident,  is  a  piece 
of  steel  a  half  inch  square  and  three  or  four  inches  long.  It  consists 
of  two  halves  riveted  together  at  the  top,  each  tapering  nearly  to  a  point. 
By  turning  a  small  screw,  inserted  midway  in  one  leg,  the  points  held 
opposite  the  pins  are  separated  to  their  exact  distance.  A  slight  tap 
of  the  hammer  marks  this  upon  the  backing,  and  then  the  holes  are 
made  with  an  ordinary  punch.  Pins  often  set  very  irregularly  in  a 
tooth ;  they  should  be  parallel,  but  not  necessarily  perpendicular.  Too 
much  bending  of  a  pin  close  to  the  tooth  makes  it  more  liable  to  fract- 
ure in  soldering,  or  by  use  in  the  mouth.  Pins  also  vary  much  in 
thickness;  it  is  better  to  have  the  pin  of  the  punch-forceps  of  medium 
size,  and  to  ream  Avith  a  broach  for  large  platina  pins.  A  set  of 
broaches  are  indispensable  in  backing  teeth,  and  in  many  other  oper- 
ations. 

The  holes  should  be  slightly  countersunk  on  both  sides,  and  after 
placing  the  backing  on  the  tooth,  it  is  made  fast  by  splitting  with  a 
strong  knife  or  a  wedge-shaped  excavator  the  ends  of  the  platina  rivets, 
or  pinching  them  together  with  pliers.  If  the  ends  of  the  platina  rivets 
are  hammered  so  as  completely  to  fill  the  holes  in  the  backings,  it  will 
prevent  the  solder  from  flowing  in  and  uniting  the  two  as  firmly  as  it 
should  do.     The  backings  should  be  slightly  hollowed  before  they  are 


ADJUSTMENT    OF    TEETH.  599 

put  on ;  by  so  doing,  tliey  will  fit  up  closely  to  every  part  of  the  back 
of  the  tooth. 

After  the  backings  have  been  made  fast  to  the  teeth,  they  are  to  be 
accurately  fitted  to  the  plate,  standing  off  from  the  plate  enough  for 
a  very  thin  piece  of  watch-spring  to  be  passed  under  it,  TJiis  shows 
that  the  tooth  is  not  raised,  by  the  backing,  from  its  place  in  the  in- 
vestment. A  much  wider  space  makes  the  flow  of  solder  uncertain ; 
the  practice  of  placing  scraps  of  gold  under  badly-fitted  backings  is  a 
very  slovenly  one. 

Some  dentists  back  the  teeth  as  they  grind  and  fit  them,  and  before 
investing ;  others  invest  with  the  soldering  mixture,  and  back  without 
taking  them  from  the  investment ;  others,  again,  partially  invest  with 
the  soldering  mixture,  remove,  and  back  the  teeth,  then  replace,  and 
add  more  plaster  and  asbestos  or  sand  over  the  edges  of  the  teeth.  By 
the  first  two  methods  neat  or  secure  work  cannot  be  made ;  the  last  is 
unsafe,  because  the  two  layers  of  mortar  are  apt  to  separate  in  heating, 
and  may  displace  the  teeth.  The  most  certain  method,  which  proves 
in  the  end  the  shortest,  is  that  o:^  the  temporary  plaster-band  above 
described. 

Backings  (called  also  stays  or  standards)  vary  much  in  size,  shape, 
and  thickness.  Some  variations  are  matters  of  taste ;  as,  whether  they 
shall  be  rounded,  square,  or  beveled  at  the  top  corners ;  whether 
chamfered  to  a  thin  edge,  or  left  thick,  and  then  beveled  or  rounded. 
But  other  points,  often  considered  optional,  are  not  so,  inasmuch  as 
they  affect  the  appearance  or  stability  of  the  work.  Backings  which 
cover  the  translucent  edge  of  the  tooth  darken  it  by  the  refraction  of 
the  oxidized  surface  next  the  tooth,  and  which  cannot  be  kept  bright ; 
even  if  it  could,  the  gold  would  impart  a  yellowish  tinge.  They  should 
cover  enough  of  the  tooth,  and  fit  so  accurately,  as  to  prevent  motion 
of  the  tooth ;  for  this  will  inevitably  cause  the  pins,  sooner  or  later, 
to  break  off.  Backings,  in  relation  to  each  other,  must  either  be  so 
far  apart  at  their  base  that  the  solder  will  not  flow  from  one  to  the 
other,  forming  a  continuous  band,  or  they  must  be  in  contact  through- 
out whatever  distance  the  solder  will  unite  them.  This  rule  is  par- 
ticularly applicable  to  backings  of  single  gum  teeth,  which  are  often 
(perhaps  usually)  made  the  full  width  of  the  tooth  up  to  the  shoulder. 
This  continuous  band  gives  great  stiffiiess  to  the  plate.  But  the  con- 
traction of  the  solder  will  certainly  warp  it,  unless  prevented  by  actual 
contact  of  the  edges  soldered.  In  case  of  plain  teeth,  a  heavy,  con- 
tinuous line  of  solder  will  almost  certainly  warp  the  plate.  A  block 
may  be  backed  for  soldering  in  one  piece,  or  in  parts  closely  fitted,  or 
in  distinct  backings  opposite  each  tooth.  A  block  much  curved  is 
with  difliculty  backed  in  one  piece ;  long  or  thin  blocks  are  liable  to 


600  ADJUSTMENT    OF    TEETH. 

be  cracked  by  the  contraction  of  a  backing,  either  in  one  piece  or  made 
^'ontinuous  by  soldering.  Backings  should  be  of  the  same  gold  as  the 
plate,  but  heavier,  especially  if  long  or  large. 

Sometimes  the  shape  of  a  gum  or  block  tooth  may  require  the  re- 
moval of  the  plaster  rim,  which  can  readily  be  done ;  then  replaced 
after  the  backing  is  completed,  for  the  final  adjustment  of  the  teeth. 
The  teeth  are  next  to  be  fastened  to  the  plate  with  a  small  quantity  of 
cement  (resin  mixed  with  wax,  or,  still  better,  with  gutta-percha  and 
plaster),  and  a  small  roll  of  softened  wax  (not  melted  or  made  adhe- 
sive) placed  over  the  entire  surface  to  be  soldered.     In  Fig.  269  the 

inner  band  may  be  taken  to  represent 
Fio-  2G9.  the  width  of  this  wax  roll,  which  is  of 

great  service  in  preventing  any  plaster 
of  the  investment  from  getting  acci- 
dentally ujion  the  j^fii'ts  to  be  soldered. 
If  the  teeth  have  been  previously  sol- 
dered to  the  backings,  this  wax  strip 
should  be  narrower ;  but  if  rivets  and 
backings  are  to  be  soldered  at  the  same 
time,  the  rim  must  be  made  carefully 
to  cover  every  point  where  solder  is  to 
flow.  The  plaster-band  is  then  very  carefully  removed,  and  the  piece 
surrounded  with  the  soldering  investment,  which  must  be  no  thicker 
than  is  sufficient  to  protect  the  teeth  and  hold  them  in  place.  The 
wax  and  cement  are  easily  removed,  leaving  the  surfaces  perfectly 
clean  and  ready  for  the  borax  and  solder.  The  investment  should  not 
project  so  far  over  the  inner  edge  of  the  teeth  as  to  obstruct  the  blow- 
pipe flame ;  it  should  not  cover  the  lingual  surface  of  the  plate,  nor 
should  it  be  thick  on  the  palatine  surface.  On  the  palatine  side  it 
would  be  well  also  to  cut  along  the  median  line  nearly  or  quite  through 
the  investment ;  the  object  of  this  is  to  give  play  to  the  lateral  expan- 
sion of  the  plate,  the  autero-posterior  expansion  being  usually,  from 
the  shape  of  the  plate,  sufficiently  free.  This  we  regard  the  simplest 
and  best  method  to  prevent  warping  of  the  plate,  so  often  caused  by 
the  very  means  taken  to  prevent  it. 

We  have  said  nothing  of  fastening  the  teeth  with  a  firm  body  of 
cement  instead  of  w^ax,  so  as  to  try  them  in  the  mouth  before  soldering, 
because  a  correctly  taken  articulation  makes  this  unnecessary.  As 
remarked  in  the  chapter  on  articulation,  this  process  admits  of  per- 
fect accuracy.  Its  very  object  is  to  prevent  the  necessity  of  any 
change  in  arrangement  after  teeth  are  adjusted.  An  error  of  articu- 
lation will  often  involve  a  change  in  the  jointing  of  blocks  more 
troublesome  than  the  original  grinding  ;  in  fact,  neatly-ground  blocks 


ADJUSTMENT    OF    TEETH.  601 

(or  gum  teeth)  will  not  permit  tlie  slightest  change  of  position  without 
fresh  grinding  somewhere.  Trial  of  teeth,  merely  to  test  the  correct- 
ness of  articulation,  is  either  unnecessary,  or  it  is  evidence  of  a  want  of 
skill.  When  used  to  test  correctness  in  the  selection  of  teeth,  it  is 
more  excusable ;  for  it  requires  experience  to  enable  us  to  determine, 
a  priori,  just  what  style  of  work  is  best  adapted  to  the  case.  But  the 
awkward  and  momentary  retention  of  a  jjlate,  to  which  the  teeth  are 
so  slightly  attached,  is  no  test  of  its  sesthetic  correctness,  unless-the 
selection  has  been  grossly  misjudged.  It  is  only  after  the  patient  has 
become  habituated  to  the  piece,  giving  time  for  the  natural  form  of  the 
lips  and  motions  of  the  mouth,  that  we  can  best  decide  whether  or  not 
our  work  has  beauty  of  expression  as  well  as  artistic  finish. 

Mr.  Andrew  Wilson,  of  Scotland,  adopts  the  following  method  of 
backing  teeth :  After  having  partially  fitted  the  tooth  to  the  plate, 
take  a  piece  of  platina  foil,  as  thick  as  can  be  used  conveniently,  and, 
pressing  it  against  the  tooth,  perforate  it  where  it  is  marked  by  the 
pins;  then  cut  it  into  the  required  shape  of  the  backing,  and  press  it  as 
closely  as  possible  to  the  back  of  the  tooth.  Apply  a  little  borax  to 
the  platina  pins  which  come  through  the  back;  then  place  the  tooth  with 
its  face  downward  upon  a  thin  piece  of  pumice,  covered  with  dry 
plaster,  putting  upon  the  platina  sufficient  gold  for  the  thickness  re- 
quired ;  slowly  heat  it,  gradually  raising  the  heat  until  the  gold  melts, 
when  it  will  rapidly  flow  over  the  whole  platina  surface,  uniting  so 
firmly  with  the  pins  in  the  tooth,  that  Mr.  W.  has  never,  during  eight 
years'  use,  seen  a  case  in  which  they  have  loosened,  even  where  there 
has  been  sufficient  violence  to  break  the  tooth.  After  the  backing 
has  been  run,  and  the  tooth  allowed  to  cool  slowly,  it  is  filed  to  the 
requisite  thickness  and  shape  ;  tooth  and  backing  are  then  closely  fitted 
and  finally  soldered  to  the  plate.  In  arranging  the  teeth  on  the  plate 
for  soldering,  Mr.  Wilson  uses  a  mortar  of  white  sand  and  plaster  equal 
parts,  placing  a  thin  strip  of  platina  on  the  outside  of  the  teeth,  with 
a  layer  of  the  mortar  on  both  sides  of  it,  so  that,  should  the  plaster 
crack  in  soldering,  the  platina  may  keep  the  teeth  from  shifting  their 
places.  The  whole  time  occupied  in  heating  and  backing  a  tooth  is 
about  half  an  hour;  when  several  are  don3  at  once,  a  little  longer  time 
is  required.  Of  course,  all  the  backings  of  the  set  should  be  flowed  at 
the  same  heating. 

Instead  of  using  the  strip  of  platina  plate  to  prevent  the  teeth  from 
becoming  displaced,  in  case  the  plaster  cracks,  thin  sheet  iron  or  iron 
wire  may  be  used  ;  but  platina  is  undoubtedly  the  neatest,  and  has  the 
advantage  of  being  indestructible;  it  may  be  narrow  and  thin,  so  that 
its  cost  would  form  no  objection  to  its  use.  But  if  the  plaster  is  not  in 
excess,  the  investment  will  not  crack.   A  mortar,  made  of  three  or  four 


602 


ADJUSTMENT    OF    TEETH. 


parts  of  asbestos  to  one  of  plaster,  will  stand  the  hottest  fire  of  the 
laboratory.  Mr.  "Wilson's  method  might  be  improved,  first,  by  com- 
pletely fitting  the  tooth  before  backing;  secondly,  by  running  the  thin 
platina  backing,  one-sixteenth  of  an  inch  on  the  plate,  to  any  irregula- 
rities of  which  it  can  be  quickly  burnished  down  by  making  several 
slits  in  the  edge.  This  flange  secures  a  very  perfect  and  strong  attach- 
ment to  the  plate,  and  is  the  method  of  backing  (with  heavier  platina) 
practised  in  the  continuous-gum  work. 

Ordinarv  backings,  after  they  have  been  fitted  to  the  plate  and  held 
to  the  teeth  by  bending  or  splitting  the  pins,  may  be  removed  from  the 
plate,  set  in  a  Ijatter  of  plaster  (with  or  Avithout  asbestos),  and  soldered  ; 
the  plaster  should  be  so  stifi"  as  not  to  flow  over  the  backings.  The  solder 
should  be  rather  harder  to  fuse  than  that  used  to  fasten  the  teeth  to  the 
j)late.  The  backings,  after  slowly  cooling,  should  be  filed,  and  may  even 
be  Scotch-stoned.  Backings  can  be  better  and  moi-e  quickly  finished 
singly  than  when  attached  to  the  plate.  This  method,  or  Mr.  Wil- 
son's, are  much  to  be  preferred  to  the  common  practice  of  soldering 
the  backings  to  both  teeth  and  plate  at  the  same  heating. 

A  piece  invested  preparatory  for  soldering,  and  placed  upon  a  lump 
of  solid  charcoal,  is  seen  in  Fig.  270. 


Fig.  270. 


ADJUSTMENT    OF    TEETH.  603 

Directions  for  applying  borax  and  solder  have  already  been  given. 
Some  cut  the  solder  into  very  small  pieces ;  others  use  one  piece  to  each 
tooth  at  its  base,  and  a  second  for  the  pins  unless  previously  soldered  : 
in  the  figure  the  pieces  are  unnecessarily  small.  If  the  backings  are 
soldered  to  the  teeth  beforehand,  a  more  fusible  grade  of  solder  should 
be  used  at  the  second  soldering.  The  work,  as  before  stated,  must  be 
very  gradually  and  thoroughly  heated  up,  before  directing  the  flame 
ujDon  the  plate  or  backings.  The  last  point  to  be  touched  with  the 
flame  is  the  solder,  and  this  not  before  a  slight  melting  of  the  edge 
shows  that  it  is  just  on  the  point  of  flowing.  If  every  preparation  for 
soldering  has  been  properly  made,  the  actual  flowing  of  the  solder  on 
a  full  piece  will  take  less  than  a  minute,  and  will  be  so  smooth  as  to  re- 
quire no  other  finish  than  the  Scotch-stone  and  polishing-wheels.  After 
soldering,  the  cover  should  be  placed  upon  the  soldering-pan  (Fig.  255), 
and  the  work  allowed  to  become  quite  cold  before  removal :  when  a 
charcoal  (Fig-  270)  lump  or  pumice-stone  is  used,  the  work  must 
also  be  covered  while  cooling. 

Finishing  Process. — When  the  piece  is  cold,  the  plaster  is  to  be  care- 
fully removed  from  the  teeth  ;  the  piece  is  then  placed  in  a  glass  or 
porcelain  vessel  containing  a  mixture  of  equal  parts  of  sulphuric  acid 
and  water,  and  heat  applied.  As  soon  as  the  borax  (which,  by  the 
process  of  soldering,  has  lost  its  water  of  crystallization  and  assumed 
a  glassy  hardness)  is  decomposed,  the  vessel  is  removed  and  allowed 
slowly  to  cool.  This  process  is  termed,  by  jewellers,  pickling,  and  re- 
quires from  ten  minutes  to  half  an  hour  for  its  completion,  according 
to  the  strength  of  the  acid  and  the  quantity  of  vitrified  borax  on  the 
plate.  After  this  the  acid  is  washed  from  the  piece ;  or  it  is  still  more 
effectually  deprived  of  acid  by  boiling  in  water  containing  a  little 
caustic  soda. 

In  removing  the  roughness  which  may  have  been  occasioned  by 
imperfect  soldering,  care  must  be  taken  not  to  cut  away  too  much  of 
the  plate.  For  this  purpose  scrapers,  files,  and  lathe-burrs  are  used, 
according  to  the  position  and  quantity  of  surplus  solder.  After  the 
work  has  been  made  as  smooth  as  possible  with  scrapers,  etc.,  it  should 
be  rubbed  with  pieces  of  Scotch-stone  and  water  until  every  scratch  is 
removed;  some  use  a  fine,  smooth  cork  attached  to  the  lathe,  and 
charged  with  water  and  powdered  pumice  or  silex.  The  piece  is  then 
polished  with  tripoli,  applied  by  means  of  oil  or  tallow  to  a  brush- 
wheel  (Fig.  271),  which  is  made  to  revolve  rapidly  against  the  work. 
As  to  the  rapidity  with  which  a  lathe  should  be  worked  :  drills  and 
burrs  require  a  slow  movement ;  corundum-wheels  a  quicker  one ; 
rotten-stone  a  rapid  motion  ;  and  whiting,  zinc-white,  or  rouge,  the 
most  rapid  of  all. 


604  ADJUSTMENT    OF    TEETH. 

The  piece  may  now  be  placed  in  a  porcelain  vessel  containing  the 
following  mixture  :  nitre,  two  ounces,  salt  and  alum,  each,  one  ounce  — 
dissolved  in  four  ounces  of  water.  After  boiling  for  half  an  hour  in 
this,  to  decompose  the  copper  from  the  surface  layer  of  the  solder  and 
plate,  it  is  boiled  a  few  minutes  in  a  solution  of  one  ounce  of  caustic 
soda  in  four  ounces  of  water,  to  neutralize  the  acid,  then  washed  with 
a  brush  in  pure  water. 

The  removal  of  the  copper  from  the  surface  of  the  plate  gives  to 
the  gold  the  beautiful  orange  hue,  which  is  its  natural  color,  and  which 
it  will  retain  until  the  friction  of  mastication  wears  off  this  surface. 
The  secretions  of  the  mouth  will  fail  to  tarnish  it;  and  it  will  be  free 
from  the  disagreeable  taste  of  which  so  many  complain,  who  wear 
artificial  teeth  set  on  metallic  plate.  But  when  plate  is  made  from 
coin  without  alloy,  or  is  of  twenty  carats  fineness,  and  the  solder  has 
a  corresponding  quality,  the  pickling  process  may  be  omitted. 

The  process  of  finishing  is  completed  by  polishing  every  part  of 
the  lingual  surface  of  the  plate,  backings,  and  clasps  with  highly- 
tempered  and  finely-polished  steel  burnishers.  They  should  be  fre- 
quently rubbed  on  a  piece  of  wet  Castile  soap,  and  carried  backward 
and  forward  in  the  same  direction  over  the  plate  until  every  part  of 
Fjg  2"1  *^®  So^^  exhibits  a  high  polish.     Burnishers  of 

-'^'^iTpsr-  different  shapes  are  required  for  different  parts 

c^i^^lmi^^^     of  the  work:    bloodstone    burnishers    are   also 

^^^  /^rt^wi  ^^a  -^  piece,  however,  can  be  polished  in  less  time, 
^01  ^  J-  ^S  if  not  more  perfectly,  with  brush-wheels.  (Fig. 
\.  •:    271.)   Brush-wheels  vary  in  diameter,  thickness, 

V  ,      -■"''      and  material.     Bristle-wheels    vary  in  stiffiiess 

■"—""  and  length  of  bristle;  the  stiffer  being  used  for 

tripoli  or  rotten-stone,  the  softer  for  whiting  and  rouge.  Cotton  is  often 
substituted  for  bristles ;  buckskin  or  felt  are  also  much  used  for  wheels 
or  circular  "  laps,"  and  are  especially  useful  in  dressing  up  the  recesses 
of  a  plate.  It  is  of  the  utmost  importance  that  wheels  or  laps,  used  for 
different  polishing  substances,  should  be  kept  entirely  separate:  a 
little  tripoli  or  pumice  powder,  on  a  rouge-wheel,  may  render  useless 
the  work  of  an  hour.  The  brush  should  be  set  on  the  spindle  of  the 
lathe,  then  lightly  smeared  with  suet,  by  holding  a  small  piece  against 
it  while  it  is  revolving.  The  rotten-stone  is  applied  in  the  same 
manner,  and  with  the  brush  thus  charged,  the  polishing  may  com- 
mence; but  the  plate  must  not  be  exposed  too  long  to  the  friction,  as 
it  will  rapidly  wear  away  the  pure  gold  surface  brought  out  by  the 
pickle ;  hence  some  use  only  the  burnisher  or  rouge  after  pickling, 
Tripoli  has  a  sharper  grit,  and  cuts  more  rapidly  than  the  ordinary 


RETENTION    OF    PLATES.  605 

rotten-stone  prepared  for  daguerreotypists'  use ;  but  the  latter  gives  a 
very  smooth  surface,  and  will,  in  most  cases,  give  a  sufficiently  brilliant 
finish  without  rouge.  A  very  high  watch-case  finish  can  only  be  given 
by  very  rapid  revolution  of  wheels  or  buffers,  charged  with  the  finest 
quality  of  rouge,  wet  with  alcohol.  The  piece  must  be  previously 
washed  with  soap  and  water,  so  as  to  remove  every  trace  of  oil. 
Sometimes  rouge  is  applied  on  a  piece  of  soft  buckskin,  wrapped  or 
sewed  around  small  blunt-pointed  pieces  of  cork  or  wood.  The  lingual 
surface  of  the  plate  is  the  only  one  that  should  be  polished.  The  dead 
color  of  the  palatine  surface  throws  out  the  polish  of  the  other  side, 
and  greatly  improves  the  appearance  of  the  piece.  The  adhesion  of 
a  plate  is  frequently  improved  by  roughening  the  plate  with  a  file  or 
by  engraving  lines  upon  it.  The  process  of  finishing  on  a  gold  piece, 
properly  soldered,  is  a  very  simple  matter,  and  one  of  secondary  im- 
portance. A  piece  with  a  Scotch-stone  finish  is  in  eveiy  respect  as 
useful,  and  sesthetically  as  beautiful,  as  the  most  highly-polished  plate. 
There  is,  however,  no  objection  to  this  sort  of  appeal  to  the  eye,  pro- 
vided it  is  not  the  chief  merit  of  the  work. 

There  are  three  methods  adopted  for  the  retention  of  dental  plates, 
and  many  modifications  of  form  required  by  the  various  circumstances  of 
different  mouths.  An  enumeration  of  all  the  required  forms  would  be 
impossible  in  this  work ;  but  we  hope  to  represent  a  sufficient  variety 
to  enable  the  operator  to  decide  which  is  best  for  any  given  case.  We 
think  it  far  more  important,  however,  to  endeavor  to  explain,  as  far  as 
can  be  done,  the  principles  which  determine  these  different  forms  and 
modes  of  retention,  than  to  lay  down  any  set  of  didactic  formulas  for 
unreasoning  adoption. 


CHAPTER  XIII. 


RETENTION    OF    BASE  -  PLATES  —  THEIR    SIZE    AND    FORM    OF 

OUTLINE. 

THE  utility  of  a  piece  depends  largely  upon  the  firmness  with  which 
it  keeps  its  place  during  mastication  or  in  conversation.  The 
means  adopted  to  secure  this  are  threefold  :  The  first  two  retain  the 
plate  by  extrinsic  support ;  the  last  depends  upon  an  intrinsic  quality 
of  the  plate  itself.  1.  Spiral  springs,  by  constant  pressure,  keep  the 
plates  of  a  double  set  in  position.  2.  Clasps,  by  grasping  some  natural 
tooth,  hold  a  partial  piece  firmly  in  place.     3.  The  close  adaptation 


606 


SPIRAL    SPRINGS. 


of  the  plate,  whether  of  a  full  or  partial  set,  causes  it  to  adhere  with  a 
lorce  which  is  lessened,  first,  by  the  amount  of  air  between  the  sur- 
faces ;  secondly,  by  the  liability  to 
displacement.  These  modes  of  reten- 
tion will  be  considered  in  the  order 
named. 

Spiral  springs,  formerly  very  much 
used,  are  now  seldom  employed : 
they  are  applied  only  to  double 
dentures.  Fig.  272  gives  a  correct 
idea  of  the  position  of  the  springs, 
their  points  of  attachment,  length, 
and  direction  of  curvature.  Fig.  273 
represents  the  detached  portions  of  the  spring,  consisting  of  standards, 
screws,  tangs,  and  spiral  coil.     The  tendency  of  the  curved  spring  to 

Fig.  273. 


straighten,  presses  each  plate  upon  the  alveolus,  acting  at  the  points  of 
attachment  of  the  standards.  These  points  are  chosen,  first,  in  the  upper 
jaw,  as  nearly  as  possible  on  the  line  of  equipoise,  which  will  be  some- 
Avhere  between  the  centres  of  the  second  bicuspid  and  of  the  first  molar ; 
secondly,  in  the  lower  jaw,  where  a  vertical  line  from  the  upper  standard 
meets  it.  Perforated  bicuspids  and  molars  are  sold,  adapted  to  such 
cases ;  and  the  usual  plan  is  to  attach  the  standards  before  soldering 
the  teeth.  A  more  accurate  method  is  to  determine  the  position  of  the 
standards  after  the  pieces  are  finished.  The  presence  of  the  teeth  makes 
soldering  of  the  standards  more  troublesome,  but  not  impossible:  they 
may  also  be  riveted  to  the  outer  rim  of  the  plate.  With  the  diamond 
drill,  holes  can  be  made  through  the  teeth,  or  blocks,  opposite  each 
standard. 

Directions  for  making  the  coil  have  already  been  given  :  they  are 
usually  purchased  ready  made.  Their  length  must  be  such  that  the 
curve  will  not  irritate  the  ascending  ramus  of  the  lower  jaw.  If  too 
stiff",  their  forcible  pressure  will  irritate  the  gum  ;  if  too  slight,  they 
■will  fail  to  keep  up  the  piece.  The  tangs  are  held  in  the  coil  by  close- 
ness of  fit ;  when  loose,  they  may  be  tightened  by  floss  silk.  The 
screws,  represented  in  the  figure,  are  troublesome  to  make,  and  are  very 


CLASPS.  607 

apt  to  loosen.  A  better  plan  is,  to  pass  a  headed  pin  through  standard, 
tang,  and  tooth,  and  rivet  or  solder  it  in  the  backing.  This  plan 
makes  the  tang  permanent ;  the  pieces  are  separated  by  detaching  the 
upper  or  lower  tangs  from  the  coils.  It  adds  greatly  to  the  strength 
of  the  pin  to  pass  it  through  the  tooth  or  block.  There  should  also  be 
a  shoulder  on  the  standards,  to  limit  the  movement  of  the  tang  ;  else 
the  springs,  by  too  great  upward  or  downward  motion,  may  irritate  the 
mouth.  It  is  unnecessary,  in  view  of  the  present  limited  use  of  springs, 
to  describe  other  and  very  ingenious  methods  of  attaching  them. 

Their  use  is  now  confined,  first,  to  very  flatly-arched  upper  jaws, 
usually  small,  covered  with  hard  membrane,  and  having  the  attach- 
ment of  the  facial  muscles  close  to,  or  quite  upon,  the  ridge ;  also  to 
lower  cases,  where  all  trace  of  the  ridge  is  gone.  Secondly,  to  pieces 
inserted  so  soon  after  extraction  that  the  rapid  absorption  will  quickly 
destroy  the  adaptation.  We  shall  speak  elsewhere  of  other  means 
adopted  to  meet  these  exigencies ;  in  failure  of  which,  spiral  springs 
are  to  be  used.  But  they  are  troublesome  to  make,  annoying  to  wear, 
difiicult  to  keep  clean,  and  liable  to  accident ;  hence  we  only  use  them 
as  a  last  resort.  In  conclusion,  it  should  be  noticed  that  the  upper 
plate  of  spiral-spring  pieces  does  not  cover  the  palate,  but  is  shaped 
more  like  the  lower  piece.  This  is  one  of  its  compensating  advantages  ; 
for  it  is  an  objection  to  the  otherwise  valuable  principle  of  atmospheric 
pressure  that  it  covers  so  large  a  portion  of  the  mucous  surface. 

CLASPS. 

This  method  of  retention,  necessarily  applicable  only  to  partial  pieces, 
has  fallen  into  much  disfavor,  and  given  place  to  methods,  in  lieu 
thereof,  which  are  really  more  objectionable.  But,  like  many  other 
time-honored  practices  which  modern  dentistry  has  thrown  in  its  waste- 
basket,  there  are  very  decided  advantages  in  this  mode  of  retention, 
which  make  it,  in  certain  cases,  the  best  possible  one.  The  disuse  of 
clasps  has  grown  out  of,  first,  their  injurious  effects,  due  to  improper 
construction  and  injudicious  application ;  secondly,  the  difiiculties  of 
making  a  clasp -piece.  We  venture  the  assertion,  that  one-half  the 
dentists  do  not  really  know  how  to  make  a  perfectly  adapted  clasp- 
piece  ;  and  that,  of  the  remaining  half,  two-thirds  will  not  take  the 
trouble.  The  tediousness  of  clasp  adjustment  is  out  of  place  in  that 
rapidity  of  manipulation  demanded  by  the  cheapness  of  modern  den- 
tistry. Nor  can  we  expect  to  see  the  easily  made,  but  inefiectual, 
vacuum  cavity  give  place,  in  turn,  to  the  clasp  attachment,  which  it  has 
to  such  an  extent  superseded,  until  the  profession  becomes  awakened  to 
the  necessity  of  substituting  good  work  for  fast  work  —  economical 
high-priced  work  for  expensive  low-priced  work ;  until  the  mechanician 


608  CLASPS. 

so  far  respects  himself  as  to  value  his  labor  more  than  the  cost  of  his 
materials,  and  ceases  to  use  certain  substances  because  they  are  cheap, 
rather  than  others  because  they  are  better. 

Next  to  pivoting,  the  clasp  is  the  most  secure  of  all  methods  of 
attaching  artificial  teeth  in  partial  cases.  But  it  is  not  universally  ap- 
plicable for  reasons  hereafter  stated.  In  deciding  upon  the  propriety 
of  using  clasps,  the  remaining  teeth  must  be  carefully  examined,  to 
determine  whether,  in  shape,  position,  texture,  and  relation  to  other 
teeth  and  to  the  proposed  plates,  there  are  any  which  admit  of  being 
clasped.  If  there  are  such  teeth,  a  perfect  impression  of  them  is 
necessary;  then  greatest  accuracy  in  fitting  the  clasp;  lastly,  a  most 
exact  adjustment  of  this  to  the  plate,  to  which  it  is  to  be  fastened  with 
great  care.  Scrupulous  observance  of  these  points,  in  connection  with 
a  properly  fitted  and  shaped  plate,  will  take  from  clasp  work  the  force 
of  the  objections  urged  against  it. 

In  the  selection  of  teeth  to  be  clasped,  the  points  for  consideration 
are:  1.  Their  condition  :  never  clasp  loose  teeth,  or  those  where  there 
is  much  alveolar  absorption ;  or,  if  possible  to  avoid  it,  those  which 
have  filed  surfaces.  2.  Their  shape :  avoid  all  conical  teeth,  such  as 
third  molars  and  canines;  also  teeth  considerably  larger  at  the  grind- 
ing surface  than  at  the  gum.  The  proper  shape  for  clasping  is  the 
cylinder,  or  rounded  prism ;  and  only  so  much,  or  such  part,  of  any 
tooth  should  be  clasped  as  has  this  shape.  Hence  it  is  that  thick 
narrow  clasps  are  best,  because  few  teeth  have  much  breadth  of  cylin- 
drical shape.  3.  Their  position  :  incisors,  canines,  and  third  molars 
must  be  rejected  for  this  reason ;  and  second  molars  are  unfit,  if  the 
plate  holds  incisor  teeth.  The  incisors  and  cuspids  are,  of  all  the 
teeth,  least  suited  for  the  attachment  of  a  clasp.  It  is  exceedingly 
difficult  to  ap]dy  clasps  to  these  teeth  in  such  a  manner  as  to  retain 
even  a  single  tooth  with  sufficient  stability  to  be  worn  with  any  degree 
of  comfort.  We  remember  once  to  have  seen  a  case  in  which  a  central 
incisor  (natural  tooth)  was  inserted  and  kept  in  place  by  a  gold  wire 
projecting  from  each  side  of  the  tooth  into  holes  drilled  into  the  adjoin- 
ing teeth.  A  stage  of  dental  progress  that  permitted  such  a  process, 
might  also  have  allowed  the  clasping  of  incisors ;  but  we  know  of  no 
possible  circumstances  that  will  justify,  in  the  present  state  of  dental 
art,  the  clasping  of  any  of  the  six  front  teeth.  No  lower  teeth  should  be 
clasped  ;  but  in  some  cases  a  stay  (half-clasp)  may  be  used.  The  best 
teeth,  in  respect  of  position,  are  the  second  bicuspids;  next,  the  first 
molars;  thirdly,  the  first  bicuspids;  and,  lastly,  the  second  molars. 
These  eight  teeth  are  the  only  ones  that  should  ever  be  clasped ;  and, 
if  possible,  the  choice  should  be  confined  to  the  first  four.  4.  Their 
relation  to  the  plate  and  to  the  other  teeth.     Let  the  clasped  tooth  be 


CLASPS.  609 

as  near  the  line  of  equipoise  as  is  consistent  with  other  considerations. 
For  incisors  alone  we  should,  for  this  reason,  give  preference  to  the 
first  over  the  second  bicuspids ;  and,  in  case  of  the  loss  of  the  ten  or 
twelve  anterior  teeth,  we  should  use  no  clasp  on  the  remaining  molars. 
Teeth  not  decayed  should  never  be  separated  from  others,  with  which 
they  are  in  contact,  for  the  purpose  of  jjassing  a  clasp.  If  no  other 
tooth  can  be  found,  a  stay  (half-clasp)  must  suffice. 

Observance  of  the  conditions  above  enumerated  restrict  very  much 
the  range  of  cases  that  admit  of  clasps.  In  the  matter  of  position 
and  relation  to  the  plate,  circumstances  may  compel  a  choice  not  the 
most  favorable  to  success  ;  but,  in  other  respects,  it  is  far  better  to  dis- 
pense with  clasps  than  to  apply  them  so  as  to  incur  risk  of  failure  or 
injury  to  good  teeth. 

The  liability  of  the  tooth  to  decay,  around  which  a  clasp  is  applied, 
is  always  greatly  increased  by  the  removal  of  any  portion  of  its  enamel. 
The  application  of  clasps  to  diseased  or  loose  teeth  always  aggra- 
vates the  morbid  condition  of  the  parts,  and  causes  the  substitute, 
which  they  keep  in  place,  to  become  a  source  of  annoyance  to  the 
patient.  Besides,  such  teeth  can  be  retained  in  the  mouth  only  for  a 
short  time,  and  when  they  give  way,  the  artificial  appliance  becomes 
comparatively  or  entirely  useless ;  and  even  before  their  loss,  it  is  not 
held  firmly  in  its  place.  Its  instability  exposes  its  presence  to  the 
observation  of  the  most  careless  observer,  and  this  motion  is  injurious 
to  all  the  teeth  near  or  against  which  the  piece  comes.  In  the  lower 
jaw,  parts  of  sets  are  much  less  frequently  called  for  than  in  the  upper, 
and  when  they  are,  the  use  of  clasps  may  be  dispensed  with  alto- 
gether. A  clasp  can  seldom  be  applied  advantageously  to  a  lower 
molar.  The  lower  front  teeth  are  least  liable  to  decay  of  any  in  the 
mouth,  and  therefore  do  not  require  replacement,  except  in  full  sets, 
unless  lost  by  a  blow  or  by  the  destructive  action  of  salivary  calculus. 
A  partial  lower  front  piece  calls  for  half-clasps  or  stays ;  but  other 
partial  lower  pieces  (replacing  bicuspids  and  molars)  should  not  depend 
for  their  stability  upon  any  remaining  bicuspid  or  cuspid. 

If  the  injurious  effects  liable  to  result  from  the  apj^lication  of  clasps- 
to  teeth,  selected  according  to  the  rules  given,  could  not  in  any  way- 
be  counteracted,  dental  substitutes  retained  in  the  mouth  by  this  means 
would,  in  the  majority  of  cases,  be  productive  of  more  injury  than 
benefit ;  but  they  may  be  in  great  measure  prevented.  They  are  not 
caused,  as  many  have  erroneously  supposed,  solely  by  the  mechanical 
action  of  the  clasps  upon  the  teeth,  but  also  by  the  chemical  action 
of  the  secretions  of  the  mouth  and  decomposing  particles  of  food.  The 
method  of  measurably  preventing  these  deleterious  effects  is  twofold  : 
First,  to  prevent  the  chemical  action,  the  removal  of  the  artificial: 
39 


610  CLASPS. 

teeth,  and  thorough  cleansing  of  thera  and  the  natural  organs ;  this 
should  be  done  every  night  and  morning,  and  the  teeth  rubbed  with  a 
brush  and  waxed  floss  silk  until  every  particle  of  clammy,  vitiated 
mucus  and  foreign  matter  is  removed.  Tiie  inner  surface  of  the  clasps 
should  be  freed  from  all  impurities,  and  the  whole  piece  cleansed  with 
a  brush  and  water.  Secondly,  to  prevent  or  lessen  the  mechanical 
action,  the  clasp  should,  as  before  remarked,  fit  with  great  accuracy 
the  parts  of  the  tooth  protected  with  hard  enamel ;  the  whole  piece 
should  have  such  closeness  of  adaptation  as  to  prevent  motion  of  the 
clasp  upon  the  tooth.  We  have  elsewhere  spoken  of  other  injurious 
consequences  of  clasps  placed  too  near  the  gums  or  exposed  necks. 
Rapid  decay  and  breaking  off  of  the  teeth,  inflammation  of  the  gums, 
of  the  alveolo-dental  periosteum,  destruction  of  the  alveoli,  and  loosen- 
ing of  the  teeth,  are  among  the  common  results  of  the  clasping  of  teeth 
as  it  is  too  often  practised.  Consequences  such  as  these  have  led  many 
to  an  unqualified  condenmation  of  this  method ;  yet,  as  we  have  said, 
when  suitable  teeth  are  selected  for  clasping,  and  the  work  is  properly 
executed,  it  is  the  best  and  most  durable  way  in  which  a  partial  piece 
can  be  secured. 

Shapwg  and  Adjusting  Clasps.  —  The  gold  employed  for  clasps 
should  be  about  one-third  or  one-half  thicker  than  the  plate,  and  as 
wide  as  the  cylindrical  portion  of  the  crowns  of  the  teeth  to  be  fitted. 
Some  clasps  are  best  made  of  half-round  wire,  and  narrow  ;  others  may 
be  broader  and  thinner :  thick  narrow  clasps  are  more  universally 
applicable.  In  quality,  it  is  better  that  clasp  and  plate  be  the  same ; 
except  when  the  plate  is  of  pure  coin.  In  this  case,  add  copper  (but 
no  silver),  to  give  elasticity.  Platina,  often  used  for  this  purpose, 
imparts  too  much  brittleness,  after  the  piece  has  been  worn  for  some 
time.  Some  may  fit  the  tooth  close  to  the  gum ;  but  in  other  cases, 
the  shape  of  the  tooth,  absorption  of  the  alveolus,  or  morbid  sensitive- 
ness of  the  neck,  forbid  this.  Enamel  surfaces  best  resist  the  wearing 
action  of  clasps ;  dentine,  exposed  by  the  file  or  chisel,  is  more  liable 
to  abrasion  or  decay ;  cemeutum  should  in  no  case  be  brought  in  con- 
tact with  clasp  or  plate.  If  the  clasps  chafe  against  sensitive  parts, 
inflammation  of  the  alveolo-dental  membrane  may  be  set  up,  followed 
by  wasting  of  their  sockets,  and  ultimate  loss  of  the  teeth. 

With  the  plate  in  position  in  the  mouth,  a  wax  impression  may  be 
taken  ;  the  plate,  adhering  to  it,  on  being  withdrawn,  will  have  a  cor- 
rect relation  to  the  teeth  which  are  to  be  clasped.  Others  adopt  the 
less  accurate  method  of  adjusting  the  plate  to  the  original  j^laster 
model.  But  as,  for  reasons  before  given,  it  is  advisable  to  cut  off"  the 
teeth  from  the  model  used  in  moulding,  a  second  model  is  necessary, 
and  usually  for  this  purpose  a  second  impression.     Moreover,  if  the 


CLASPS. 


611 


mouth  has  marked  irregularities,  or  rugae,  and  the  plate  covers  much 
surface,  it  cannot  be  fitted  upon  a  plaster  model  so  as  to  hold  the  same 
precise  relation  to  the  teeth  as  when  in  the  mouth. 

When  accurately  fitted,  they  may  be  at  once  soldered  on  the  model, 
or  may  be  attached  to  the  plate  by  means  of  a  small  piece  of  wax  or 
cement  composed  of  one  part  wax  and  two  of  resin ;  this  should  be 
softened,  and  applied  to  the  plate  and  to  the  inner  side  of  each  clasp. 
The  plate  and  clasps  thus  united  are  carefully  removed  from  the  plas- 
ter model,  and  laid  with  the  convex  side  downward  on  a  piece  of  paper. 
Plaster  is  then  poured  on  the  upper  side  of  the  plate,  covering  it  and 
the  clasps  to  the  thickness  of  half  an  inch.  After  this  has  set,  the 
piece  may  be  taken  from  the  paper,  placed  on  charcoal,  the  wax  being 
softened  and  removed,  and  prepared  for  soldering. 

This  is  the  simplest  way  of  fitting  clasps  to  the  plate  and  preparing 
the  piece  for  soldering ;  but  when  the  clasp-teeth  deviate  from  a  verti- 
cal position,  or  when  the  teeth  are  of  such  a  shape  that  tlie  wax  im- 
pression does  not  copy  them  accurately,  this  method  is,  in  such  cases, 
not  reliable.  The  clasps  must  be  fitted  to  the  teeth  in  the  mouth, 
instead  of  on  the  plaster  model,  and  may  then  be  attached  to  the  plate 
as  just  directed.  Often  only  one  can  be  attached  at  a  time,  and  after 
this  has  been  soldered,  the  piece  is  replaced  in  the  mouth,  and 
the  other  made  fast  to  the  plate.  The  greatest  care  is  necessary  to 
prevent  altering  the  position  of  the  clasp  in  taking  the  piece  from  the 
mouth. 

The  following  is  Dr.  Fogle's  method  for  securing  accurate  adaptation 
of  the  clasps.  They  are  first  fitted  to  the  plaster  model,  leaving  the 
ends  straight.  A  narrow  strip  of  plate,  about  five-eighths  of  an  inch 
in  length,  is  used  as  a  temporary  fastening,  one  end  of  which  is  sol- 
dered to  the  lingual  surface  of  the  clasp ;  the  plate  and  clasp  are  now 
both  placed  on  the  model,  (made  from  impression  taken  while  the  plate 


Fig.  274. 


612  CLASPS. 

is  in  the  mouth,)  and  the  other  end  fitted  and  sohlered  to  the  plate, 
forming  a  sort  of  semicircle  or  bow.  Fig.  274  represents  the  plate, 
clasps,  and  temporary  fastenings  on  the  plaster  model.  In  Fig.  275, 
they  are  seen  separate  from  the  model. 

The  clasps  are  now  adjusted  to  the  model :  however  accurately  this 
is  done,  it  will  be  found,  on  applying  the  plate  to  the  mouth,  that  they 
will  not  fit  the  teeth  there.  After  properly  adjusting  them,  the  tem- 
porary fastenings  Avill  be  found  sufficient  to  hold  the  clasps  in  their 
exact  position  while  the  piece  is  being  removed.  This  done,  it  may  be 
invested  in  plaster,  placed  on  charcoal,  and  the  other  steps  connected 
with  the  process  of  permanent  soldering  gone  through  with;  detach- 
ing the  temporary  fastenings  when  the  plaster  has  fixed  the  clasps  in 
position. 

Dr.  Cushman  advises,  in  very  difficult  cases  of  adjustment,  as  where 
the  clasp-teeth  are  much  inclined,  and  where  you  have  to  fasten  to  sec- 
ond molars,  a  slight  modification  of  this  plan.  After  soldering  one 
end  of  the  strip  to  the  clasp,  and  having  bent  the  other  to  touch  the 
plate  when  on  the  model,  put  both  in  their  proper  place  in  the  mouth  ; 
then,  with  a  sharp-pointed  instrument,  indicate  the  point  where  the  bow 
touches  the  plate  ;  place  them  on  the  model  again  ;  adjust  the  end  of  the 
bow  to  the  point  marked  ;  confine  it  there,  and  solder  fast.  Dr.  Cush- 
man considers  Dr.  Fogle's  method  of  adjusting  clasps  so  valuable  that 
he  never  ventures  to  set  clasps  permanently,  even  in  the  simplest  case, 
upon  the  original  model,  with  the  plaster  teeth  as  the  only  guide  for 
position. 

Dr.  Lester  Noble's  method  is  as  follows:  Place  the  plate  in  the 
mouth,  and  let  the  clasp  bind  ujDon  the  tooth  with  only  sufficient  firm- 
ness to  keep  it  in  its  proper  place.  Then  mix  a  small  quantity  of  plas- 
ter from  a  lot  which,  by  previous  trial,  you  find  requires  four  or  five 
minutes  to  set ;  put  it  upon  a  piece  of  paper  or  sheet  lead  about  an  inch 
square,  and,  just  before  it  begins  to  harden,  introduce  it  into  the  mouth 
upon  the  forefinger,  pressing  it  into  gentle  contact  with  a  portion  of 
the  plate  and  about  one-half  of  the  clasp.  It  must  be  held  there  for 
three  or  four  minutes,  until  it  is  sufficiently  hard  to  break  with  a  shai'p 
fracture ;  this  point  you  can  determine  by  examining  the  plaster  left 
in  your  bowl.  The  plaster  must  then  be  withdrawn.  Sometimes  plate, 
clasp,  and  plaster  will  be  brought  away  together ;  or  the  plaster  and 
clasp  together  leaving  the  plate ;  or  the  plaster  will  separate,  leaving 
both  clasp  and  plate  in  the  mouth.  Should  the  plaster  by  any  acci- 
dent break,  it  can  readily  be  united  at  the  point  of  the  fracture,  with- 
out in  the  least  altering  its  shape — one  great  advantage  over  wax.  If 
the  plaster  adheres  to  the  plate  on  Avithdrawal  from  the  mouth,  it  must 
then  be  carefully  detached,  the  plate  replaced,  and  the  same  process 


CLASPS. 


613 


repeated  for  the  second  clasp;   or  possibly  the  impressions  for  both 
clasps  can  be  taken  at  once. 

Several  precautions  are  necessary.  If  the  clasp  bind  too  tightly 
around  the  tooth,  its  ends  will,  when  removed,  spring  together  ;  and 
thus  it  will  not  exactly  fill  the  original  impression  made  in  the  plaster. 
If  the  part  of  the  clasp  which  you  design  to  cover  with  plaster  be  so 
regular  in  shape  as  to  make  its  adjustment,  when  out  of  the  mouth, 
uncertain,  mark  it  with  a  file  or  by  a  small  point  of  solder ;  this  will 
be  copied  in  the  plaster,  and  remove  all  doubt  as  to  its  definite  posi- 
tion. If  the  plaster  be  extended  over  some  part  of  the  edge  of  the 
plate,  it  will,  in  the  absence  of  any  marked  irregularities  of  surface, 
give  a  better  guide  for  its  readaptation.  Lastly,  if  the  plaster  cover 
too  much  of  the  clasp-tooth,  it  will  be  more  liable  to  break  on  being 
withdrawn. 

Take  now  the  clasps,  place  them  each  in  their  separate  impressions 
in  the  pieces  of  plaster,  securing  them  if  necessary  by  a  small  piece  of 
softened  wax.  Place  one  end  of  your  plate  in  its  corresponding  bed 
in  one  of  the  plaster  pieces.  If  proper  care  has  been  used,  both  clasp 
and  plate  will  fit  into  the  plaster  with  unerring  accuracy,  and  of  course 
hold  the  precise  relation  as  when  in  the  mouth.  While  in  this  position, 
cover  the  clasp  and  the  under  surface  of  the  plate  with  fresh  plaster, 
or  plaster  and  sand;  when  this  has  hardened,  remove  the  first  plaster, 
just  as  in  other  cases  you  would  remove  the  wax,  preparatory  to  sol- 
dering. 

The  methods  of  Drs.  Fogle  and  Noble  may  be  thought  too  tedious 
for  cases  where  the  shape  and  position  of  the  teeth  are  such  that  a  wax 
impression  will  accurately  copy  them ;  but  in  the  great  majority  of 
cases  it  will  be  found  essential,  to  accurate  adjustment,  to  resort  to  one 
vr  other  of  them. 

If  the  clasp  stands  ofiT  from  the  tooth  on  its  coronal  edge,  the  food 
is  apt  to  pack  into  the  wedge-shaped  space  and  loosen  it,  or  even 
change  its  shape ;  if  on  the  edge  near  the  gum,  it  gives  lodgment  to 
the  food  and  mucous  secretions,  to  the  injury  of  the  tooth.  Dr.  Spald- 
ing recommends,  as  a  preventive  against  such  lodgment,  to  use  in  all 
cases  thick  narrow  clasps ;  to  attach 
them  by  two  or  more  standards  (Fig. 
276),  if  the  clasp  is  long;  to  put  them 
well  up  on  long  teeth,  and  on  short 
teeth,  to  cut  away  the  plate.  In  this 
way  most  of  the  neck  is  exposed  to 
the  cleansing  action  of  the  tongue. 

The  close  adaptation  of  the  clasp 
to  the  surface  of  the  tooth  is  too 


Fig.  276. 


614  CLASPS. 

often  neglected.  It  is  commonly  done  with  round  pliers,  making  trial 
from  time  to  time  upon  the  tooth  of  the  model.  This  is  an  uncertain 
method  in  any  case,  and  in  many  utterly  worthless.  Prof.  Austen 
advises  always  to  take  a  separate  plaster  impression  of  the  teeth  to 
be  clasped  ;  for  which  purpose  a  small  cup  of  wax,  lead,  or  tin  foil  is 
used,  one-eighth  inch  larger  than  the  tooth.  Let  the  plaster  get  quite 
hard;  then  slightly  open  the  impression;  withdraw  it,  and  close  up  the 
fissure.  Make  from  this  either  a  plaster  or  a. fusible-metal  tooth;  if 
the  former,  harden  it  with  soluble  glass.  With  round  pliers  and  a 
hammer,  clasps  can  be  fitted  with  great  exactness  to  such  a  metallic 
tooth.  Extreme  accuracy  of  fit  may  most  easily  be  obtained  when 
the  contour  of  the  tooth  is  irregular,  by  the  following  method:  burnish 
down  to  the  tooth  a  strip  of  very  thin  platina ;  then  on  the  outside  of 
this  strip  lay  pieces  of  gold  (of  the  fineness  suitable  for  clasps),  with 
borax,  and  flow  them  with  the  blow-pipe. 

A  common  error  in  soldering  clasps  is  to  make  their  union  to  the 
plates  too  wide.  Clasps  are  often  called  springs,  but  if  soldered 
through  nearly  their  whole  length,  they  become  rigid  stays,  devoid  of 
elasticity.  There  should  always  be  a  proportion  between  the  size  of 
the  clasp  and  the  width  of  its  attachment ;  in  no  case  should  it  exceed 
three-sixteenths  of  an  inch,  and  one-eighth  inch  is  ample  for  most 
eases.  When  practicable,  the  two  arms  of  a  clasp  should  be  of  equal 
length  ;  but  in  short  clasps  it  is  sometimes  preferable  to  throw  all  the 
elasticity  into  a  single  arm.  A  single  attachment  is  better  than  two, 
as  it  gives  more  play  to  the  arms  of  the  clasp  in  the  slight  unavoid- 
able motions  of  the  plate.  Again,  in  shaping  the  plate,  cut  it  well  off 
from  the  tooth,  allowing  a  tapering  tongue  to,extend  up  to  the  clasp, 
for  its  attachment.  In  clasp-pieces  and  in  all  partial  pieces,  remember 
that  the  plate  should  come  in  contact  with  teeth  it  approaches,  or  else 
stand  as  far  off  as  the  case  will  permit ;  the  narrow  band  of  gum,  .so 
often  left  between  plate  and  teeth,  is  liable  to  irritation  by  compression 
between  the  two;  this  is  productive  of  more  annoyance  and  injury 
than  the  direct  contact  of  the  plate  against  the  tooth. 

Partial  Clasps  or  Stays.  —  These  differ  from  clasps  in  the  absence  of 
elastic  arms  grasping  the  tooth.  Taking  a  short,  rounded  prism  (tri- 
angular in  case  of  bicuspids,  in  molars,  quadrangular)  as  the  "type"  of 
a  clasped  tooth,  the  clasp  proper  must  grasp  a  side  and  two  angles  or 
two  sides  and  three  angles.  If  it  lies  against  two  sides  and  one  angle, 
or  if  two  opposite  sides  are  so  inclined  (in  the  line  of  the  clasp)  that 
it  will  not  take  hold,  then  it  becomes  merely  a  stay. 

Stays  demand  for  serviceable  action  a  point  d'appui ;  hence  they 
must  be  in  pairs  — lying  either  against  the  two  teeth  bounding  an  in- 
terdental space,  or  against  teeth  on  opposite  sides  of  the  mouth.    They 


CLASPS.  615 

have  great  value  in  all  partial  cases  where  there  are  no  isolated  teeth 
suitable  for  clasps.  Their  function  is  to  give  stability  to  the  plate  by 
preventing  lateral  motion.  When  the  bicuspids  or  molars  have  inclined 
or  bulging  inner  surfaces,  the  stays  hold  the  piece  after  the  manner 
of  a  clasp ;  the  elastic  force  being  given  by  the  plate.  This  result 
can  only  be  obtained,  however,  by  a  very  carefully  taken  plaster  im- 
pression when  a  vulcanite  plate  is  made ;  or,  in  case  of  gold  plate,  by 
getting  the  exact  relation  of  the  'parts  by  Dr.  jSToble's  method.  It  is 
a  mistake  to  attempt  forcible  retention  of  a  plate  by  the  lateral  thrust 
of  stays;  any  such  pressure  causes  the  teeth  to  yield,  and  then  the  stays 
can  only  act  as  in  the  cases  first  given. 

It  will  be  observed  that,  when  the  stay  on  each  side  is  double,  as  in 
Fig.  277,  it  not  only  prevents 
lateral  motion,  but  the  points 
between  the  teeth  prevent  back- 
ward motion.  The  stability  given 
in  this  manner  by  stays,  taken 
with  an  exact  adaptation  of  the 
plate,  is  far  more  trustworthy 
than  that  given  by  any  form  of 
vacuum  cavity. 

In  connection  with  clasps,  we  shall  briefly  notice  two  methods  occa- 
sionally practised  for  the  retention  of  plates.  First,  by  the  pressure 
of  wood  against  the  tooth.  This  method  was  formerly  much  used, 
when  human  or  ivory  teeth  were  set  on  bone.  Stays  were  carved  in 
bone  (see  Fig.  277)  ;  or  metallic  stays,  or  clasps,  were  riveted,  or 
grooves  and  cavities  were  cut,  holding  slips  of  some  hard  wood  which 
pressed  against  the  teeth.  This  method  was  applied  by  Dr.  Stokes  to 
metallic  plates  —  soldering  gold  tubes  to  the  plate  near  the  teeth,  so 
that  the  end  of  the  inserted  wooden  pivot,  slightly  projecting,  pressed 
on  each  side  of  the  tooth  selected. 

Secondly,  by  drilling  into  one  or  two  sound  roots  of  incisors,  canines, 
or  bicuspids,  a  short  canal,  and  lining  it  with  a  gold  tube.  Correspond- 
ing pins,  soldered  to  the  plate,  keep  it  in  place  much  as  stays  do  ;  if  the 
roots  permit  deep  canals,  they  may  retain  it  with  considerable  force. 
Such  a  pin  may  be  used  in  combination  with  a  clasp  or  stay.  Directions 
given  in  chapter  on  pivot  teeth  easily  explain  how  to  prepare  and 
attach  such  pins.  In  some  cases  it  may  be  desirable  to  use  such  a  pin 
in  place  of  clasp  or  stay ;  but  the  plate  must  cover  enough  mucous 
surface  to  give  stability.  We  question  the  propriety  of  subjecting  the 
roots  of  two  incisors  to  the  strain  of  five  or  six  teeth  on  a  plate  of 
this  kind. 

Size  and  Outline  Form  of  Special  Cases. — It  is  impossible  to  enumerate 


616 


FORM    OF    CLASP-PIECES. 


all  varieties  of  clasp-pieees,  nor  could  we  delineate  under  each  variety 
any  one  form  as  absolutely  best  for  all  its  sub-varieties.  The  more 
philosophical  course  is  to  find,  if  possible,  what  principles,  mechanical 
and  physiological,  determine  the  best  form  in  any  c^se,  and  to  illus- 
trate, by  a  few  examples,  the  application  of  these  principles. 

Upper  Incisors.  —  The  plate  must  not  cover  the  front  of  the  alveolus, 
so  that,  on  front  or  side  views  of  the  mouth,  its  presence  can  be  de- 
tected. This  rule  applies  also  to  canines  and  front  edges  of  bicuspids. 
The  model  at  these  points  should  be  scraped  so  that  the  corresponding 
die  shall  give  a  shape  which  will  sink  into  the  gum.  The  plate  must 
also  be  filed  to  a  thin  edge  before  grinding  the  tooth.  With  these 
precautions,  a  tooth  or  block  may  have  the  support  of  the  plate  under 
the  centre  of  its  base.  Otherwise,  it  becomes  necessary  to  cut  the 
plate  along  the  line  of  the  backings ;  and  this  is,  in  some  cases,  the 
best  plan.  Incisor  teeth,  if  firmly  bedded  in  the  gum,  may  trust  for 
stability  to  their  hold  in  the  standards,  provided  they  have  been  pro- 
perly fitted  and  soldered. 

The  size  and  shape  of  plate  between  teeth  and  clasps  will  depend 
upon  the  number  of  incisors,  position  of.  clasps,  presence  or  absence  of 
other  teeth,  and  upon  peculiarities  of  the  mouth  or  of  the  patient.  For 
the  application  of  the  principles  already  given,  to  these  several  condi- 
tions, we  shall  select  a  few  particular  cases. 

One  Incisor. — A  central  or  lateral  may  be  clasped  to  a  first  molar 

on  the  same  side  by  a  plate  clasped, 
as  in  Fig.  278,  fitting  closely  against 
the  intervening  teeth,  or  by  a  plate, 
as  in  Fig.  279.  When  three  or  more 
natural  teeth  intervene  between  the 
clasp  and  artificial  teeth,  the  latter 
form  is  preferable,  because  there  is 
no  possibility  of  irritating  the  teeth 
by  the  plate  or  by  mucous  deposits. 
It  will  be  noticed  that  the  curve  of 
the  plate  is  opposite  that  of  the  den- 
tal arch,  thus  giving  proximity  to  the 
teeth  only  where  it  is  unavoidable.  A  lateral  incisor,  cuspid,  or  bicus- 
pid may  be  applied  in  the  same  way ;  and  if  the  second  bicuspid  or 
first  molar  is  unfit,  from  its  shape  or  from  decay,  to  be  clasped,  the 
plate  may  be  extended  to  the  second  molar,  or  it  may  be  even  carried 
across  the  mouth,  and  clasped  to  a  plate  on  the  opposite  side;  but  these 
modifications  are  suggested  only  in  cases  of  necessity.  Such  plates 
may  be  made  very  narrow,  if  strength  is  given  by  increased  thickness; 
but   too  narrow  plates   are  open   to   the   objection  of  allowing  the 


Fig.  27 


FORM    OF    CLASP-PIECES. 


617 


Fig.  279. 


attached  tooth  to  bed  itself  too  deeply  under  the  pressure  of  mastica- 
tion. When  the  form  in  Fig.  278  is  adopted,  it  is  usual  to  direct 
soldering  a  wire  or  band  along  the  festooned  edge, 
to  give  strength.  A  much  better  plan  is  to  gain 
strength  by  thickness  of  plate,  and  to  chamfer  the 
plate  along  this  edge.  The  thin  edge  protects  the 
gum  equally  well,  does  not  wear  the  teeth  more 
than  the  thick  one,  and  has  the  decided  advan- 
tage of  giving  no  space  for  lodgment  of  food. 

This  plate  will  permit  attachment  of  clasp  to  the 
molar  or  to  either  of  the  bicuspids,  accordingly  as 
one  or  other  of  these  may  be  best  for  clasping. 
Decision  in  this  case  is  based  on  principles  w^hich  apply  to  many 
other  cases.  'Supposing  the  three  teeth  well  shaped  and  sound, 
the  molar  is  firmly  implanted  by  its  trifid  root,  and  permits  com- 
plete encircling  with  the  clasp ;  but  it  is  farther  from  the  incisor ; 
hence  there  is  more  strain  upon  tooth  and  clasp.  With  the  clasp  to 
the  second  bicuspid,  the  plate  having  the  same  length  as  before,  we 
have  the  best  possible  application  of  its  retentive  power ;  it  cannot, 
however,  pass  around  the  outside  or  front  angle  of  either  bicuspid, 
consequently  the  clasp  does  not  have  so  firm  a  hold  on  the  tooth.  The 
same  remarks  apply  with  even  more  force  to  the  first  bicuspid.  There 
will  usually  be  some  modifying  circumstances  to  determine,  in  this 
class  of  cases,  choice  of  the  clasp-tooth. 

Two  or  Four  Incisors.  —  Two  incisors  may  be  attached  to  a  plate 
shaped  as  for  one  (Fig.  278),  with 
the  addition  of  a  second  clasp,  when 
the  teeth  permit.  But  much  the 
best  practice  is  to  select  the  second 
tooth  on  the  opposite  side.  Fig.  280 
gives  the  form  when  it  is  decided  to 
run  the  plate  up  to  the  intervening 
teeth.  Fig.  281  represents  the  se- 
cond form,  better  suited  than  the 
first  in  certain  cases  of  two  in- 
cisors. With  four  incisors  and 
clasps  on  second  bicuspids,  the  first 
form  is  best,  because  only  two  teeth  lie  between  the  incisors  and  clasp ; 
and  it  is  better  to  carry  the  plate  up  to  the-  teeth  than  to  expose  so 
small  a  portion  of  gum.  For  four  teeth,  the  plate  should  be  rather 
wider  than  for  two. 

In  these  cases  a  closely-fitting  plate  assists  so  much  in  its  own  reten- 
tion, that  bicuspid  stays  will  often  sufiice  to  retain  them,  or  a  clasp  on 


Fig.  280. 


618 


FORM    OF    CLASP-PIECES. 


Fig.  281. 


Fig.  282. 


one  side  and  a  stay  on  the  other.     "When  the  adliesion  of  the  plate  to 
the  gum  is  thus  jjartly  relied  upon,  it  is  not  necessary  to  make  the 

plate   for   four   incisors    larger 
than  in  Fig.  280. 

When  the  patient  is  very  in- 
tolerant of  the  presence  of  much 
metal  in  the  mouth,  two  teeth 
may  sometimes  be  securely  in- 
serted, as  suggested  by  Dr.  ^lay- 
nard,  upon  a  T-shaped  plate — 
the  cross-piece,  one -fourth  to 
three-eighths  of  an  inch  wide,  fitting  the  arch  from  bicuspid  to  bicus- 
pid ;  the  slip  to  which  the  tooth  is  attached  being  soldered  to  the 
centre,  and  also  fitting  the  arch.  Such  a  piece,  well  made,  will  resist 
considerable  traction  upon  the  incisor.  Owing  to  the  peculiarity  of 
its  shape,  the  attempt  to  draw  down  the  tooth  springs  the  transverse 
slip  of  metal,  and  causes  it  to  bind  upon  the  bicuspids. 

When  the  four  incisors  and  the  cuspids  are  to  be  replaced,  the  con- 
struction of  the  plate  (Fig.  280)  is 
upon  precisely  the  same  principle  as 
the  preceding,  the  only  difference 
being  that  the  plate  should  he  rather 
larger.  "When  the  teeth  on  one  side 
of  the  mouth  are  too  much  decayed, 
I  >v  are  incapable  of  affording  a  secure 
attachment,  or  are  missing,  even  this 
number  of  teeth  may  be  held  by  one 
clasp  on  one  side  of  the  mouth  and 
a  stay  on  the  other.  But  the  plate 
should  be  extended  half  or  three- 
fourths  of  an  inch  back  of  the  tooth  to  which  it  is  clasped.  If  this 
precaution  is  neglected,  the  piece,  from  its  weight,  may  act  as  a  lever 
upon  the  tooth,  and  loosen  it  or  cause  periostitis.  It  sometimes  hap- 
pens that  a  piece  made  originally  with  clasps  on  both  sides  of  the 
mouth  loses  the  benefit  of  one  clasp  from  the  loss  of  the  tooth ;  and 
yet  the  patient  retains  it  in  place  as  well  as  before.  The  piece  is  then, 
in  part,  retained  by  the  fit  of  the  plate  to  the  gum  ;  from  which  we 
learn  that  if  only  one  clasp  can  be  attached  to  a  plate  with  from  four 
to  six  teeth,  it  is  advisable  to  cover  rather  more  of  the  surface  of  the 
mouth.  In  this  combination  the  clasp  and  stay  give  steadiness,  and 
the  close  fit  of  the  plate  to  the  gum  gives  adhesion. 

Uppei-  Bicmpidb:  —  One  or  both  bicuspids  on  one  side  are  often  at- 
tached to  a  plate  about  the  size  of  a  cent,  clasped  to  the  bicuspid  or 


FORM    OF    CLASP-PIECES, 


619 


Fig.  283 


molar  behind.  But  such  pieces  are  not  of  much  service  in  mastication. 
It  is  better  practice  to  leave  such  a  space  unfilled,  than  endanger  the 
durability  of  a  good  tooth  by  clasping  it.  If  there  is  a  bicuspid  space 
on  either  side,  the  plate  crosses  the 
mouth.  Fig.  283  represents  such  a 
plate  clasped  to  the  first  molar  and 
fitted,  as  is  very  commonly  done, 
closely  to  the  incisors.  But  in  this 
and  all  other  cases  where  the  four  or 
six  front  teeth  remain,  it  is  decidedly 
better  to  leave  as  large  a  space  between 
the  plate  and  the  teeth  as  possibl:. 
The  strength  of  the  plate  is  preserved 
by  giving  less  curve  to  the  back  edge, 
or  by  doubling  the  plate  in  the  middle. 
The  design  of  this  form  is  not  merely  to  keep  the  plate  from  the  front 
teeth,  but  to  leave  uncovered  the  part  of  the  mouth  immediately  behind 
the  incisors.  Two  important  points  are  gained  by  this.  The  sense  of 
taste  is  more  impaired  by  covering  this  part  of  the  palatine  surface 
than  any  other — not  because  fibres  of  the  gustatory  nerve  have  any 
special  distribution  here,  but  because  of  the  universal  habit  of  press- 
ing the  tip  of  the  tongue  here,  in  the  act  of  tasting ;  and  pressure 
against  the  natural  mucous  surface  develops  this  sense  most  fully. 
Secondly,  the  articulation  of  the  dental  letters  (the  mutes  T,  D,  Th, 
the  nasal  N  and  the  liquid  L)  is  thickened  by  a  plate  covering  this 
part.  Such  covering  is  in  many  plates  necessary ;  but  it  is  well  to 
avoid  it,  for  the  above  assigned  reasons,  whenever  possible. 

When  the  loss  of  bicuspids  is  accompanied  by  that  of  the  six  front 
teeth,  and  the  first  molars  alone  re- 
main, a  good  form  of  plate  is  shown 
in  Fig.  284.  The  backv/ard  exten- 
sion of  the  plate,  curving  partly 
over  the  alveolus,  is  designed  to 
prevent  the  weight  of  the  piece 
from  acting  injuriously  on  the  mo- 
lars, and  to  assist  their  retentive ^ 

powder.     If  the  second  molars  are^^^^ ^ 

also  in   the   mouth,  the  extended 
plate  must  be  differently  shaped.* 


Fig.  284. 


*  The  festooned  shape  of  this  and  similar  cuts  is  designed  to  mark  the  number 
and  position  of  the  artiticial  teeth.  The  forms  of  the  teeth  are  omitted,  as  having 
nothing  to  do  with  the  subject  of  this  chapter.  The  plates  on  the  models  are 
taken  from  the  valuable  work  of  Prof.  Richardson. 


620 


FORM    OF    CLASP-PIECES. 


If  the  molars  are  well  shaped  and  firm,  the  plate  may  be  narrower 
than  here  represented,  being  careful  to  make  it  thicker  also.  But  if 
the  presence  of  adjacent  molars  prevents  the  use  of  complete  clasps,  or 
if  their  form  renders  stays  necessary  instead  of  clasj^s,  the  plate  may 
be  rather  wider.  Be  careful,  however,  not  to  cover  the  hard  floor  of 
the  palate,  or  to  attempt  giving,  by  a  cross-band  at  the  back  of  the 
plate,  the  stiffness  which  is  best  gained  by  thickness  of  metal. 

Plates  of  this  class  are  kept  in  place  as  much  by  the  adhesion  of  con- 
tact with  the  gum  as  by  the  clasps.  In  many  cases  the  force  of  adhe- 
sion is  such,  that  the  lateral  support  of  stays  is  quite  as  effectual  as 
clasps.  Hence,  after  a  clasp-piece  of  this  kind  has  been  worn  for  some 
time  and  become  perfectly  set  to  the  mouth,  it  may  be  advisable  to 
shorten  the  clasps  into  stays ;  indeed,  it  is  better  practice,  in  all  cases, 
to  anticipate  this  ultimate  fit  of  these  plates,  and  make  stays  at  first 
instead  of  clasps.  This  applies  with  still  more  force  to  the  loss  of 
twelve  teeth,  the  second  molars  remaining,  which  should  in  no  case  be 
clasped ;  stays  may  very  properly  be  used  to  prevent  lateral  or  backward 
motion  of  the  plate.  The  presence  of  these  second  molars,  by  giving 
lateral  steadiness  to  the  plate,  prevents  all  necessity  for  covering  the 
hard  palate,  and  makes  a  vacuum  cavity  wholly  uncalled  for.  A  soli- 
tary molar  should  never  be  clasped,  nor  should  it  be  allowed  to  remain 
in  the  mouth. 

Alternate  Spaces.  —  It  remains  to  consider  the  forms  of  plates  for 
vacancies  alternating  with  natural  teeth.  The  forms  given  for  four 
incisors  will  answer  for  all  alternating  vacancies  anterior  to  the  second 
bicuspids,  remembering  to  make  the  plate  wider  in  proportion  to  the 
number  of  teeth,  and  thicker  in  proportion  as  it  is  made  narrow;  also, 
that  a  first  bicuspid  may,  in  many  of  these  cases,  be  clasped  with  better 
^flTect  than  a  second,  or  than  the  first  molar.    Fig.  285  is  a  good  type  for 


Fig.  285. 


Fig.  286. 


cases  where  the  vacancies  include  the  bicuspids ;   notice  in  this  cut 
the  backward  extension  of  the  plate.     AVhere  the  natural  teeth  are  in 


FOEM    OF    CLASP-PIECES.  621 

groups  of  two,  it  is  best  to  carry  the  plate  close  up ;  if  as  many  as 
three  or  four  are  together,  the  plate  may  Idc  cut  away,  especially  if 
they  are  incisors.  Fig.  286  represents  an  exceptional  case,  in  which 
two  laterals  and  two  left  bicuspids  are  attached,  by  clasping,  to  the 
right  first  bicuspid  and  molar.  The  left  molars  are  supposed  to  be 
loose,  or  sockets  much  absorbed,  or  from  some  other  cause  forbidding 
clasps  or  stays.  In  this  case,  the  undue  strain  on  the  clasp-teeth  will 
ultimately  cause  their  loss.  Whenever  an  unavoidable  strain  of  this 
kind  is  thrown  upon  a  tooth,  a  clasp  may  be  used  in  preference  to  cov- 
ering the  palate,  provided  the  patient  is  content,  for  the  sake  of  the 
firmness  which  it  gives,  to  risk  the  loss  of  the  tooth.  Teeth  are  more 
firmly  retained  by  clasps  than  by  atmospheric  pressure,  and  this,  with 
many  patients,  outweighs  all  considerations  of  injury  to  the  other  teeth. 

Partial  pieces,  with  alternating  spaces,  do  not  acquire  that  adhesion 
by  contact  found  in  cases  where  the  lost  teeth  lie  together.  The  inter- 
rupted margin  between  the  teeth  so  readily  admits  air  under  the  plate, 
on  the  slightest  motion,  that  the  atmospheric  pressure  is  imperfectly 
applied.  Hence  there  is  continued  demand  for  the  retentive  power  of 
the  clasps.  The  vacuum  cavity  does  not  correct  this  difficulty,  or 
supply  the  place  of  clasps,  since,  as  will  be  explained  in  the  next 
section,  the  vacuum  acts  on  soft  membrane  and  has  necessarily  a  tem- 
porary force. 

When  the  six  or  eight  front  teeth  remain,  a  plate  holding  bicuspids 
and  molars  cannot  be  retained  by  clasps.  In  the  first  case  the  cuspids 
could  not  be  clasped,  nor  would  it  be  proper  even  to  carry  stays  against 
them.  In  the  latter  case,  the  weight  and  leverage  of  the  piece  would 
be  too  great  for  the  slight  clasp  that  a  first  bicuspid  permits  ;  but  two 
stays,  with  the  points  passing  as  far  to  the  front  of  the  bicuspids  as  the 
cuspids  allow,  would  tend  to  prevent  the  slipping  of  the  plate  back- 
ward. 

Lower  Partial  Pieces.  —  These  do  not  properly  come  under  the  head 
of  clasp  Avork.  In  replacing  one  or  more  incisors,  lost  by  accident  or 
salivary  calculus,  half-clasps  may  be  applied  to  the  bicuspids.  For 
such  cases  the  best  style  of  work,  beyond  all  question,  is  a  vulcanite 
plate,  made  on  a  model  from  a  plaster  impression.  Fitting  with  great 
accuracy  the  inner  surfaces  of  the  bicuspids,  it  is  firmly  held  without 
injury  to  the  retaining  teeth.  Partial  pieces  filling  bicuspid  and  molar 
vacancies  should  not  clasp  cuspids  or  bicuspids  ;  the  position  of  re- 
maining molars  seldom  permits  clasping,  even  stays  cannot  always  be 
applied. 

In  chapter  fourth,  on  preparatory  treatment  of  the  mouth,  the  ques- 
tion of  extracting  molar  or  bicuspid  teeth,  which  might  otherwise  be 
used  for  clasping,  is  considered.     The  importance  of  permanence  of 


622  •      ATMOSPHERIC    PRESSURE. 

the  work  outwoiglis  any  temporary  advantage  resulting  from  clasping 
one  or  two  such  teeth.  In  chapter  third,  and  in  the.section  on  i-eten- 
tion  by  clasps,  are  many  remarks  which  it  is  unnecessary  to  repeat, 
but  which  are  important  for  the  full  understanding  of  the  details  of 
construction  given  in  this  section. 

PLATES    KETAINED    BY   ATMOSPHERIC   PRESSURE. 

Of  the  two  methods  of  retaining  a  dental  appliance,  already  con- 
sidered, the  first,  by  springs,  is  suited  only  to  entire  dentures;  tlie 
second,  by  clasps,  is  adapted  only  to  partial  cases.  The  principle  of 
retention  now  to  be  considered  is  applicable  to  both:  where  practicable, 
it  is  the  most  perfect  way  of  retaining  a  set  of  artificial  teeth.  If  the 
pressure  of  the  atmosphere  could  be  removed  from  the  mucous  side  of 
a  plate,  allowing  its  full  force  to  be  exerted  upon  the  lingual  surface, 
the  smallest  plates  would  adhere  with  a  force  of  four  pounds,  the 
largest,  forty.  But,  for  reasons  to  be  given,  plates  seldom  have  one- 
fourth  of  this  resistance  to  displacement.  There  are  two  methods  in 
present  use  for  securing  the  service  of  atmospheric  pressure.  One  is 
by  close  adaptation  of  the  plate ;  the  other,  by  construction  of  a  cavity 
of  definite  form.  Both  act  by  the  more  or  less  perfect  exclusion  of 
air  from  between  the  plate  and  the  mouth.  The  first  will  be  con- 
sidered as  the  Adhesion  of  Contact ;  the  second  as  the  power  of  the 
Vacuum  Cavity.  Before  describing  the  separate  application  of  these 
to  dental  plates,  a  few  remarks  are  necessary,  in  addition  to  what  has 
already  been  said  in  the  last  section  of  the  third  chapter,  in  exposition 
of  the  general  principles  of  atmospheric  pressure. 

The  surfaces  of  two  pieces  of  highly  polished  ground-glass,  if  pressed 
together,  will  adhere  firmly ;  so  much  so,  sometimes,  as  to  resist  every 
attempt  at  separation.  Surfaces  less  smooth  and  close-grained  will 
also  adhere  with  great  tenacity,  if  their  pores  or  irregularities  are 
filled  by  wetting  with  water.  If  both  surfaces  are  rigid,  t'ley  may  be 
made  to  slide  upon  each  other,  but  will  resist  a  force  of  five  to  fifteen 
pounds  for  every  square  inch,  if  applied  at  right  angles  to  the  surface; 
if  one  surface  is  soft  and  pliant,  it  becomes  difficult  to  keep  it  in  con- 
tact around  the  edges.  Traction  ujDon  the  centre,  as  in  the  case  of  a 
disc  of  wet  leather  upon  a  flat  stone,  will  draw  in  the  edges,  and  create 
a  vacuum  in  the  centre.  It  might  be  supposed  that  in  this  vacuum 
space  lies  the  power  that  raises  the  stone ;  whereas,  it  lessens  the 
power  by  reducing  the  area  of  stone  in  contact  with  the  leather, 
even  if  the  vacuum  is  perfect.  Still,  if  the  entire  circumference  is  in 
contact,  no  air  enters  the  cavity,  except  what  passes  through  the  porous 
leather,  and  for  a  time  the  lifting  power  of  the  disc  is  sufficient  to 
raise  the  stone.     If  traction  be  made  upon  the  disc  anywhere  but  in 


ATMOSPHERIC    PRESSURE.  623 

tte  centre,  the  flexible  edge  will  be  raised,  air  enters  between  the  sur- 
faces, and  counteracts  that  pressure  on  the  under  side  of  the  stone, 
which  was  the  lifting  force. 

Hence,  between  two  surfaces  adhering  by  simple  contact,  one  of 
which  is  soft  and  pliant,  adhesion  is  not  so  persistent  as  where  both 
are  rigid,  because  of  the  liability  to  separation  around  the  edges 
admitting  air  between  the  surfaces.  Applying  this  to  dental  plates, 
we  may  understand  their  liability  to  become  detached  by  a  degree  of 
motion  which  separates  them  from  the  gum  at  any  one  point  around 
the  edge.  We  learn,  also,  that  so  long  as  absolute  contact  is  main- 
tained, we  have  the  most  perfect  exclusion  of  air  practicable ;  hence, 
no  force  of  udhesion  in  a  limited  vacuum  cavity  (the  perfect  exhaus- 
tion of  which  is  impossible)  is  comparable  to  the  adhesion  of  the  entire 
surface  of  the  plate,  provided  this  is  made  as  perfect  as  possible  by 
accurate  workmanship,  and  is  not  weakened  by  the  admission  of  air 
around  the  edges. 

If  we  exhaust  the  air  from  the  barrel  of  a  key,  and  apply  the  lip,  it 
will  be  drawn  in,  and  held  with  a  force  sufficient  to  support  the  weight 
of  the  key  for  some  time.  This  simple  experiment  will  prove  on 
examination  very  instructive.  The  mucous  and  sul^mucous  tissues  are 
pressed  into  the  key,  because  the  fluids  pervading  these  parts,  being 
under  pressure  in  every  other  direction,  tend  toward  the  point  from 
which  the  pressure  is  wholly  or  partially  removed.  The  extent  to 
which  the  lip  is  drawn  into  the  key  will  depend  upon  two  conditions. 
First,  the  softness  and  mobility  of  the  tissue ;  secondly,  the  shape  of 
the  edge  of  the  orifice.  If,  in  addition  to  these  two  points,  we  inquire, 
thirdly,  why  the  key,  after  a  time,  drops  ofl*,  we  shall  from  this  simple 
illustration  have  fully  explained  the  rationale  of  the  vacuum  cavity, 
as  aj^plied  for  the  retention  of  a  piece  of  dental  mechanism. 

First:  the  extent  to  which,  or  rapidity  with  which,  a  partial  vacuum 
becomes  filled  up  by  any  yielding  tissue  with  which  it  is  brought  in 
contact  depends  upon  the  mobility  of  its  structure.  We  say,  partial 
vacuum,  because  the  process  of  mechanical  exhaustion  can  never  pro- 
duce a  perfect  vacuum.  If  the  water  Avhich  gives  softness  to  mucous 
tissues  was  perfectly  free  to  move,  the  cavity  would  be  instantly  filled, 
however  deep.  Parts  as  mobile  as  the  tongue  and  lips  yield  readily 
to  this  fluid  pressure;  but  the  mucous  membrane  of  the  alveolar  ridge 
and  palate  being  more  or  less  tied  down  to  the  bone,  fills  the  cavity 
more  slowly ;  if  too  deep,  it  will  not  fill  it  at  all,  except  by  hyper- 
trophy. Reverting  to  the  experiment  of  the  key :  if  violent  suction  is 
made,  a  purple  spot  is  left  upon  the  lip ;  the  mucous  tissues  being  pre- 
vented by  their  structure  from  filling  the  vacuum,  the  fluids  still  feel 
the  impulse  of  atmospheric  pressure :  the  blood,  thus  impelled  vtiih  a 


624  ATMOSPHERIC    PRESSURE. 

force  which  the  thin  capilLiry  walls  cannot  resist,  is  extravasatecl,  as 
takes  place  also  in  the  application  of  "  dry  cups."  Hence,  where  a 
dental-plate  cavity  is  so  deep  that  the  tissues  cannot  fill  it;  if  the 
degree  of  exhaustion  is  such  as  still  to  draw  upon  the  suruice,  the 
tissues  are  in  danger  of  being  ruptured.  Such  a  source  of  irritation 
will,  in  many  persons,  develop  morbid  action,  and  should  forbid  the 
use  of  deep  cavities  in  any  plate. 

Secondhj:  the  shape  of  the  edge  modifies  the  rapidity  with  which 
the  cavity  fills.  If  the  edge  of  a  cupping-glass  is  rounded,  the  skin 
glides  under  it,  and  is  drawn  from  the  adjoining  parts  into  the  glass ; 
but  if  the  glass  is  ground  so  as  to  present  a  sharp  edge  on  the  inside, 
this  beds  itself  in  the  surface,  and  prevents  so  much  of  the  adjacent 
skin  from  being  drawn  in.  It  rises  to  a  less  height  in  the  cup,  and  the 
remaining  force  of  the  vacuum  is  spent  upon  the  capillary  vessels, 
which  are  ruptured.  Hence,  we  learn  that  sharp-edged  cavities  fill 
less  rapidly,  but  act  with  more  power  upon  the  tissues ;  they  are  con- 
sequently more  apt  to  excite  disease,  if  the  cavity  has  sufficient  depth 
to  allow  continued  action. 

Thirdly:  as  to  the  cause  of  the  final  dropping  off  of  the  key:  water, 
and  all  the  moist  tissues  of  the  bo^ly,  contain  atmosijheric  air,  which 
they  yield  up  under  a  vacuum.  Hence,  a  mucous  membrane,  although, 
at  first  drawn  strongly  into  a  cavity,  will  make  the  vacuum  less  com- 
plete, by  giving  out  the  air  contained  in  its  tissue  and  in  the  blood, 
constantly  circulating  through  it.  The  adhesion  of  a  vacuum,  there- 
fore, over  mucous  membranes,  requires  renewal  by  occasional  suction ; 
since  the  blood  is  constantly  circulating  through  the  surface,  and  sup- 
plies air  to  the  cavity.  Mucous  membranes  have  also  the  property  of 
absorbing  air ;  as  is  seen  in  the  lining  of  the  bronchial  cells  constantly, 
and  in  the  power  of  the  mucous  membrane  of  the  intestines  to  absorb 
the  gases  there  generated.  This  property  acts  an  important  part  in 
absorbing  small  quantities  of  air  unavoidably  caught  between  the 
plate  and  the  mouth  ;  thus  partly  explaining  the  well-known  fact,  that 
plates  adhering  by  simple  contact  become  tighter  after  being  worn 
awhile. 

Thus  the  double  action  of  mucous  membrane,  absorbing  minute  por- 
tions of  air  pressed  against  it,  and  giving  out  its  contained  air  to 
a  vacuum,  favors  the  retention  of  simple  contact,  whilst  it  acts  against 
the  efficacy  of  the  vacuum.  In  either  case  it  prevents  the  full  force 
of  pressure,  theoretically  possible.  The  practical  inference  from  the 
lesson  of  the  key  is,  that  the  Vacuum  Cavity  acts  well  at  first,  and 
may  be  useful  for  the  temporary  purpose  of  retaining  a  plate,  until 
the  changes  of  which  the  mouth  is  capable  adapt  it  more  perfectly  to 
the  plate ;  but  for  permanent  adhesion,  the  only  reliable  application 


ADHESION    OF    COXTACT. 


625 


of  the  atmosplieric-pressure  principle  is  the  Adhesion  of  Contact, 
which  is  fully  developed  only  when  the  contact  of  the  plate  is  com- 
plete. A  vacuum  cavity,  acting  as  such,  gradually  draws  the  gum  into 
it,  and  finally  fills  it  by  a  more  or  less  permanent  enlargement ;  when 
thus  filled,  the  plate  is  retained  solely  by  the  adhesion  of  contact. 
^"VVhen  a  cavity,  intended  to  hold  up  a  plate,  leaves  no  prominence  or 
mark  in  the  mouth,  it  unmistakably  proves  that  it  is  exerting  no  force  ; 
so  far  from  aiding  in  the  retention  of  the  plate,  it  diminishes  the  force 
of  adhesion  by  the  presence  of  air,  and  has  no  compensating  advan^ 
tage,  except  in  removing  pressure  from  a  hard  palate  membrane; 
There  are,  however,  other  and  better  ways  of  obtaining  an  air-space, 
as  elsewhere  explained,  without  the  presence  of  a  cavity,  which  markt 
the  failure  of  its  original  purpose. 


Fig.  287. 


ADHESION   OF   CONTACT. 

Full  plates,  which  are  designed  to  adhere  by  force  of  contact,  diffei- 
from  those  retained  by  spiral  springs,  in  that  the  former  are  larger  thai 
the  latter,  covering  more  of  the  palate,  so  as  to  give  a  larger  surfacj 
for  the  pressure  of  the  atmosphere.  They  may  cover  the  whole  of  th.^ 
outer  surface  of  the  alveolar  ridge,  and  a  considerable  portion  of  the 
roof  of  the  mouth;  but  should  not  go  as  far  back,  nor  run  so  high  up, 
as  some  dentists  are  in  the  habit  of  extending  them.  If  allowed  to 
cover  those  parts  of  the  bone,  where  the  cheek-muscles  on  the  outside 
of  the  ridge,  or  the  palate-muscles  at  the  back  of  the  mouth,  are- 
inserted,  the  gums  will  be  chafed  or  ulcerated,  the  patient  nauseated,, 
and  the  piece  rendered  unstable  by  the  action  of  the  muscle.  It  is 
not  always  necessary  to  employ  a  very  wide  plate  to  give  secure  reten- 
tion, for  a  comparatively  narrow  one 
will  often  adhere  with  very  great  te- 
nacity to  the  gums.  But  such  a 
plate  is  more  liable  to  be  bent,  and 
lose  its  perfect  adaptation  to  the  parts, 
than  a  wide  one,  unless  made  thicker 
in  proportion  as  it  is  narrower.  As  it 
is  never  necessary  to  make  an  upper 
plate  so  narrow  as  a  lower  one,  there 
can  be  no  difficulty  in  giving  the 
requisite  strength,  either  by  increas- 
ing the  thickness  throughout,  or  by 
doubling  the  anterior  half 

The  diagram  (Fig.  287)  represents 
half-section  outlines  of  six  modifications  of  form  in  the  posterior  mar- 
gin of  the  plate,  where  it  is  proposed  to  overcome  the  difficulties  inci' 
40 


626  ADHESION    OF    CONTACT. 

dent  to  a  hard  palatine  membrane  by  cutting  out  the  plate.  The  line 
P,  curving  forward  from  a  little  behind  the  termination  of  the  top  of 
the  ridge  (dotted  line),  is  the  extreme  limit  of  any  plate  not  compli- 
cated with  cleft-palate.  The  curve  a  or  a'  will  give  surface  sufficient 
for  the  retention  of  most  plates,  except  in  small  arches.  This  form  is 
more  agreeable  to  the  patient  than  the  first,  and  is  less  apt  to  produce 
nausea;  it  removes  the  plate  from  all  action  of  the  palate-muscles,  and 
lessens  the  liability  to  di-slodgment,  often  caused  by  the  forcible  action 
of  the  tongue  against  the  back  of  the  palate,  in  certain  efforts  of  deglu- 
tition. The  curve  b  or  b'  may  often  be  used  solely  to  avoid  unneces- 
sary covering  of  the  palate.  In  mouths  of  average  size,  and  having 
moderate  and  regular  softness,  such  shape  Avill  prove  quite  as  firm  as 
one  following  the  line  P.  But  these  lines  are  more  frequently  to  be  fol- 
lowed, for  the  same  reason  that  we  take  the  curve  c  or  c\  to  keep  the 
plate  off  the  hard  central  ridge.  When  this  ridge  is  narrow,  we  give 
greatest  width  to  the  plate  by  following  the  curves  on  the  side  R  of 
the  diagram ;  but  if  the  surface  is  broad,  the  space  must  be  widened, 
as -on  the  side  L;  and  the  plate  made  thicker. 

"This  method  of  relieving  the  central  bearing  of  plates  gives  them 
great  steadiness  on  the  ridge,  and  has  an  advantage  over  other 
methods,  in  having  no  band  or  ridge  of  plate  pressing  along  the  line 
P  —  a  point  very  often  as  hard  as  any  other  part  of  the  palate.  It  is 
advisable,  in  those  cases  where  a  vacuum  cavity  has  been  tried  with 
unsatisfactory  results,  to  cut  out  the  cavity  and  part  behind  it,  and 
thus  try  the  effect  of  a  plate  following  curve  b  or  c. 

There  are  other  methods  of  taking  off  the  central  bearing  of  plates. 
When  the  ridge  is  soft,  a  wax  impression  does  this  by  compressing  the 
gum.  Models  from  plaster  impressions  are  scraped  on  the  ridge  for 
the  same  purpose;  but  this  is  not  so  good  a  plan,  as  it  is  difficult  to  do 
it  uniformly.  A  much  better  expedient  is  to  brush  some  thin  plaster 
over  the  central  part  of  the  model,  being  careful  to  mark  the  line  of 
the  back  edge  of  the  plate,  and  put  no  plaster  there:  this  layer  must 
not  be  thicker  than  a  card,  and  should  have  no  abrupt  edges.  In  deep 
arches,  the  shrinkage  of  the  zinc-die  accomplishes  the  same  object ;  if 
the  model  is  carefully  scraped  along  the  back  edge  of  the  plate,  this 
part  will  fit  closely,  while  the  central  portions  will  stand  off;  this  is 
far  better  than  the  attempt  to  adjust  the  edge  with  pliers. 

In  adapting  atmospheric-pressure  plates,  the  form  and  fit  of  the 
alveolar  margin  must  be  considered.  Close  adaptation  of  this  edge  is 
by  no  means  so  essential  to  firm  retention  of  a  full  upper  piece  as  in 
the  posterior  margin ;  for  the  reason  that,  in  most  cases,  the  loose 
mucous  folds,  which  lie  against  the  plate,  prevent  the  access  of  air. 
But  closeness  of  fit  is  very  desirable  for  other  reasons :  to  prevent 


ADHESION    OF    CONTACT.  627 

lateral  motion ;  to  avoid  unnecessary  fulness ;  to  prevent  irritation 
of  the  soft  parts  by  projecting  edges  of  metal.  The  form  of  the  alve- 
olar edge  is  not  essential  to  adhesion,'  provided  it  rises  high  enough  to 
give  steadiness  to  the  plate.  J^^sthetic  considerations,  however,  often 
compel  us  to  run  the  plates  up  as  high  as  the  muscular  attachments 
will  permit;  either  for  the  support  of  an  artificial  gum  or  to  restore 
sunken  features.  In  both  jaws,  especially  the  lower,  the  effort  to  get 
the  deepest  possible  edge  often  gives  instability,  by  subjecting  the 
piece  to  the  action  of  the  facial  and  lingual  muscles.  In  any  case  of 
doubt  make  the  plate  too  shallow  rather  than  too  deep ;  especially 
when  the  edge  is  turned  over,  which  makes  it  impossible  to  take  off 
any  excess  without  spoiling  the  plate. 

Full  lower  plates  are  held  by  adhesion  of  contact ;  but  in  these 
the  weight  of  the  piece  increases  the  adhesion.  The  surface  is  so  small 
that  every  part  of  such  plates  should  fit  the  gum  with  accuracy.  The 
simple  rule  for  the  form  of  lower  plates  is  to  extend  them  as  far  on  the 
inner  and  outer  edges  as  the  muscular  attachments  will  jaermit.  The 
outer  and  inner  edges  are  often  rounded  by  soldering  a  gold  wire,  after 
determining  the  exact  outline.  Thickness  of  edge  is  also  given  by 
doubling  the  plate  necessary  for  the  strength  of  narrow  plates.  The 
second  plate  is  to  be  swaged  precisely  as  the  first ;  then,  after  partial 
trimming,  the  two  plates  are  swaged  together  over  a  new  die.  One 
should  be  wider  than  the  other,  on  the  outer  or  inner  edge,  to  give  a 
place  for  the  solder ;  the  borax-cream  should  be  free  from  granules, 
and  the  blow-pipe  flame  directed  on  the  edge  opposite  the  solder.  A 
simple  and  convenient  clamp  for  binding  plates  together,  or  holding 
rims  whilst  being  soldered,  is  made  of  iron  (or  nickel)  wire  (Fig.  288). 
a  The  first  bend ;  b  the  second  bend  ;  c  a 
side  view  of  the  same ;  d  side  view  of 
clamp,  open  and  grasping  two  pieces  of 
plate.  The  curves  should  be  so  adjusted 
that  the  points  of  contact  with  the  plates 
will  be  just  opposite,  else  clamp  or  plates 
are  liable  to  change  position. 

Partial  pieces  may  also  be  retained  by 
closeness  of  adaptation  ;  but  there  are  two 
elements  of  instability  which  usually  will 
prevent  them  from  having  the  security  of 

full  sets,  or  of  partial  clasp-pieces  —  lateral  movement  and  extent  of 
margin,  admitting  air  on  slightest  motion.  All  such  pieces  should,  if 
possible,  have  two  stays,  one  on  each  side  of  the  mouth,  to  prevent 
lateral  motion ;  they  should  cover  an  extent  of  surface  proportioned 
to  the  number  of  teeth ;  the  edges  of  the  plate  should  fit  with  great 


628  THE    VACUUM    CAVITY. 

accuracy.  If  the  exact  outline  of  the  plate  is  determined  on,  a  good 
plan  is,  to  paint  the  model  with  a  coat  of  thin  plaster,  keeping  one- 
eighth  inch  inside  the  margin,  and  laying  an  extra  coating  over  very 
hard  places  ;  this  causes  the  edge  to  sink  slightly  into  the  gum  ;  yet, 
if  carefully  done,  it  -will  not  change  the  general  contour  of  the  sur- 
face. Partial  plates,  holding  the  eight,  ten,  or  twelve  aijterior  teeth, 
if  assisted  by  stays  against  the  remaining  molars,  are  nearly  or  quite 
as  firm  as  full  plates.  But,  in  either  partial  or  full  pieces,  whenever 
the  plate  has  to  be  cut  off,  for  setting  the  six  front  teeth  directly  on  the 
gum,  this  deutated  margin  is  more  apt  to  admit  air  than  the  upturned 
rim,  which  has  the  folds  of  the  lip  lying  against  it.  Partial  lower 
plates  are  unstable,  not  from  any  admission  of  air,  but  because  of  the 
small  extent  of  surface,  inadequate  to  the  pressure  of  mastication. 

THE   VACUUM   CAVITY. 

In  some  mouths  the  base-plate  of  a  full  upper  piece  adheres,  from 
the  beginning,  with  great  firmness.  When  the  gum  is  moderately  and 
regularly  soft,  the  jDalatine  arch  deep,  and  the  mouth  of  average  size, 
want  of  adherence,  on  trial  of  the  plate,  is  positive  evidence  of  defect 
in  construction.  But  very  hai'd,  or  very  small,  or  very  shallow  mouths 
usually  require  time  for  the  perfect  adaptation  of  the  best  made  plates. 
Dr.  Dwinelle  thus  explains  the  temporary  failure  of  a  simple  atmos- 
pheric-pressure plate  to  fit  firmly  when  first  inserted.  When  the  plate 
is  applied  and  an  effort  made  to  exhaust  the  air,  the  gums  are  drawn 
down  so  as  to  meet  it,  along  the  line  and  behind  the  edge  of  the  plate, 
thus  resisting  every  effort,  made  from  without,  to  withdraw  the  air 
from  the  central  part  of  the  plate;  so  that  the  pressure  of  the 
atmosphere  is  exerted  upon  only  a  small  breadth  of  surface,  along 
its  edge,  where  the  adhesion  is  constantly  liable  to  be  disturbed  in 
mastication. 

AVith  the  view  of  obviating  this  difficulty,  the  idea  of  constructing 
a  plate  with  a  cavity  suggested  itself  to  the  author  as  early  as  1835, 
and  was  mentioned  at  the  time  to  several  of  his  professional  brethren. 
The  construction  of  the  chamber  then  devised  was  found  objectionable, 
and  he  abandoned  its  use ;  and  it  was  not  until  the  early  part  of  1848, 
when  he  had  the  opportunity  of  seeing  a  cavity -plate  upon  a  plan 
contrived  by  Dr.  J.  A,  Cleaveland,  two  or  three  years  previously,  that 
he  was  again  induced  to  construct  a  base-j)late  of  this  kind.  Dr. 
Dwinelle  made  a  cavity-plate,  with  an  external  opening  and  valve  for 
exhausting  the  air,  in  the  winter  of  1845;  and  in  the  summer  of  1847 
or  1848,  Dr.  Jahial  Parmly  exhibited  to  the  author  a  plate,  with  a 
simple  cavity  .struck  into  it  by  swaging.  Some  months  after,  he  heard 
for  the  first  time  of  a  cavity-plate  patented  by  Mr.  Gilbert,  of  New 


THE    VACUUM    CAVITY.  629 

Haven.  The  cavity  now  generally  employed  is  formed  on  the  median 
line,  either  far  back  for  full  plates  (Fig.  289),  or  immediately  behind 
the  alveolar  ridge  for  some  partial  plates.  Dr.  Flagg  adds  two  lateral 
cavities  on  the  slope  of  the  palate,  with  a  view  to  prevent  the  plate 
from  rocking,  and  to  give  it  increased  stability.  Dr.  Levett's  lateral 
cavities  are  placed  directly  upon  the  ridge.  (Fig.  290.)  With  this  brief 

Fig.  289.  Fig.  290. 


history  of  cavity-plates,  we  shall  proceed  to  give  a  concise  description 
of  the  manner  of  constructing  them.  The  following  is  the  mode  of 
construction  of  Dr.  Cleaveland's  cavity-plate,  which,  for  reasons  given 
below,  is  now  seldom  used. 

A  metallic  die  and  counter-die  having  been  obtained,  a  plate  is 
swaged,  covering  the  entire  alveolar  border  and  extending  back  as  far 
as  the  line  P  (Fig.  287).  This  done,  it  is  placed  in  the  mouth,  and 
if  found  to  be  accurately  adapted  to  the  parts,  it  is  removed ;  a  half- 
round  gold  wire,  about  the  size  of  a  common  knitting-needle,  is  then 
soldered  to  the  lingual  side  of  the  plate,  enclosing  a  space  shaped 
somewhat  as  is  shown  in  Fig.  289,  varying  in  size  and  form  with  the 
differences  in  shape  and  size  of  the  plate  and  alveolar  ridge.  The 
part  within  the  wire  is  next  cut  out  with  punch-forceps,  or  saw,  and 
the  plate  placed  on  the  model ;  a  piece  of  wax,  about  a  tenth  or 
twelfth  part  of  an  inch  in  thickness,  having  a  circumference  one-fourth 
greater  than  the  hole  in  the  plate,  is  then  placed  over  the  opening, 
extending  a  short  distance  beyond  the  wire  on  every  side.  The  wax 
at  the  outside  is  brought  to  a  thin  edge,  and  is  also  made  thinner  in 
the  centre  than  where  it  covers  the  wire  surrounding  the  opening  in 
the  plate.  From  this  model  with  plate  and  wax  upon  it,  die  and 
counter-die  are  obtained  with  which  to  swage  a  thin  plate  of  gold, 
large  enough  to  cover  the  wax ;  its  edge  is  chamfered  off,  and  it  is 
then  soldered  to  its  place  on  the  plate,  where  it  may  be  secured, 
during  soldering,  either  by  iron  wire  clamps  or  by  gold  rivets.  A 
sectional  view  of  the  cavity  is  represented  in  Fig.  291,  A.  The 
Cleaveland  cavity  causes  the  plate  to  adhere  with  great  tenacity ;  as, 
from  its  shape,  it  is  impossible  for  the  mucous  membrane  entirely  to 


630  THE    VACUUM    CAVITY. 

fill  it;  the  traction  of  this  cavity  is  constant.  A  serious  objection  to 
its  use  is  the  great  irritation  it  excites  in  the  mucous  membrane,  in  the 
majority  of  cases. 

The  simpler  cavity-plate  used  by  Dr.  Jahial  Parmly,  of  New  York, 
and  patented  by  Mr.  Gilbert,  of  New  Haven,  may  be  formed  with 
nearly  as  much  ease  as  a  plain  plate.     Fig.  291,  B,  represents  a  sec- 
tional view  of  this  description  of  plate.     If  it  is  desired  to  have  lateral 
Pjq_  291.  cavities,  three  pieces  of  wax  are 

placed  on  the  plaster  model  — one 
A  in  the  centre,  as  already  described, 
and  one  on  the  slope  of  the  alveo- 
'  3  lar  ridge,  on  each  side.     When  it 

^ ^  is  desirable  to  make  a  cavity  with 

-        ^r  ^V       #Q  sharply  defined  border  D,  a  second 

^*^  plate,  a  little  larger  than  the  pro- 

,Q  jection,  should  be  swaged  over  the 
base-plate.     From  the  base -plate 


""^  t^6  projection  is  to  be  cut  out,  and 

the  smaller  plate  soldered  over  the 

opening.     For  hard  mouths,  the  thickness  of  the  main  plate  will  give 

suflBcient  depth  of  cavity  C;  in  this  case  no  projection  is  to  be  placed 

on  the  model. 

Should  the  usual  method  of  exhausting  air  from  these  cavities  be 
thought  insuflRcient,  the  valve  of  Dr.  Dwindle  (Fig.  291,  V)  may  be 
inserted  in  the  plate  covering  the  cavity.  The  conical  portion  is 
neatly  fitted  by  gi'inding :  the  stem  is  soldered  to  a  spring  on  the  pala- 
tine surface.  A  valve  of  easier  construction  is  given  at  V ;  a  small 
rubber  pad  acts,  by  the  spring,  upon  the  outside  of  the  hole.  The  size 
of  valves  and  thickness  of  plate  are  exaggerated,  the  better  to  illustrate 
the  details  of  construction.  By  means  of  either  of  these  valves,  a 
vacuum  may  be  created,  which  w'ill  draw  with  great  force  upon  the 
membrane  over  the  cavity. 

The  forms  B  and  D,  Fig.  291,  necessitate  a  prominence  in  the  die, 
which  is  variously  formed.  When  the  die  is  made  by  sand-moulding, 
a  corresponding  one  formed  of  wax,  lead,  tin,  or  plaster,  is  put  on  the 
model ;  a  die  made  by  dipping,  or  pouring,  or  by  the  fusible  metal 
process  requires  plaster.  Dies  made  by  pouring  into  the  impression 
require  the  cavity  to  be  cut  out  in  the  impression  itself.  A  variety 
of  shapes  in  tin  and  lead  are  furnished  by  the  depots,  chiefly  for  vul- 
canite work ;  but  they  may  be  used  also  for  the  sand-moulding  model. 
Plates  made  by  the  metallo-plastic  processes  require  plaster  prominences. 

The  size,  depth,  form,  and  position  of  the  cavity  are  important  con- 
siderations.    In  size,  it  must  be  proportioned  to  the  plate.     Fig.  292 


THE    VACUUM    CAVITY. 


631 


Fig.  292. 


gives  a  fair  average  size,  and  is  excellent  in  form,  except  that  it 
is  unnecessarily  pointed ;  all  angles  and  sharp  corners  should  be 
avoided,  and  fanciful  shapes  are 
aesthetic  blunders :  the  form  should 
appear  to  grow  out  of  some  neces- 
sity ;  and  hence  it  should  be  modi- 
fied to  suit  the  form  of  plate. 
Shallow  cavities  may  be  larger 
than  deep  ones ;  partial  pieces 
usually  have  a  cavity  larger  in 
proportion. 

In  depth,  the  cavity  must  vary 
with  the  softness  of  the  membrane. 
If  soft,  it  quickly  fills  a  shallow 
cavity,  and  is  less  liable  to  injury  by  a  deep  one.  Sharp-edged  cavities 
fill  less  quickly  than  round-edged  ones.  They  may  vary  in  thick- 
ness from  ISTo.  14  to  No.  24,  gauge  plate,  page  535.  When  the  cavity 
is  designed,  after  a  temporary  retaining  power,  to  act  permanently  in 
relieving  pressure  on  central  hard  parts,  it  should  be  very  shallow. 
When,  in  very  flat  mouths,  it  is  proposed  to  prevent  lateral  motion  by 
the  mucous  prominence,  the  cavity  should  be  deeper.  Extreme  depth, 
with  a  view  to  keep  up  constant  action,  makes  a  most  unsightly  piece, 
and  injures  the  mouth. 

As  to  position,  there  would  seem  to  be  much  difference  of  opinion, 
if  we  judge  by  the  various  points  selected.  We  have  never  had  but 
one  opinion  on  this  subject,  and  that  is  in  favor  of  the  central  cavity. 
The  cavity  resists  the  greatest  force  of  displacement,  when  applied  at 
right  angles ;  as  this  force  is  always  nearly  or  quite  vertical,  it  follows 
that  the  most  effective  cavities  are  horizontal ;  hence,  they  should  only 
be  on  the  roof  of  the  palate,  and  limited  to  its  level  portion.  Cavities 
covering  the  rugee,  or  sloping  walls  of  the  palate,  act  at  disadvantage. 
Again,  after  the  cavity  ceases  to  act,  its  secondary  use  in  relieving 
pressure  can  be  available  only  in  this  position.  The  very  worst  posi- 
tion for  a  cavity  is  on  the  ridge  of  either  upper  or  lower  jaw.  Firm 
pressure  on  the  ridge  is  one  of  the  most  important  elements  of  stability 
in  a  plate.  It  is  difficult  to  comprehend  what  compensation  for  the 
loss  of  this  is  found  in  the  cavity. 

Partial  plates  require,  when  the  cavity  is 
used,  a  modification  of  form  to-  enable  the 
cavity  to  be  placed  on  the  roof  of  the  palate. 
Yet  the  shapes  elsewhere  given  may  be  used 
in  connection  with  FJagg's  lateral  cavities  as 
represented  by  the  oval  in  Fig.  293.     If  no 


Fig.  293. 


632  THE    VACUUM    CAVITY. 

stays  can  be  used,  as  in  a  piece  of  artificial  bicuspids  and  molars 
with  natural  incisors  and  canines,  a  central  or  two  lateral  sharp- 
edged  cavities  may  be  of  service  to  prevent  lateral  motion.  In  all 
other  partial  cases  stays  may  be  used ;  these  combined  with  accurate 
fitting  will  give  as  firm  a  piece  as  any  form  of  cavity. 

In  comparing  the  two  applications  of  atmospheric  pressure,  it  is 
unnecessary  to  add  to  what  has  already  been  said.  Dentistry,  like 
medicine,  has  its  fashions.  The  salivating  and  blood-letting  fashion 
of  a  bygone  age  is  matter  of  sad  wonder  to  the  physician  of  the  present 
day  ;  because  adopted  not  alone  by  the  routine  practitioner,  but  by  men 
of  profoundest  learning  and  widest  experience.  The  universally  joreva- 
lent  fashion  of  the  vacuum  cavity,  which  characterizes  the  decade 
in  dental  mechanism  just  passed,  will  form  the  subject  of  w^ondering 
comment  to  some  future  generation.  As,  in  times  past,  no  case  of 
pleurisy  was  permitted  to  take  its  chance  of  recovery  without  the 
preliminary  bleeding;  so,  in  these  days,  many  of  our  best  mecha- 
nicians can  scarcely  be  persuaded  to  allow  any  plate  to  disjilay  its 
power  of  attachment,  without  the  inevitable  cavity.  Thousands  of 
plates,  that  are  worn  without  leaving  their  mark  on  the  palate,  give 
evidence  of  its  uselessness ;  ulcerated  mouths  speak  in  strong  language 
of  its  injuriousness ;  whilst  the  myriads  of  slovenly-made  pieces  that 
are  thus  temporarily  stuck  to  the  mouth,  until  in  the  fervor  of  satis- 
faction the  bill  is  paid,  attest  the  injury  which  this  perverted  ap- 
plication of  a  valuable  principle  has  wrought  upon  the  moral  and 
artistic  status  of  the  profession.  In  view  of  this  last  influence,  whilst 
acknowledging  its  occasional  utility,  we  urge  its  total  exclusion  from 
practice :  we  unhesitatingly  assert  that  any  skilful  mechanician  who 
shall  do  so  will  never  have  occasion  to  feel  that  he  has  lost  any  real 
advantage. 

The  processes  heretofore  described,  and  the  rules  laid  down,  have 
been  considered  mainly  in  their  relation  to  artificial  teeth  mounted 
upon  GOLD  PLATE  by  the  operation  of  soldering.  But  other  metals 
may  be  swaged  by  the  same  processes,  as  platinum,  aluminum,  and 
silver. 

Silver  is  the  least  valuable  of  these,  and  has  nothing  to  recommend 
it  except  its  cheapness,  in  which  questionable  merit  it  has  aluminum 
and  vulcanite  as  its  competitors;  and  hence  it  is  now  not  very  much 
used.  It  is  manipulated  in  all  respects  like  gold;  except  in  the  oper- 
ations of  refining  by  acids,  the  composition  of  solders  used,  and  the 
care  necessary  in  soldering,  from  the  fusibility  of  the  plate.  As  every 
good  dental  mechanic  values  his  work  far  beyond  the  mere  cost  of 


CONTINUOUS    ARTIFICIAL    GUM.  633 

material,  we  can  in  no  case  recommend  silver  as  a  base-plate.  Patients, 
who  can  pay  the  greater  cost  of  the  work,  can  pay  the  lesser  cost 
of  the  gold ;  and  dentists,  who  can  afford  to  give  the  work,  can  give 
the  gold  still  more  easily.  We  assume  that  he  who  gives  work  gives 
his  best;  otherv/ise  he  gives  away  his  reputation  also  —  an  excess  of 
generosity  not  to  be  commended. 

Aluminum  can  be  rolled  into  plate,  and  swaged.  It  requires  extreme 
care  in  annealing,  but  makes  a  rigid,  strong,  and  very  light  plate.  It 
does  not  withstand  the  buccal  secretions  as  well  as  twenty-carat  gold, 
but  is  nearly  or  quite  as  good  as  eighteen-carat  gold.  The  obstacle 
to  its  general  use  lies  in  the  fact  that,  as  yet,  there  is  no  good  solder 
for  it.  Hence  it  is  necessary  to  attach  the  teeth  by  vulcanite.  This 
can  be  very  successfully  done,  as  vulcanized  rubber  adheres  more  closely 
to  this  metal  than  to  any  other,* excepting,  perhaps,  pure  gold  or  pure 
platinum.  The  process  will  be  described  in  the  section  on  vulcanite  : 
it  is  equally  applicable  to  twenty-carat  gold  and  to  platinum,  but  not 
at  all  to  silver. 

Platinum,  if  alloyed  with  five  to  ten  per  cent,  of  gold,  has  stiffness 
sufficient  to  be  used  as  a  base-plate,  in  the  manner  previously  given  for 
gold.  As  it  has  no  advantage  over  gold  when  used  in  this  way,  its 
less  cost  is  not  a  sufficient  offset  to  the  inconveniences  attending  its  use 
and  to  the  color,  which  is  so  objectionable  to  most  persons  that  they 
are  unwilling  to  pay  as  much  as  for  the  same  work  in  gold.  Platinum 
has,  however,  one  remarkable  property,  possessed  by  no  other  used  by 
dentists  except  palladium,  which  is  now  scarcely  at  all,  if  ever,  used. 
It  cannot  be  fused  in  the  highest  heat  of  the  forge  or  porcelain-baking 
furnace.  Hence  it  is  the  only  metal  used  for  the  metallic  pins  and 
other  fastenings  inserted  into  porcelain  teeth ;  requiring  for  its  fusion 
the  flame  of  the  oxyhydrogen  blow-pipe.  It  is  also  the  only  metal  used 
in  a  remarkably  beautiful  style  of  work  known  as  the  Continuous 
Gum  Work,  which  forms  the  subject  of  the  next  section. 

TEETH    SET   UPON   PLATINA   WITH   A   CONTINUOUS   ARTIFICIAL   GUM. 

The  idea  of  uniting  porcelain  teeth  to  a  metallic  base  by  means  of 
a  fusible  silicious  composition  originated  in  France,  where  the  method 
has,  to  some  extent,  been  practised  since  1820.  But  Dr.  Fitch,  who 
spent  much  time  in  Paris,  and  was  well  acquainted  with  the  French 
method  and  Delabarre's  formulae,  states,  that  the  latter  had  never  per- 
fected his  recipes,  or  brought  them  into  practical  use.  The  composition 
employed  -there,  judging  from  the  specimens  which  the  author  has  in 
his  possession,  cannot  be  used  in  connection  with  porcelain  teeth  con- 
taining as  large  a  proportion  of  felspar  as  those  manufactured  in  this 


634  CONTINUOUS    ARTIFICIAL    GUM. 

country.  Delabarre's  compound,  according  to  Dr.  Locke,  required 
3761°  Falirenheit  to  fuse  it  completely.  Below  this,  it  fused  imper- 
fectly, and  was  found  too  fragile. 

The  process  now  known  as  the  Continuous-Gum  consists  essentially 
of  a  silicious  paste,  similar  (except  more  fusible)  in  composition  to  that 
of  which  the  teeth  are  made,  which  i>:  applied  around  the  bases  and 
fastenings  of  teeth  previously  soldered  ui)un  a  plate  of  purest  platina, 
and  then  fused  at  a  temperature  of  about  2200"  Fahrenheit.  It  takes 
its  name  from  the  fiiet  that,  unlike  blocks  or  single  gum  teeth,  it  presents 
an  unbroken  continuous  gum  outside  the  alveolar  ridge,  as  is  shown 

in  Fig.  294.  It  is  applied  in  two  layers  — 
^'"'  ~  a  yellowish  white  body,  giving  the  general 

contour  of  the  gum,  and  an  enamel  to 
produce  that  correct  imitation  of  the  nat- 
ural gum,  for  which  nothing  but  ceramic 
materials  have  as  yet  been  found  suitable. 
Dr.  Allen  covers  with  the  same  material 
the  entire  lingual  surface  of  the  plate, 
and  also  certain  projections  outside  of  the  molars  and  above  the 
cuspids,  designed  by  him  for  the  restoration  of  the  natural  fulness  of 
the  face. 

This  falling  in  of  the  features  is  due  to  the  absorption  of  the  alveolar 
ridge,  and  cannot  be  fully  restored  by  an  artificial  set  of  teeth,  as  usu- 
ally made ;  since,  if  the  molars  were  set  out  to  the  original  width  of 
the  teeth,  the  force  of  mastication  would  fall  outside  the  absorbed 
alveolus  and  render  it  practically  useless.  Dr.  Allen's  device  corrects 
this  sinking,  under  the  malar  prominence  of  the  superior  maxilla  and 
in  the  canine  fossa,  and  thus  greatly  aids  in  the  restoration  of  the  face 
to  its  original  appearance. 

This  process  was  patented  by  Dr.  John  Allen,  in  1851 ;  but  the 
priority  of  invention  was  contested  by  Dr.  William  H.  Hunter,  in  a 
suit,  the  progress  and  result  of  which  are  well  known  to  all  readers  of 
the  journals.  Dr.  Allen  surrendered  his  patents  of  1851,  owing  to 
certain  defects  in  the  same,  and  in  1856,  a  new  patent  was  issued  to 
him  for  the  process  as  then  improved.  The  process  is  very  generally 
known  as  "Allen's  Continuous  Gum,"  the  materials  for  which,  as  pre- 
pared by  him,  can  be  obtained  at  all  the  depots.  The  formulae  given 
in  this  chapter  are  those  of  Dr.  Hunter,  and  the  earlier  ones  of  Dr. 
Allen.  As  all  such  materials  are  more  perfectly  prepared  on  a  large 
scale,  we  think  it  much  better  to  purchase  than  to  make  them. 
.  A  "  continuous-gum "  piece,  made  in  the  most  perfect  manner,  is 
only  surpassed  in  point  of  beauty  by  the  occasional  productions  of  a 
very  few  block  carvers  ;  but  so  rare  are  these  specimens  of  perfection 


CONTINUOUS    ARTIFICIAL    GUM.  635 

in  block  work,  that  we  may  safely  say  of  the  coDtinuous-gum  work 
that,  when  properly  made,  it  is  the  most  beautiful,  as  it  certainly  is 
the  purest  and  sweetest,  that  can  be  worn  in  the  mouth,  so  long  as  the 
porcelain  covering  maintains  its  integrity.  As  regards  this  important 
point,  durability,  our  own  experience  does  not  permit  us  to  speak  con- 
fidently. It  was  thought,  when,  this  method  of  mounting  artificial 
teeth  was  first  adopted,  that  the  springing  of  the  plate  in  the  act  of 
mastication  would  cause  the  gum  to  crack  and  scale  off;  which  did 
occur  in  a  large  proportion  of  the  cases.  Although  the  injury  could 
be  repaired  by  replacing  the  loss  with  fresh  composition,  and  fusing  it 
to  the  fractured  edges  of  the  remaining  portions  and  to  the  plate,  yet 
this  formed  a  very  serious  objection  to  its  use.  But  later  improve- 
ments in  the  strength  of  the  compound,  and  also  in  the  rigidity  of  the 
plate  and  soldered  backings,  have  so  far  corrected  this  evil,  that  it  is 
perhaps  no  more  liable  to  accident  while  in  the  mouth  than  any  other 
kind  of  work.  But,  out  of  the  mouth,  its  weight  renders  it  peculiarly 
exposed  to  accident ;  a  fall  is  almost  certain  to  break  one  or  more 
teeth,  or  crack  the  silicious  covering  of  the  plate.  Hence,  it  is  neces- 
sary to  impress  upon  the  patient  the  great  importance  of  the  most 
careful  handling. 

By  uniting  the  teeth  to  each  other  near  their  base,  and  to  the  plate 
with  a  glazed  porcelanic  material,  the  cleanliness  of  the  substitute  is 
most  perfectly  secured ;  as  all  the  openings  beneath  and  around  them 
are  completely  closed,  excluding  the  secretions  of  the  mouth  and  par- 
ticles of  food,  which  have  no  affinity  for  or  action  upon  the  porcelain. 
In  this  respect,  they  are  superior  to  the  most  perfectly  mounted  block 
teeth ;  while  the  labor  of  putting  up  a  set  of  the  former  can  be  per- 
formed in  half  the  time  required  for  making  and  mounting  a  set  of  the 
latter,  A  person  who  can  mount  single  teeth  well  may  acquire  a 
knowledge  of  this  method,  with  proper  instruction,  in  a  few  weeks  : 
although  much  of  the  peculiar  talent  required  in  block-carving  is 
needed  in  arranging  the  teeth  and  shaping  the  gum  for  this  process, 
the  details  are  comparatively  simple,  and  may  soon  be  taught.  Of 
course,  much  practice  will  be  required,  especially  in  the  management 
of  the  furnace  heats.  The  necessity  for  such  practice,  to  enable  one 
successfully  to  manage  the  furnace,  is  the  chief  obstacle  to  its  casual 
use  by  the  practitioner.  Unless  he  makes  it  a  specialty,  and  does  all 
his  own  work,  and  some  for  his  neighbors,  he  will  be  certain  to  meet 
with  many  discouraging  failures  in  the  final  process  of  baking  an 
otherwise  perfectly  constructed  piece. 

We  therefore  advise  the  dentist  to  swage  the  platina  plate,  select  and 
arrange  and  articulate  the  teeth ;  for  no  one  should  be  so  competent  to 
this  as  the  one  whose  intercourse  with  the  patient  enables  him  to  judge 


636  CONTINUOUS    ARTIFICIAL    GUM, 

exactly  what  form,  color,  and  arrangement  of  teeth  are  best  suited  to  the 
case ;  and  only  he  can  decide  upon  the  correctness  of  the  fit  of  the 
plate.  But  when  all  this  is  done,  the  piece  should  be  securely  packed, 
and  sent  by  express  or  mail  to  Dr.  John  Allen,  of  New  York,  or  some 
experienced  worker  in  the  Continuous-gum.  The  piece  will  be  returned 
with  the  plate  unchanged  in  shape,  and  the  porcelain  work  executed  in 
such  style  as  can  be  reached  only  by  constant  practice  and  familiarity 
with  the  special  details  of  this  work. 

The  artificial  gum  consists,  as  we  have  stated,  of  two  parts  ;  the  first 
is  termed  the  base  or  body,  as  this  constitutes  the  principal  part  of  the 
cement,  and  is  used  for  filling  in  between  the  teeth  and  building  up  the 
gum  on  the  plate  ;  the  other  is  gum-enaviel.  The  materials  employed 
by  Dr.  Hunter,  in  the  composition  of  his  compounds,  are  silex,  fused 
spar,  calcined  borax,  caustic  potash,  and  asbestos.  The  silex  and  spar 
should  be  of  the  clearest  and  best  quality,  and  ground  very  fine. 
The  asbestos  should  be  freed  from  talc  and  other  foreign  substances, 
and  reduced  to  a  fine  powder.  He  gives  the  following  formulse  and 
directions. 

Flux. — Take  of  silex,  8  oz. ;  calcined  borax,  4  oz. ;  caustic  potash, 
1  oz.  The  potash  is  first  ground  fine  in  a  wedgewood  mortar,  and  the 
other  materials  gradually  added  until  they  are  thoroughly  mixed. 
Line  a  Hessian  crucible  (as  white  as  can  be  had)  with  pui-e  kaolin,  fill 
with  the  mass,  and  lute  on  a  cover  of  a  piece  of  fire-clay  slab  with 
the  same.  Expose  to  a  clear,  strong  fire  in  a  furnace  with  coke  fuel, 
for  about  half  an  hour,  or  until  it  is  fused  into  a  transparent  glass, 
which  should  be  clear  and  free  from  stain  of  any  kind.  This  is  broken 
and  ground  until  it  will  pass  a  bolting-sieve. 

Granulated  Body.  —  Spar,  3  oz. ;  silex,  I2  oz. ;  kaolin,  i  oz.  ; 
completely  fused.  Break  and  grind  so  that  it  will  pass  through  a 
wire  sieve  No.  50,  and  again  sift  ofi*  the  fine  particles,  which  pass 
through  No.  10  bolting  cloth,  which  leaves  it  in  grains  about  the  size 
of  the  finest  gunpowder.  It  may  be  made  of  hard  porcelain,  fine  china, 
or  wedgewood  ware. 

Body.  —  Take  flux,  1  oz.  ;  asbestos,  2  oz. ;  grinding  together  very 
finely,  completely  intermixing.  Add  granulated  body,  li  oz. ;  and 
mix  with  a  spatula  to  prevent  grinding  the  granules  of  body  any 
•finer. 

Enamels.  —  No.  1.  Flux,  1  oz. ;  fused  spar,  1  oz. ;  English  rose- 
red,  40  grains.  Grind  English  rose-red  extremely  fine  in  a  mortar, 
and  gradually  add  the  flux,  and  then  the  fused  spar,  grinding  until 
the  ingredients  are  thoroughly  incorpoi'ated.  Cut  down  a  large  Hess- 
ian crucible,  so  that  it  will  slide  into  the  mufile  of  a  furnace,  line  with 
a  mixture  of  equal  parts  silex  and  kaolin,  put  in  the  material,  and  raise 


CONTINUOUS    ARTIFICIAL,    GUM.  637 

the  heat  to  the  point  of  vitrification,  not  fusion,  then  withdraw  from 
the  muffle.  The  result  will  be  a  red  cake  of  enamel  which  will  easily 
leave  the  crucible,  which,  after  removing  any  adhering  kaolin,  is  to  be 
broken  down  and  ground  tolerably  fine.  It  may  now  be  tested,  and, 
if  of  too  strong  a  color,  tempered  by  tbe  addition  of  covering.  This 
is  the  gum  which  flows  at  the  lowest  heat,  and  is  never  used  before  sol- 
dering. 

No.  2.  Flux,  1  oz. ;  fused  spar,  2  oz. ;  English  rose-red,  60  grains. 
Treat  the  same  as  No.  1.  This  is  a  gum  intermediate,  and  is  used  upon 
platina  plates. 

No.  3.  Flux,  1  oz. ;  fused  spar,  3  oz. ;  English  rose-red,  80  grains. 
Treat  as  the  above.  This  gum  is  used  in  making  pieces  intended  to 
be  soldered  on,  either  in  full  arches  or  in  the  sections  known  as  Mock 
work.  It  is  not  necessary  to  gx'ind  very  fine_.  in  preparing  the  above 
formulae. 

Covering.  —  What  is  termed  covering  is  made  by  the  same 
formulse  as  for  the  enamel,  omitting  the  English  rose-red.  Being  with- 
out any  coloring  whatever,  it  is  used  for  tempering  the  above  enamels 
when  too  highly  colored,  which  may  be  done  by  adding,  according  to 
circumstances,  from  one  to  six  parts  of  covering  to  two  of  enamel,  thus 
procuring  the  desired  shade.  When  it  is  to  be  used  for  covering  the 
base  prior  to  applying  the  enamel,  it  may  be  covered  with  titanium, 
using  from  two  to  five  grains  to  the  ounce. 

Investient.  —  Take  two  measures  of  white  quartz  sand,  mix  with 
one  measure  of  plaster  of  Paris,  using  just  enough  water  to  make  the 
mass  plastic,  and  apply  quickly.  The  slab,  on  which  the  piece  is  set, 
should  be  saturated  with  water  to  keep  the  material  from  setting  too 
soon,  and  that  it  may  unite  with  it. 

Memoranda.  —  In  preparing  material,  always  grind  dry,  and  use 
the  most  scrupulous  cleanliness  in  all  the  manipulations.  In  all  cases 
where  heat  is  applied,  it  should  be  raised  gradually  from  the  bottom 
of  the  mufile,  and  never  run  into  a  heat.  Where  it  is  desired  to 
lengthen  any  of  the  teeth,  or  to  mend  a  broken  tooth,  it  may  be  done 
with  covering,  properly  colored  with  platina,  cobalt,  or  titanium. 

In  repairing  a  piece  of  work,  wash  it  with  great  care,  using  a  stiff 
brush  and  pulverized  pumice-stone.  Bake  over  a  slow  fire  to  expel  all 
moisture,  and  wash  again,  when  it  will  be  ready  for  any  new  applica- 
tion of  the  enamel.  Absorption,  occurring  after  a  case  has  been  some 
time  worn,  by  allowing  the  jaws  to  close  nearer,  causes  the  lower  jaw 
to  come  forward  and  drive  the  upper  set  out  of  the  mouth.  By  putting 
the  covering  on  the  grinding  surfaces  of  the  back  teeth  in  sufficient 
quantity  to  make  up  the  desired  length,  this  difficulty  may  be  to  some 
extent  remedied. 


638  CONTINUOUS    ARTIFICIAL    GUM. 

Any  alloy,  containing  copper  or  silver,  should  not  be  used  for  solder 
or  j)late,  if  it  is  intended  to  fuse  a  gum  over  the  lingual  side  of  the 
teeth,  as  it  will  surely  stain  the  gum.  Simple  platina  backs  alone  do 
not  possess  the  requisite  stiffness,  and  should  always  be  covered  —  on 
platina  with  the  enamel,  and  on  gold  with  another  gold  back.  In 
backing  the  teeth,  lap  the  backs,  or  neatly  join  them  up  as  far  as  the 
lower  pin,  in  the  tooth,  and  higher  if  admissible,  and  in  soldering  be 
sure  to  have  the  joint  so  made  perfectly  soldered. 

The  compositions,  originally  employed  by  Dr.  Allen,  consist  of — 
Body:  Silex,  2  oz. ;  flint  glass,  1  oz. ;  borax,  1  oz. ;  wedge-wood  ware, 
14  oz.;  asbestos,  2  drachms;  felspar,  2  drachms;  kaolin,  1  drachm. 
Enamel:  Felspar,  i  oz. ;  white  glass,  1  oz. ;  and  oxide  of  gold,  1 J  grs. 
Since  the  publication  of  the  seventh  edition  of  this  w'ork,  great  im- 
provements have  been  made  by  Dr.  Allen  in  the  composition  and  prep- 
aration both  of  the  body  and  gum-enamel,  which  are  furnished  by 
the  manufacturers,  and  may  be  obtained  at  any  of  the  dentists'  fur- 
nishing establishments  at  a  very  moderate  price. 

The  metals  which  may  be  employed  for  the  base  in  this  method  of 
mounting  artificial  teeth  are  platina  or  pure  palladium.  The  common 
commercial  article  of  palladium  is  not  pure,  and  is  never  used  in  this 
country.  Platina,  alloyed  with  from  one  to  ten  per  cent,  of  pure  gold, 
may  also  be  used;  but  it  is  objectionable  from  its  liability  to  spring  or 
warp.  It  makes  a  stiffer  plate,  and  so  far  has  the  advantage  over  pure 
platina,  but  for  the  reason  given  the  purest  metal  should  be  selected. 
Because  of  its  softness,  it  must  be  used  thicker  than  gold  plate.  The 
process  of  swaging  the  plate  is  the  same  as  before  given.  It  must  be 
often  annealed,  and  gradually  carried  into  any  deep  depressions,  for 
its  softness  makes  it  more  liable  than  gold  to  be  torn,  made  thin,  or 
punched  through.  A  narrow  rim,  partially  turned  up,  is  to  be  left 
around  the  outside.  The  process  of  articulating,  etc.,  is  similar  to  that 
for  gold.  In  adjusting  the  teeth,  accurate  grinding  is  unnecessary; 
but  each  tooth  should  touch  the  plate.  Part  of  each  backing  should 
lap  over  the  adjoining  ones,  and,  behind  the  six  front  teeth,  should 
also  be  lapped  over  an  additional  narrow  band,  to  give  greater  rigidity 
to  the  plate.  In  this  process,  there  is  great  opportunity  to  give  to  the 
teeth  that  irregularity  of  arrangement  which  forms  one  of  the  charac- 
teristics of  natural  teeth  ;  neglect  of  which  gives  to  many,  otherwi.se 
excellent  pieces  of  work,  an  unnatural,  artificial  appearance,  that 
shows  great  deficiency  in  the  cultivation  of  dental  (esthetics. 

Before  backing  the  teeth,  the  piece  may  be  tried  in  the  mouth,  and 
any  inaccuracy  of  ai-ticulation  readily  corrected  ;  careful  articulation 
makes  this  trial  unnecessary ;  but  if  from  any  causes  changes  are 
found  on  trial  to  be  needed,  they  can  be  made  more  readily  in  this 


CONTINUOUS    ARTIFICIAL    GUM.  639 

work  before  the  gum  is  added,  than  in  any  other ;  since  no  joints  or 
neat  fitting  to  the  plate  are  disturbed  by  changes  in  the  position  of 
a  tooth.  After  they  are  backed,  the  piece  should  be  set  in  a  mixture 
of  plaster  and  asbestos  (Dr.  Allen  prefers  asbestos  to  sand),  resting  on 
a  muffle-slide,  and  coming  up  around  the  outside  of  the  teeth,  to  keep 
them  in  place.  The  solder  used  must  contain  no  trace  of  either  silver 
or  copper,  as  they  will  stain  the  gum-enamel  and  body ;  but  must  be 
either  pure  gold,  or  alloyed  with  about  five  per  cent,  platina.  Borax 
may  be  used,  not  in  this  case  as  a  flux  —  for  where  there  is  no  oxidation 
no  flux  is  required  —  but  to  tack  the  pieces  of  solder  to  place  until 
ready  to  flow.  The  slide  is  then  gradually  carried  into  the  muffle,  and 
the  whole  piece  raised  to  the  melting-point  of  the  solder. 

The  form  of  furnace,  and  rules  for  the  management  of  the  heat, 
are  the  same  as  hereafter  given  for  block  work.  The  heat  required  for 
this  is  not,  however,  so  great  as  that  required  in  block  work ;  the  gold 
and  the  continuous-gum  materials  fusing  at  about  2200°  Fahrenheit. 

Having  thus  soldered  and  cooled  off  the  piece  very  gradually,  it 
must  be  thoroughly  washed,  so  as  to  remove  every  particle  of  invest- 
ment. Then,  with  a  camel's-hair  brush  and  small  knife,  such  as  are  used 
in  block-carvingj  the  spaces  between  the  teeth  and  plate  are  to  be 
perfectly  filled  with  a  finely-compacted  paste  of  body  and  rain-water. 
The  paste  must  be  applied  very  moist,  so  as  to  exclude  the  air  and 
run  into  all  the  spaces ;  then  dried  with  cloth  or  blotting  paper,  and 
compressed  with  the  knife.  If  the  Jingual  surface  of  the  plate  is  to 
be  covered,  this  should  be  made  rough  by  soldering  small  clippings 
of  platina  over  it,  at  the  time  the  teeth  are  soldered.  The  natural 
rugse  of  the  palate  should  be  imitated  in  the  thin  layer  of  body  which 
is  applied. 

The  work  must  then  be  slowly  and  thoroughly  dried,  and  the  piece 
put  on  a  slide  with  the  coronal  ends  of  the  teeth  downward,  and  im- 
bedded to  the  depth  of  an  eighth  of  an  inch  in  a  thick  batter  of  plaster 
and  asbestos.  But  if  the  teeth  are  very  securely  soldered,  it  will  be 
best  to  flow  the  body  with  the  plate  resting,  teeth  upward,  on  the 
plaster  and  asbestos  model  on  which  the  soldering  was  done.  The 
slide  is  then  gradually  introduced  into  the  muffle,  and  subjected  to 
a  heat  sufficiently  high  to  fuse  the  compound  — say,  twenty-two  hun- 
dred and  fifty  degrees.  It  is  then  withdrawn  slowly,  and  completely 
cooled.  Usually  there  will  be  cracks  and  flaws  which  need  filling 
with  paste.  The  outside  rim  is  also  to  be  turned  down  over  the  edge 
of  the  body  with  hammer  and  pliers,  and  any  defects  at  this  point 
filled  up ;  then  heat  a  second  time  with  the  same  care  as  at  first. 

The  piece,  now  ready  for  enamelling,  should  present  a  semi-vitrified 
appearance ;  if  too  highly  glazed,  it  is  too  much  done,  and  the  enamel 


640  PLASTIC    WORK. 

will  not  take  so  firm  a  hold ;  if  too  dull-looking,  it  is  not  sufficiently 
baked,  and  will  be  deficient  in  strength.  The  enamel  must  be  applied 
moist,  and  is  be-st  put  on  with  a  brush  :  much  plastering  with  the  knifis 
makes  it  apt  to  fly  off  in  baking,  and  for  the  same  reason  it  must  be 
heated  very  gradually.  The  layer  of  enamel  should  be  thin  and  irreg- 
ular, the  yellowish  white  of  the  body  showing  more  or  less  through 
it,  so  as  to  give  the  variations  of  tint  observed  in  the  natural  gum. 
If  a  thick  and  even  layer  is  applied,  the  result  will  be  an  unnatural 
uniform  color,  which  will  destroy  much  of  the  peculiar  beauty  of  this 
work. 

The  greatest  care  is  necessary,  in  applying  the  paste,  to  remove 
every  particle  from  the  parts  of  the  teeth  and  plate  which  are  not  to 
be  covered,  as  it  adheres  with  great  tenacity  and  roughness,  and  dis- 
figures these  parts.  Much  experience  is  also  necessary  in  determining 
the  exact  heat  necessary  to  develop  the  full  beauty  and  strength  of 
the  work.  Repeated  heatings,  either  for  the  first  making  or  for  re- 
pairs, do  not  injure  the  plate  or  teeth,  provided  i^roper  care  is  taken  to 
heat  and  cool  gradually ;  and  provided,  in  case  of  repair,  the  piece  is 
thoroughly  cleaned  in  strong  soda,  to  remove  all  trace  of  the  buccal 
secretions. 

This  work  is  peculiarly  adapted  to  full  lower  dentures.  The  prin- 
ciples of  construction  are  precisely  the  same,  only  the  plate  should  be 
very  heavy,  and  the  extra  band  behind  the  six  or  eight  front  teeth 
very  thick  and  strong.  Many  use  it  for  partial  cases  ;  for  which,  how- 
ever, the  author  does  not  regard  it  as  well  suited.  The  three  distin- 
guishing advantages  of  the  continuous-gum  work  are  its  ready  adapta- 
bility to  every  variety  in  shape  of  gum  and  arrangement  of  teeth,  its 
extreme  beauty,  and  its  great  cleanliness  ;  its  three  disadvantages  are 
its  weight,  its  liability  to  be  broken  by  accident,  and  inapplicability 
to  partial  cases. 


CHAPTER  XIV. 

MOULDED   PLATES   OF   PLASTIC   MATERIALS. 

IX  the  classification  of  operations,  for  the  Replacement  of  Teeth, 
given  on  pages  485-7,  difierence  in  the  order  of  these  operations 
was  made  the  ground-work  of  a  division  of  all  base-plates  into  two 
classes :  Swaged  and  Plastic.  In  describing,  up  to  the  point  of 
completion  of  the  model,  the  operations  common  to  both  classes,  the 


PLASTIC    WOEK.  641 

modifying  requirements  of  each  were  duly  considered.  The  special 
order  and  details  of  swaged  work  were  then  taken  up,  with  incidental 
allusions  to  plastic  work,  by  way  of  comparison  or  contrast.  Operations, 
materials,  and  apparatus  peculiar  to  the  latter,  will  form  the  subjects 
of  this  and  succeeding  chapters. 

Plastic  work  includes  all  dental  substitutes,  in  which  the  base- 
plate is  brought  into  contact  with  the  teeth  and  the  model  of  parts  to 
be  fitted,  whilst  in  a  fluid  softened  or  plastic  condition,  then  hard- 
ened, during  continuance  of  this  contact,  either  by  the  application 
or  the  withdrawal  of  heat.  Plasticity,  as  thus  used,  is  the  property  of 
being  moulded,  and  has  already  been  spoken  of  as  an  essential  quality 
of  impression  materials.  In  them  it  is  associated  with  other  qualities 
especially  fitting  them  for  their  particular  use ;  so  in  plastic  work,  mere 
plasticity  is  of  no  avail,  if  other  properties  do  not  give  to  the  material 
the  qualities  essential  to  a  base-plate.  It  must  have  strength  and 
durability,  and  must  be  in  harmony  with  the  parts  to  which  it  is 
applied.  This  harmony  implies  that  it  shall  not  act  injuriously  upon 
the  mouth,  or  receive  injury  from  it ;  that  it  shall  not,  in  form,  color, 
taste,  or  smell,  be  repulsive  to  paLients.  It  ought  not,  if  possible,  to  h  e 
even  objectionable ;  but  tastes  are  so  variable,  that  this  contingency 
cannot  be  a  positive  ground  for  exclusion  of  an  otherwise  valuable 
material. 

As,  in  swaged  work,  there  are  four  metals  of  which  plates  may  be 
formed  —  gold,  platinum,  aluminum,  and  silver  —  so,  in  plastic  \york, 
there  are  four  varieties  of  plastic  material  of  which  plates  may  be 
moulded:  1,  Porcelain  clay;  2,  tin  and  its  alloys;  3,  sulphurated  gum;. 
4,  aluminum.  The  first  two  have  been  longest  in  use;  the  third  has; 
become  the  most  important  in  modern  dentistry ;  the  fourth  and  latest 
has  yet  to  pass  the  ordeal  of  experience.  The ^irs^  is  moulded  by  tools,, 
not  in  flasks,  as  are  the  other  three ;  it  also  requires  intense  heat  to 
vitrify  or  harden  it.  The  second  is  made  plastic  by  fusion,  requiring 
a  flask,  hot  to  prevent  cracking  of  teeth,  and  tight  to  prevent  escape 
of  metal :  these  plates  harden  by  cold.  The  third,  less  plastic,  demands 
force  in  the  act  of  moulding :  it  is  hardened  by  heat ;  but  the  tempera- 
ture to  which  the  teeth  are  subjected  is  less  than  in  the  other  three. 
The  fourth  is  made  plastic  by  fusion  ;  but,  though  more  plastic  than 
the  third,  it  does  not  flow  as  readily  as  the  second ;  its  extreme  light- 
ness and  sluggish  flow  necessitates  peculiar  apparatus  in  moulding. 

Comparing  them  in  respect  of  certain  other  properties  —  weight, 
durability,  strength,  and  necessary  thickness  of  plate;  arnount  of 
change  in  shape  from  contraction  ;  resistance  to  change  by  the  action 
of  the  buccal  fluids  —  Gum  is  lightest;  aluminum,  being  thinner,  is^ 
very  nearly  as  light;  porcelain,  though  a  light  substance,: requires  suck 
41 


642  PORCELAIN    PLATES. 

bulk,  that  it  is  heavier  than  either  ;  tin  and  its  alloys  are  heaviest 
Gum  plates,  properly  made,  are  strong,  durable,  and  may  be  as  thin 
as  any,  except  aluminum  ;  aluminum  plates  are  thinnest  and  strongest, 
their  durability  is  still  an  open  question  ;  tin  alloys  are  variable,  some 
being  tough  and  strong,  others  stiff  and  brittle,  others  soft  and  flexi- 
ble ;  they  have  about  the  same  bulk  as  gum,  and  the  best  are  perhaps 
nearly  or  quite  as  durable.  Porcelain  plates  contract  very  much  ; 
aluminum  much  less,  but  still  very  considerably ;  tin  alloys  contract 
very  slightly ;  gum  has  no  contraction.  Porcelain  most  perfectly 
resists  the  buccal  secretions  and  substances  taken  into  the  mouth; 
gum  nearly  on  quite  as  effectually;  tin  alloys  undergo  some  change; 
aluminum  is  not  changed  by  sulphur,  as  silver  is,  but  will  probably  be 
found,  in  some  mouths,  to  undergo  slight  change. 

To  give  uniformity  of  nomenclature,  the  four  varieties  of  plastic 
work  will  be  classed  under  three  heads.  1.  Ceramo-plastic,  or  porcelain. 
2.  Metallo-plastic,  includiug  tin,  cheoplastic  metal,  other  tin  alloys, 
and  aluminum.  3.  Vulcano  -  plastic,  including  caoutchouc,  gutta- 
percha, and  all  vegetable  substances  that,  by  combination  with  sulphur, 
iodine,  etc.,  have  the  property  of  hardening  by  heat,  under  the  process 
known  as  "  vulcanizing." 

CERAMO-PLASTIC   WORK. 

Porcelain  plates  are  remarkable  for  cleanliness,  and,  in  the  hands 
of  a  skilful  worker  in  the  ceramic  art,  may  have  great  artistic  beauty. 
There  are,  however,  several  considerations  that  must  prevent  their  ex- 
tensive use.  Like  continuous-gum  work,  ceramic  plates  are  adapted 
only  to  full  sets.  They  are  frail,  occasionally  breaking  under  the 
force  of  powerful  mastication  ;  they  will  inevitably  break,  falling  on 
any  very  hard  surface.  It  is  but  just,  however,  to  state  that  the  few, 
who  make  porcelain  plates  a  specialty,  claim  that  they  are  no  more 
liable  to  accident  than  other  pieces ;  that  the  teeth  of  all,  especially 
continuous-gum,  are  as  apt  to  break  as  this  work ;  and  that  a  broken 
tooth,  or  plate,  is  more  easily  and  quickly  mended  in  porcelain-plate 
work  than  in  any  other. 

A  second  objection  is  the  great  shrinkage  of  any  strong  porcelain 
substance.  Efforts  to  correct  in  the  material  itself,  this  shrinkage, 
makes  it  proportionately  weak.  Correction  by  enlargement  of  the 
model  is  not  only  troublesome,  but  it  is  uncertain :  the  same  is  true  of 
the  correction  by  grinding  with  corundum  -  wheels,  which  is  very 
tedious,  and  cannot  be  exact.  When  base-plates  were  made  of  ivory, 
and  fitted  to  the  mouth  by  carving,  this  imperfection  of  porcelain 
plates  w^as  not  objected  to,  because  the  former  fitted  no  better,  if  as 
well :  but  in  contrast  with  the  exact  adaptation  of  other  forms  of  plas- 


BASE-PLATES    OF    TIN    AND    TIN-ALLOYS.  643 

tic  work,  and  of  swaged  plates,  it  becomes  very  manifest.  There  are 
many  mouths  in  which  a  porcelain  plate  could  not  be  retained  at  all; 
there  are  others  which  adapt  themselves  so  readily  to  moderate  inac- 
curacies, that  such  a  plate  is  worn  with  entire  satisfaction. 

A  third  objection  is  the  necessity  of  constant  practice,  to  keep  up 
that  skill  in  ceramic  art  which  is  essential  to  an  artistic  piece,  and  to 
insure  uniformity  of  result  by  proper  control  of  the  furnace.  This 
difficulty,  however,  can  be  met  in  the  same  way  as  in  continuous-gum 
work.  If  the  dentist  will  make  the  model,  select  and  articulate  the 
teeth,  arrange  them  on  a  temporary  plate  with  wax,  to  give  the  ful- 
ness of  gum,  and  a  sample  tooth  to  show  its  color,  then  pack  se- 
curely, and  send  to  any  block-carver  or  porcelain  teeth  manufacturer, 
he  can  have  a  porcelain  plate  made  better,  and  with  more  certainty, 
than  only  an  occasional  practice  will  enable  him  to  do  for  himself.  If 
it  is  desired  that  the  teeth  and  plate  shall  be  carved  at  the  same  time, 
it  will  be  sufficient  to  send  correct  model  and  articulation,  with  direc- 
tions as  to  the  style,  color,  etc.,  of  the  teeth.  We  think,  hoAvever,  that 
it  will  be  safer  for  the  dentist  to  select  and  arrange  the  teeth,  as  he 
can  better  judge  what  is  appropriate  than  one  who  does  not  see  the 
patient. 

For  details  of  construction,  the  reader  is  referred  to  other  chapters. 
Impression  and  model  are  made  like  any  other  work ;  articulating 
processes  are  the  same  as  for  other  forms  of  plastic  work  ;  grinding  teeth 
is  very  simple,  as  in  continuous-gum  work;  enlargement  of  the  "fur- 
nace model  "  and  manipulation  of  the  porcelain  mixture  will  be  de- 
scribed in  the  chapter  on  Porcelain. 

The  second  and  fourth  varieties  of  Plastic  work  will  be  described  in 
the  next  chapter,  under  the  head  of  Metallo-Plastic  Work.  The  third 
variety  will  form  the  subject  of  the  subsequent  chapter,  under  the  head 
of  Vulcano-Plastic  Work. 


CHAPTER  XV. 

METALLO-PLASTIC  WORK. 


THE  use  of  a  fusible  metal  in  the  construction  of  base-plates  is  by 
no  means  new  ;  but  many  of  the  metallic  compounds  suggested,  or 
now  used  for  this  purpose,  are  of  quite  recent  introduction.  Except 
aluminum,  none  of  them  fuse  above  the  melting-point  of  tin,  440°. 
Pure  Tin  is  the  oldest  form  of  metallo-plastic  base-plate,  and  was  used 


644  BASE-PLATES    OF    TIN    AND    TIN-ALLOYS. 

exclusively  for  the  lower  jaw.  It  is  objectionable  on  account  of  its 
softness  ;  even  in  a  heavy  lower  rim,  it  is  apt  to  bend,  and  for  an  upper 
plate  it  is  wholly  unsuited.  In  its  resistance  to  chemical  change  in  the 
mouth,  it  stand:*  next  to  gold  and  platinum;  is  superior  to  silver  and 
probably  to  aluininura;  superior  also,  in  this  respect,  to  any  of  its  own 
alloys..  The  proce.ss  of  constructing  a  lower  plate  of  pure  tin  is  the 
same  as  for  any  of  the  tin-alloys. 

Tin  may  be  made  harder  and  more  rigid  by  alloying  with  Silver, 
Copper,  Antimony,  Zinc,  Lead,  Bismuth,  or  Cadmium.  Copper  and 
lead  make  it  unfit  for  the  mouth  ;  antimony,  zinc,  and  bismuth  make 
it  brittle,  unless  used  in  very  moderate  proportion.  Silver  gives  it 
hardness,  also  cadmium,  without  imparting  the  objectionable  properties 
named.  Probably  the  best  of  all  alloys  for  tin  is  cadmium.  Closely 
resembling  tin  in  its  physical  properties,  it  hardens  it  without  making 
it  too  brittle,  or  imparting  increased  liability  to  the  action  of  fluids  of 
the  mouth.  The  majority  of  tin-alloys  at  present  recommended  for 
base-plates  contain  cadmium,  with  some  zinc,  antimony,  or  bismuth  : 
they  ought  not  to  contain  copper  or  lead.  In  absence  of  their  for- 
mulas of  composition,  it  is  impossible  to  say  that  they  will  prove  inju- 
rious or  harmless  in  the  mouth,  or  that  they  will  undergo  no  change 
by  time.  Even  if  we  knew  the  formulas,  it  would,  in  some  cases,  be 
impossible  to  speak  positively  on  thi*  point. 

The  primary  strength  of  any  of  these  alloys  can  be  easily  detected; 
with  rather  more  trouble,  its  fusion-point  and  free  flowing  qualities  may 
be  learned.  For  all  else,  the  safest  rule  is  to  use  any  or  all  of  them 
"under  protest,"  until,. by- personal  observation,  every  one  ascertains 
for  himself  how  far  they  are  free  from  change,  or  keep  their  original 
strength  after  being  worn.  It  may  be  thought  that  such  distrust  of 
the'  assertions  of  others-  is  unprofessional.  Possibly  it  may  be ;  but 
what  other  course  is  open  to  any  careful  operator,  in  the  face  of  such 
circulars  as  the  one  just  received  by  the  writer,  in  which  a  certain 
"  rubber  preparation  "  is  recommended,  as  enabling  the  dentist  to  com- 
plete a  set  of  teeth  in  "  one  hour  after  taking  the  impression."  The  sad 
truth  is  too  notorious  for  concealment,  that  the  inventors  of  dental 
"improvements"  are  like  the  discoverers  of  quack  medicines  —  they 
mao-uify  excellences,  conceal  defects,  substitute  assertion  for  evidence, 
and  claim  a  confidence  in  their  inventions  which  should  only  be  the 
slow  growth  of  experience. 

Experiments  in  tin-alloys,  unlike  those  in  vulcanite  compounds,  are 
easily  made  by  any  well-informed  dentist :  he  can  have  his  favorite  tin- 
alloy,  as  he  has  his  pet  solder,  both  the  result  of  his  own  experiment- 
ing. He  can  judge  at  once  of  certain  properties;  for  others,  he  must 
wait  the  teachings  of  experience.     If  he  prefers  to  use  the  labor  of 


CHEOPLASTIC    PROCESS,  645 

another,  and  buy  an  alloy  which  pleases  him,  hut  'of  which  he  really 
knows  nothing,  why  should  not  full  judgment  upon  this  also  be  sus- 
pended until  a  jury  of  his  patients  have  rendered  their  verdict. 

CHEOPLASTIC    METAL. 

This  alloy  was  patented  by  Dr.  A.  A.  Blandy,  of  London,  in  1856, 
together  with  certain  processes  used  in  the  construction  of  dental  plates. 
The  manipulations,  since  so  familiar  in  the  working  of  vulcanite,  were 
then  as  unknown  as  vulcanite  itself  The  peculiar  merits  of  plastic 
work  were  at  once  recognized  by  many  of  the  profession ;  and  the  Cheo- 
plastic  process  would  have  passed  into  very  general  use,  with  such  modi- 
fications as  experience  may  have  dictated,  had  it  not  been  for  the 
introduction  of  Hard  Rubber.  After  some  years'  contest,  the  profession 
decided  in  favor  of  rubber.  Dr.  Blandy's  departure  from  the  States  in 
1862,  and  the  failure  of  the  supply  of  his  metal,  led  to  a  total  disiase 
of  the  cheoplastic  metal. 

The  abuses  of  vulcanite,  and  the  gross  mismanagement  of  Rubber 
Patents,  have  urged  many  advocates  of  plastic  work  to  revert  to  vari- 
ous tin-alloys,  which  are,  in  their  principle  of  composition,  and  in  the 
essential  character  of  the  processes  employed,  identical  with  Dr. 
Blandy's  patents.  The  name  chosen  by  him  (signifying  the  making 
of  plates,  by  pouring  a  metal,  made  plastic  by  heat)  is  equally  applica- 
ble to  all  alloys  of  tin  now  used.  The  alloy  of  the  cheoplastic  metal 
was  silver,  with  some  bismuth,  and  a  trace  of  antimony.  The  exact 
jtroportions  are  not  known,  but  may  be  learned  by  reference  to  the 
patents.  The  alloy  imparted  no  taste  whatever  to  the  mouth;  and  its 
purity,  so  far  as  its  capability  of  resisting  the  action  of  the  secretions 
of  the  buccal  cavity  is  concerned,  was  said  to  be  equal  to  eighteeu-carat 
gold.  Its  color  became  slightly  darker  after  being  worn  some  weeks, 
but  was  immediately  restored  by  placing  it  in  a  strong  solution  of  caus- 
tic potash. 

Many  details  of  Dr.  Blandy's  process  were  adopted  in  the  construc- 
tion of  vulcanite ;  whilst  some  of  them  may  be  advantageously  modified 
by  the  use  of  moulding-flasks,  etc.,  contrived  for  the  latter.  The  mode  of 
forming  a  cheoplastic  model,  before  the  invention  of  the  flask,  is  shown 
in  Fig.  221,  page  550,  and  may  be  used  in  the  absence  of  flasks  of  the 
proper  size.  If  the  plate  is  to  have  a  vacuum  cavity,  one  of  the  proper 
size,  depth,  shape,  and  position  should  be  cut  in  the  impression  ;  this, 
if  of  plaster,  is  varnished,  then  placed  on  a  piece  of  foil  or  paper,  and 
surrounded  with  soft  putty,  clay,  or  other  plastic  substance.  The  lower 
edge  of  a  tin  ring  is  then  slightly  imbedded  in  the  putty,  large  enough 
to  leave  a  space  of  over  half  an  inch  between  the  impression  and  the 
ring,  for  the  formation  of  an  articulating  surface  for  the  two  parts  of 


646 


CHEOPLASTIC    PROCESS. 


the  matrix :  at  the  back  part,  the  space  should  be  an  inch  and  a  lialf, 
so  that  it  may  also  be  used  as  part  of  the  antagonizing  model :  also  by 
the  length  of  the  "gate,"  to  give  weight  to  the  melted  metal.  The 
model  should  be  an  inch  thick,  measured  from  its  shoulder,  and  is  made 
of  equal  parts,  by  weight,  of  plaster  and  finely  pulverized  spar.  This 
composition  is  not  so  hard  as  plaster  alone,  but  is  sufficiently  so  for  all 
practical  purposes :  if  desirable,  the  density  of  surface  may  be  increased 
by  the  use  of  dilute  soluble  glass.  The  directions  previously  given  for 
niaking  models  are  here  to  be  observed.  Several  models  can  often  be 
taken  from  the  same  impression.  When  the  alveolar  ridge  projects,  it 
is  sometimes  necessary  to  cut  away  the  outer  part  of  the  impression 
before  the  separation  can  be  effected  ;  when  this  is  done,  care  is  necessary 
to  prevent  injuring  the  model.  Having  removed  the  impression,  the 
prominence  which  is  to  form  the  cavity  in  the  base-plate  may  be  altered 
and  trimmed  before  proceeding  further. 

The  next  thing  to  be  done  is  to  make  an  antagonizing  model :  as  the 
method  of  obtaining  it  for  this  process  is  different  from  any  heretofore 
given,  we  subjoin  a  brief  description.  Two  or  three  conical  holes  are 
made  in  the  back  part  of  the  model,  for  the  proper  adjustment  of  the 
antagonizing  portion,  (Fig.  295:)  a  coating  of  varnish  or  soap-water, 

or  very  thin  foil,  is  applied  to 
every  part  except  that  which  is 
to  be  covered  by  the  base-plate : 
this  part  is  now  covered  with  a 
plate  of  thick  tin-foil,  stiffened 
by  the  application  of  a  thick 
sheet  of  wax  or  gutta-percha.  A 
rim  of  wax  is  then  placed  along 
the  alveolar  border  and  trimmed 
1^^  down  with  a  knife  until  its  depth 
is  a  little  greater  than  the  length 
required  for  the  artificial  teeth. 
Remove  this  articulating  plate, 
place  it  in  the  mouth,  and  if  the 
rim  is  found  to  be  properly 
shaped,  request  the  patient  to 
bite  upon  it,  closing  the  lower 
jaw  naturally,  until  a  distinct  imprint  of  all  the  lower  teeth  is  made 
in  it.  (See  Fig.  295.)  The  wax  and  plate  are  then  removed  from  the 
mouth,  replaced  on  the  model,  and  the  other  half  of  the  articulator 
made ;  first  covering  the  centre  of  the  plate  C  and  the  flanges  B  B  with 
paper  pulp,  so  that  it  shall  articulate  only  with  the  back  A  of  the  half- 
matrix  and  copy  the  impressions  of  the  teeth  in  the  wax. 


Fifi.   29.5. 


CHEOPLASTIC    PEOCESS. 


647 


This  half  is  then  removed,  also  the  articulating  plate;  and  the  por- 
tion of  the  model  representing  the  alveolar  ridge  and  roof  of  the 
mouth  is  to  be  covered  with  a  fresh  plate  of  tin.     This  is  accurately 


Fig.  296. 


moulded  to  the  various  depressions  and  prominences  with  the  finger, 
and  with  hard  rolls  of  chamois  leather,  cut  nearly  to  a  point  at  each, 
end,  called  stumps  (Fig.  296),  such  as  are  used  by  artists.  One  or  two 
extra  strips  of  foil  should  be  placed  over  the  alveolar  ridge  and  under 
the  foil  plate,  to  secure  sufficient  thickness  of  metal  between  the  teeth. 
and  gums.     A  plate  of  prepared  sheet  wax  or  gutta-percha,  No.  20, 


Fio.  208. 


(gauge  plate,  Fig.  208)  in  thickness,  covering  only  so  much  of  the 
model  as  is  to  be  occupied  by  the  metallic  base,  is  carefully  moulded  to 
the  tin-foil  plate,  and  trimmed  to  the  required  shape  (Fig.  297). 

The  teeth  are  now  selected,  ground,  and 
fitted  to  the  foil-plate,  from  the  outer  edge 
of  which  the  wax  should  be  removed,  to 
permit  the  adaptation  of  the  teeth  or  blocks. 
The  foil-plate  also  should  be  cut  away  from 
the  front  of  the  ridge,  when  the  teeth  are 
to  be  set  directly  upon  the  gum.  Gum 
teeth,  either  single  or  in  blocks  of  two  or 
three,  are  preferable  to  plain  teeth.  As 
they  are  arranged  upon  the  model,  the  ap- 
proximate sides  should  be  ground  until  they  come  together  so  perfectly 


648 


CHEOPLASTIC    PROCESS. 


Fig.  299. 


at  every  point  as  to  render  the  line  of  union  scarcely  perceptible.  The 
teeth  used  in  this  process  are  constructed  differently  from  those 
designed  for  swaged  plates.  Teeth  and  blocks  having  holes  or  dove- 
tail grooves  were  used  at  the  first  introduction  of  the  cheoplastic  pro- 
cess. A  sectional  view  of  these  single  and  block  teeth  is  given  in 
Fig.  298,  the  shaded  line  representing  the  metal.  These  teeth  are 
no  longer  made,  having  been  superseded  by  the  more  desirable  forms 
designed  for  vulcanite  work.  Fig.  299  represents  one  of  the  many  of 
these  designs,  manufactured  by  Dr.  S.  S.  White. 
Ordinary  plate  teeth  can  be  used  and  attached  by 
^bending  the  platina  pins,  if  long  enough,  until  the 
ends  come  together.  As  it  is  not  a  matter  of  import- 
ance whether  the  base  of  the  teeth  fit  closely  to  the 
wax-plateornot,  it  is  rarely  necessary  to  do  much  grind- 
ing, except  when  the  teeth  are  too  long,  or  when  the 
part  of  the  ridge  requires  careful  fitting. 
Each  tooth  or  block,  after  having  been  properly  ground,  is  secured 
by  applying  melted  wax  to  the  inner  surface,  which  fills  the  holes  or 
grooves,  and  unites  with  the  plate  beneath.  The  antagonizing  models 
are,  from  time  to  time,  applied  to  each  other  to  insure  accuracy  of 
adjustment:  if  the  bite  of  the  lower  teeth  has  been  correctly  taken, 
no  alteration  will  be  necessary  in  the  piece  upon  trying  it  in  the 
mouth.  The  amount  of  wax  applied  to  the  backs  of  the  teeth,  after 
the  grooves  or  holes  are  filled,  should  equal  the  amount  of  metal 
required  to  unite  them  firmly  to  the  base.  This  may  be  done  by 
putting  a  narrow  strip  extending  around  the  inside  of  the  arch,  or  it 


Fig.  300. 


may  be  applied  in  small  pieces ;  in  either  case  using  the  wax-knife, 
(Fig.  300,)  warmed  by  a  small  spirit-lamp,  to  unite  the  strip  or  pieces 
to  the  teeth  and  wax-plate.  Another  strip  is  applied  along  the  upper 
edge  and  on  the  outside  of  the  teeth,  filling  the  groove  above  the  gum, 
and  uniting  it  to  the  teeth  and  plate  with  the  wax-knife.  This  strip 
should  be  long  enough  to  pass  behind  the  last  tooth  or  block  on  each 
side,  and  unite  with  the  wax  on  the  lingual  surface.  As  metal  is 
ultimately  to  take  the  place  of  the  wax,  it  is  important  that  the  exact 
quantity  required  be  put  on,  and  every  part  made  perfectly  smooth. 
This  may  be  done  with  the  warm  wax-knife  and  brushes.  (Fig.  301.) 
The  larger  for  pressing  it  dow'n  upon  the  model,  and  the  smaller  for 
smoothing  it  between  the  teeth,  where  the  wax-knife  cannot  be  con- 


CHEOPLASTIC    PROCESS.  649 

veniently  employed.     The  use  of  prepared  gutta-percha  plates  will 

Fig.  301. 


Fig.  302. 


save  time,  by  limiting  the  use  of  the  wax-knife  and  brushes,  and 
give  a  more  uniform  plate.  In 
proportion  as  this  part  of  the 
operation  is  neatly  and  skilfully 
executed,  will  the  labor  of  finish- 
ing, after  the  metal  has  been 
poured,  be  lessened.  An  upper 
set  of  single  gum  teeth,  thus 
arranged  on  a  wax  or  gutta- 
percha plate  upon  the  model,  is 
represented  in  Fig.  302.  If  there 
is  any  doubt  as  to  the  proper 
adjustment  of  the  teeth,  the  piece 
may  now  be  tried  in  the  mouth ; 
any  necessary  alteration  must  be 
made  before  proceeding  further 
with  the  work. 

When   single   teeth   without 

Fig. -303. 


G50 


CHEOPLASTIC    PROCESS. 


Fig.  304. 


gums  are  used,  the  strip  of  wax  in  front  and  on  each  side  is  pressed 
between  them,  and  the  festooned  appearance  of  the  natural  gum  given 
to  it.  A  set  thus  prepared  is  represented  in  Fig.  303,  giving  an  ex- 
ternal view  of  the  festooned  wax-band.  The  work  is  placed  in  the  tin 
rin^"-  in  whicli  (Fig.  221,  page  550)  it  was  made  —  the  upper  edge  of  the 
rino-  projecting  about  a  fourth  of  an  inch  above  the  summits  of  the 

teeth,  as  shown  in  Fig.  304.  The 
exposed  surfaces  of  the  model, 
after  cutting  broad  grooves  on  the 
shoulder  of  this  half  of  the  matrix, 
(see  white  lines  of  Fig.  303,)  to 
keep  the  two  parts  in  proper  re- 
lation, and  of  the  wax  (but  not 
of  the  teeth),  are  to  be  well  oiled, 
or  covered  with  thin  foil,  and  the 
second  half  of  the  matrix  made 
of  the  mixture  of  plaster  and  spar 
above  given.  It  is  of  utmost  im- 
portance that  the  plaster  batter 
should  be  worked  into  all  the  joints 
and  interstices  between  the  teeth, 
and  be  free  from  air-bubbles  ;  for 
the  metal  searches  into  the  most 
minute  space,  and  the  attempt  to  cut  off  some  little  button  of  metal 
between  teeth  often  results  in  their  fracture.  When  the  mixture 
becomes  hard,  the  ring  is  removed,  and  the  part  of  the  matrix  first 
made  is  tapped  lightly  with  a  small  mallet ;  the  two  may  then  be  easily 
separated  :  but  if  there  is  any  undercut,  or  thin  ridge,  the  matrix  must 
be  warmed  before  separation,  so  as  to  soften  the  wax.     This  done,  a 

groove  or  gate,  and  on  each 
side  of  it  two  vents,  are  to 
be  cut  in  the  back  part  of 
the  matrix,  which  contains 
the  teeth  and  wax-plate; 
through  which  gate  the 
melted  alloy  is  to  be 
poured,  the  air  escaping 
through  the  two  vents. 

The  length  of  the  gates 
and  vents  adds  to  the  press- 
ure  on   the   fluid    metal, 
and  insures  more  certainty 
in  the  flow  of  the  plate.     It  is  well  to  have  the  flask  of  such  shape  as 


Fig.  305. 


CHEOPLASTIC    PROCESS. 


651 


Fig.  306. 


to  give  a  gate  at  least  two  inches  long.  Fig.  305  represents  the  gate 
and  vents,  also  one-half  of  the  wax-plate  removed,  showing  the  ends 
of  a  set  of  plain  teeth.  All  necessary  trimming  of  the  plaster  is 
done  before  the  wax  is  removed,  to  prevent  small  pieces  from  falling 
in  the  matrix  by  the  sides  of  the  teeth.  The  main  body  of  the  wax 
is  now  removed,  as  the  absorption  of  any  considerable  portions  left 
in  the  matrix  has  a  tendency  to  roughen  the  surface,  and  thus  to  pre- 
vent the  metal  from  running  as  smoothly  as  it  would  otherwise  do ; 
but  no  attempt  should  be  made  to  remove  the  wax  around  the  teeth 
or  pins :  these  small  remnants  of  wax  will  totally  disappear  in  the  pro- 
cess of  heating  up.  After  removing  the  wax,  each  half  of  the  matrix 
may  be  held  over  the  flame  of  a  tallow  candle^  until  a  slight  coating 
of  lampblack  forms  on  it.  The  two  parts  are  now  bound  firmly  to- 
gether with  iron  wire,  and  the  line  of  union  luted  with  a  mixture  of 
plaster  and  spar,  leaving  the  gates  and  vents  open.  This  is  done  to 
prevent  the  escape  of  the  metal  when  poured,  which  sometimes  requires 
additional  means  of  security.  One  method  is  to  put  the  matrix,  after 
wiring  it,  with  the  gate 
and  vents  upward,  into 
a  sheet-iron  or  tin  rim 
(Fig.  306),  partially  filled 
"with  a  batter  of  plaster 
and  spar. 

Another  method  is  to 
bury  the  matrix  in  sand, 
in  a  sheet-iron  box,  about 
four  inches  square ;  and 
in  this  sand-bath  to  heat 
it  up,  until  some  of  the 
cheoplastic  metal,  placed 
on  the  sand,  begins  to  fuse. 
Or  the  piece,  set  in  the 
rim  (Fig.  306),  may  be 
placed  in  a  kitchen  range  or  bake-oven,  and  exposed  to  a  bread-baking 
heat,  say  from  300^  to  400°  Fahrenheit,  for  from  three  to  five  hours, 
or  until  every  particle  of  moisture  is  driven  from  it ;  then  placed  in  an 
upright  position,  the  melted  metal  poured  quickly  into  the  matrix.  If 
there  is  no  ebullition,  and  the  metal  comes  up  into  the  vents  freely,  the 
piece  will  come  from  the  matrix  in  a  perfect  condition.  If  it  bubbles, 
it  may  be  lightly  tapped  several  times  on  some  hard  surface.  When 
perfectly  cold,  the  two  parts  of  the  matrix  are  separated,  exposing  one 
of  the  surfaces  of  the  plate. 

When  the  process  is  properly  conducted  from  the  beginning  up  to 


652 


CHEOPLASTIC    PROCESS, 


the  point  of  pouring  the  metal,  the  piece  will  come  from  the  matrix 
perfect  in  all  its  parts.  But  when  the  metal  fails  to  flow  freely  around 
the  teeth,  and  to  cover  perfectly  the  alveolar  border  and  palatine  arch, 
it  is  better  to  replace  the  removed  half  of  the  matrix;  then,  turning 
the  gate  down,  heat  it  up  to  the  melting-point  of  the  metal ;  place 
again  in  the  sand-bath,  and  pour  a  second  time.  Attempts  are  some- 
times made  to  patch  the  plate  where  the  defects  are  small ;  but  it  will 
prove  far  more  satisfactory  in  the  end  to  pour  it  entirely  anew.  The 
matrix  should  become  entirely  cold  before  any  attempt  is  made  to 
remove  the  piece ;  otherwise,  there  will  be  danger  from  the  sudden 
exposure  of  warm  teeth  to  the  air.  The  dried  felspar  and  plaster 
mixture  is  easily  cut;  dipping  it  in  water  will  make  it  still  softer,  and 
more  easily  removed. 

If  care  has  been  used  in  shaping  the  wax-plate,  if  the  plaster  has 
been  kept  free  from  air-bubbles,  and  if  the  joints  between  gum  teeth  or 
blocks  have  been  nicely  jointed  and  filled,  on  their  front  edge,  in  the 
plaster  moistened  with  soluble  glass,  the  piece  may  be  finished  with 
little  trouble.  The  gate  and  vents  and  irregular  edges  of  the  plate 
may  be  sawed  off"  or  removed  with  coarse  files ;  fine-cut  files  become 
clogged  with  the  metal.     Scrapers  (Fig.  307)  are  made  for  removing. 


Fig.  807. 


the  roughness  of  surface;  curved  and  rounded  for  the  inner  surface; 
flat,  straight-edged,  and  pointed  for  outer  surfaces  or  dental  interstices. 
If  carelessness  in  making  the  wax-plate  renders  it  necessary  to  cut 
away  much  thickness  of  metal,  the  lathe-burrs  used  for  vulcanite  will 
be  found  useful.  In  reducing  the  thickness  of  plates,  frequent  use  of 
calipers  (Figs.  308,  309)  is  necessary  to  avoid  the  accident  of  cutting 
through  the  plate.  This  is  especially  apt  to  happen  in  the  use  of 
lathe-burrs.  Fig.  309  should  have  the  tips  on  one  side  pointed  as  in 
Fig.  308,  and  they  should  be  occasionally  examined,  to  see  if  both 
sides  come  together  alike.    It  will  make  the  use  of  calipers  more  easy. 


CHEOPLASTIC    PEOCESS. 


653 


if  the  arms  are  kept  permanently  open  by  an  elastic  band,  closing  by 
pressure  of  the  fingers  at  each  trial  of  the  plate.  _  Graduated  calipers 
are  useful  also  for  measuring  the  depth  of  articulating  rims,  the 
length  of  teeth,  etc.,  and  are  quite  indispensable.  This  done,  the  sur- 
face is  rubbed  first  with  coarse  and  afterward  with  fine  emery-cloth, 
then  washed  in  soap  and  water  with  a  hard  brush,  afterward  burnished 
and  finished  by  polishing  with  chalk  on  a  brush-wheel ;  coarse  Scotch- 
stone  may  be  used  in  place  of  the  emery-cloth.  The  upper  surface  of 
the  plate  must  neither  be  scraped  nor  polished,  as  the  accuracy  of  its 
adaptation  to  the  gums  and  palatine  arch  would  be  injured :  it  should 

Fig.  308. 


Fig.  309. 


be  washed  simply  well  with  a  brush,  using  perhaps  a  little  whiting. 
Every  other  part  ought  to  be  finished  in  the  neatest  and  most  per- 
fect manner ;  the  piece  is  put  in  a  strong  solution  of  caustic  potash, 
boiled  for  two  or  three  minutes,  then  washed  in  pure  water,  wiped 
dry,  and  finished  with  chalk  and  the  brush-wheel. 

Under  no  circumstances  should  the  cheoplastic  metal,  or  any  other 
tin-alloy,  be  gilded.  The  least  imperfection  of  the  electrotype  deposit, 
or  the  abrasion  of  any  edge  or  prominence,  or  the  removal  of  the  coat- 
ing by  trimming  the  plate  at  any  point,  presents  to  the  fluids  of  the 
mouth  two  metals  having  widely  different  galvanic  relations ;  electric 


654 


CHEOPLASTIC    PROCESS. 


action  is  inevitable,  causing  decomposition  of  the  plate,  annoyance  to 
the  patient,  and  often  ulceration  of  the  gum.  The  cheoplastie  metai, 
and  some  other  tin-alloys,  are  quite  harmless  in  the  mouth.  They  all 
slightly  tarnisii,  but  the  surface  oxitle  seems  to  protect  from  further 
action,  except  where  abraded  by  the  mastication  of  food.  The  brilliant 
polish  of  new  work  cannot  be  kept  so  long  as  on  a  gold  plate,  because 
it  is  much  softer  ;  this,  however,  is  of  secondary  importance,  provided 
the  metal  is  hard  enough  to  resist  wearing  away  under  the  necessary 
operations  of  use  and  of  cleansing. 

In  mounting  a  set  of  teeth  for  the  lower  jaw,  the  gate  through  which 
the  metal  is  poured  into  the  matrix  should  have  two  lateral  branches, 
one  on  each  side,  to  admit  the  metal  more  freely.  The  wax-plate  should 
also  be  thicker,  to  give  sufficient  strength  and  stability  to  the  base  ;  in 
other  respects,  the  process  is  the  same  as  that  described  for  an  upper 
set.  For  a  partial  lower  set  of  molars  and  bicuspids  on  each  side,  the 
wax-plate  should  be  extended  behind  the  remaining  front  teeth ;  and 
two  or  three  thicknesses  should  be  applied  here,  giving  stiffness  suffi- 
cient to  prevent  breaking  or  bending  under  the  pressure  of  mastication. 
In  making  an  antagonizing  model  for  an  entire  set  of  teeth,  the  wax- 
plate  for  the  lower  jaw  is  stiffened  by  the  adjustment  of  a  stout  iron 
wire,  bent  to  the  curvature  of  the  arch,  and  made  fast  to  and  partly  bed- 
ded in  the  plate.  The  rim  of 
wax  is  now  arranged  on  the 
ridge,  and  after  being  properly 
trimmed,  it  is  taken  from  the 
model.  Upper  and  lower  plates 
are  then  adjusted  in  the  mouth  ; 
the  articulation  is  obtained,  and 
the  articulator  (Fig.  310)  made 
in  the  manner  described  for  a 
full  set  of  teeth  mounted  on  gold 
plate.  Fig.  311  represents  a 
double  set  of  teeth  arranged  in  wax  upon  a  plaster  articulation,  ready 
to  be  placed  upon  their  respective  models  preparatory  to  the  formation 

of  the  remaining  halves  of  the 
F'«-  311-  matrices  (Fig.  304).     The  Cheo- 

plastie process  is  also  applicable  to 
partial  sets  of  teeth  :  a  single  tooth, 
or  several  teeth  situated  in  dif- 
ferent parts  of  the  arch,  can  be 
replaced,  and  retained  so  as  to 
occasion  no  inconvenience  or  an- 
noyance to  the  patient.  The 
only  precaution  necessary  to  be 


FiQ.  310. 


CHEOPLASTIC    PROCESS.  655 

observed  in  their  construction,  in  addition  to  that  of  accuracy  of  ad- 
justment and  neatness  of  execution,  is  to  thicken  the  projections  of 
the  wax -plate  between  the  remaining  natural  teeth  sufficiently  to 
give  strength  to  the  metal  at  these  points.  These  portions,  Avhen  very 
narrow,  should  have  twice  the  thickness  of  the  other  parts  of  the  plate. 
Clasps  cannot  be  used,  as  the  metal  itself  has  no  elasticity,  and  gold 
clasps  could  not  be  connected  to  such  plates.  With  this  exception,  the 
forms  of  partial  pieces  for  this  work  are  the  same  as  for  vulcanite 
work,  hereafter  described.  After  having  adjusted  the  artificial  teeth, 
and  made  them  fast  to  the  wax-plate,  the  teeth  of  the  model  should  be 
cut  off  before  making  the  other  half  of  the  matrix,  as  it  would  be 
almost  impossible  to  separate  the  two  halves  without  breaking  the  teeth 
and  other  important  parts. 

But  if  iron  flasks  are  used,  similar  to  those  designed  for  vulcanite,  it 
is  not  necessary  to  cut  off  the  teeth.  In  the  same  manner,  as  here- 
after described  for  that  work,  the  model  may  be  set  in  the  deep  half  of 
the  flask  until  the  edges  of  the  teeth  are  nearly  or  quite  level  with  the 
edge  of  the  flask :  the  investing  plaster  supports  the  outside  of  the  teeth, 
and  prevents  breakage  on  separating  the  flask. 

A  piece  from  which  one  or  more  teeth  have  been  broken  can  be 
easily  repaired.  If  any  portion  of  the  tooth  remain  it  is  removed,  and 
the  metal  that  united  it  to  the  base  filed  away :  a  new  tooth  is  selected, 
and  ground  until  it  corresponds  with  the  adjoining  teeth ;  it  is  then 
put  in  place,  and  wax  applied  on  the  outside  and  inside  of  the  tooth, 
smoothing  it  with  the  warm  wax  -  knife  evenly  with  the  plate.  The 
apex  of  a  conical- shaped  roll  of  wax,  about  an  inch  and  a  half  in 
length,  is  united  to  the  wax  on  the  back  part  of  the  tooth  :  the 
apex  should  be  little  more  than  an  eighth,  and  the  base  half  an  inch  in 
diameter,  which  latter  should  be  half  an  inch  above  the  edge  of  the 
teeth.  A  small  stem  of  wax  is  united  to  the  wax  on  the  outside  of  the 
tooth,  with  the  free  extremity  half  an  inch  above  its  edge.  A  tin  ring, 
smaller  than  that  used  in  making  the  model,  is  now  filled  about  one- 
third  full  of  plaster  and  spar  mixture,  and  the  piece  put  immediately 
in  it  with  the  base  downward,  first  filling  the  irregularities  of  the  plate 
with  the  plaster :  a  thin  mixture  of  the  same  composition  is  then  poured 
on  top,  filling  the  ring,  and  covering  the  edges  of  the  teeth  about  a 
quarter  of  an  inch.  When  hard,  the  ring  is  removed,  and  the  project- 
ing stems  of  wax  withdrawn  :  the  wax  on  each  side  of  the  tooth,  and 
between  it  and  the  base,  will  be  melted  and  absorbed  during  the  drying 
process.  The  matrix  is  dried  in  a  stove  or  furnace,  as  in  the  first 
instance,  being  careful  not  to  heat  it  up  to  the  point  of  fusion  of  the 
plate.  The  alloy  is  then  melted,  and  poured  into  it  through  the  gate 
behind  the  tooth  :  and  if  it  flows,  filling  the  vent  in  front  without  bub- 


656  STANNIC    ALLOYS. 

bliug,  the  piece  will  come  from  the  matrix  perfectly  restored.  "When 
cold,  the  plaster  and  spar  are  broken  from  the  teeth,  and  the  metal 
around  the  new  tooth  finished  according  to  the  direction  given  for 
full  sets.  In  repairing  pieces,  the  heating  of  the  matrix  and  metal 
must  be  done  very  carefully.  If  the  matrix  is  too  hot,  the  plate  may 
fuse;  if  too  cool  and  the  melted  metal  too  hot,  porcelain  may  be 
cracked.  In  using  cheoplastic  metal  and  all  other  tin-alloys,  in  con- 
nection with  platina  pins,  it  should  be  remembered  that  the  exposure 
of  a  single  rivet  to  the  action  of  the  buccal  fluids  forms  a  galvanic 
battery,  which  will  cause  an  unpleasant  taste,  and  render  the  piece 
liable  to  slow  decomposition  ;  hence  all  pins  must  be  carefully  covered 
with  metal,  so  as  not  to  be  exposed  in  the  finishing  processes. 

STANNIC   ALLOYS. 

The  details  of  the  Cheoplastic  process  have  been  given  in  their  origi- 
nal form,  with  few  modifications.  These  have  been  adopted  and  im- 
proved upon  in  the  vulcanite  manipulations,  as  will  be  shown  in  the 
next  chapter.  The  cheoplastic  metal  is  the  pioneer  of  the  numerous 
allovs  of  Tin  (stannum)  which  are  now  claiming  the  attention  of  th(! 
profession  as  substitutes  for  vulcanite.  We  have  elsewhere  spoken  of 
the  necessity  of  testing  all  such  alloys  in  the  crucible  of  *"'  practice." 
We  shall  mention  only  two :  those  of  Dr.  B.  Wood,  and  that  of  Dr.  H. 
Weston.  The  first,  because,  next  to  the  cheoplastic  metal,  they  have  been 
longest  known  to  the  profession,  particularly  those  alloys  adapted  to 
the  filling  of  teeth.  The  last,  because  it  is  very  strong,  flows  well,  and, 
in  the  short  time  it  has  been  observed  by  us,  retains  its  color  well. 

Of  the  composition  of  Dr.  Weston's  alloy,  we  know  nothing  beyond 
an  assurance  that  it  contains  no  copper  or  lead.  It  may  be  better  than 
any  of  its  competitors,  closely  resembling  it ;  but,  in  ignorance  of  the 
formulai  of  any  of  them,  we  can  only  say  what,  perhaps,  if  we  knew 
these  formulae,  we  might  still  say  —  submit  to  the  test  of  experience 
that  which  seems  to  be  the  best.  Dr.  Wood's  alloys  are  the  result  of 
an  elaborate  series  of  very  careful  experiments  made  some  ten  years 
ago.  His  plate-alloys  consist  mainly,  perhaps  altogether,  of  tin  and 
cadmium  :  they  vary  in  fusibility,  hardness,  and  rigidity,  but  are  nearly, 
if  not  all,  more  fusible  than  Weston's  metal.  The  following  instruc- 
tions, in  connection  with  what  have  been  given  for  cheoplastic  work 
and  what  remain  to  be  given  for  vulcanite,  will  be  a  sufficient  guide 
in  the  construction  of  plates  made  of  Wood's,  Weston's,  or  any  other 
Stannic  alloy. 

Teeth  for  rubber-work  are  best  suited  for  this,  with  the  following  pre- 
cautions :  First :  Grind  off"  the  thin  upper  edge  of  gum  teeth  or  sec- 
tions :  the  anterior  band  is  useful  in  rubber,  and  does  no  harm ;  if  of 


STANNIC    ALLOYS. 


65: 


metal,  it  is  apt  to  crack  the  block,  and  is  unnecessary,  as  teeth  are 
rather  more  firmly  set  in  metal  than  in  rubber ;  hence,  no  metal  should 
overlap  the  upper  edge  of  the  gum.  Secondly:  In  jointing  blocks,  do 
it  as  squarely  as  possible  ;  if  merely  the  edges  of  gum  touch,  the  slight 
contraction  of  the  alloy  may  cause  them  to  scale  or  break.  If,  however, 
from  accident  or  necessity,  this  last  kind  of  joint  occurs,  do  as  in  sol- 
dering blocks  to  gold  plate — place  a  thin  piece  of  paper  in  the  joint, 
before  securing  it  to  the  wax-plate.  Before  drying  the  flasks,  this  slight 
space  caused  by  the  paper  may  be  closed  with  plaster  and  soluble  glass, 
to  prevent  metal  from  running  in  and  making  a  metallic  seam  on  the 
front  of  the  block.  Thirdly  :  Be  careful  to  cover  the  pins  with  the  wax 
which  gives  shape  to  the  metal,  so  that  in  finishing  up  the  latter  they 
will  not  be  exposed. 

Instead  of  the  cheoplastic  matrix,  the  vulcanite  flask  (Fig.  312)  may 

Fig.  312. 


be  used,  by  filing  out  at  the  back  a  central  opening  and  two  small 
side  openings,  corresponding  to  the  gate  and  vents.  But  this  does  not 
give  sufficient  length  of  gate  ;  and  there  is  occasionally  a  failure  of  the 
plate  in  such  flasks,  from  want  of  the  force  given  by  a  larger  head  of 
metal.  Hence,  a  much  better  flask  is  one  recently  made  for  Weston's 
metal,  shaped  like  the  above,  except  that  it  extends  about  two  inches 
further  back ;  it  also  has  two  flanges  in  front,  to  allow  it  to  stand 
firmly  while  the  metal  is  being  poured.  It  is  very  important  to  clamp- 
it  well  before  pouring,  that  the  weight  of  fluid  metal  may  not  separate 
the  halves  of  the  flask ;  the  slightest  space  will  allow  much  or  all  the 
metal  to  flow  out. 

Instead  of  the  felspar  used  by  Dr.  Blandy,  the  plaster  may  be 
mixed  with  soapstone  powder,  pumice-powder,  or  clean  white  sand. 
Asbestos  would  prevent  shrinkage,  but  its  fibres  would  interfere  with, 
the  free  flowing  of  the  batter.  The  same  care  in  heating  the  flask  is 
necessary  as  before  stated,  remembering  that  plaster  confined  in  metal 
flasks  takes  longer  to  become  dry.  The  flasks  would  be  much  im- 
proved by  having  a  dozen  or  more  holes  drilled  through  ends  and 
sides,  to  aid  the  escape  of  moisture ;  they  could  be  temporarily  closed 
42 


658  STANNIC    ALLOYS. 

with  wax  while  making  the  matrix.  It  is  not  safe  to  pour  under  less 
than  three  hours'  drying ;  and  this  must  never  be  done  in  direct  con- 
tact with  flame.  Moisture  is  one  of  the  products  of  combustion  in  all 
flame,  and  is  largely  absorbed  by  the  plaster;  hence  plaster  over  flame 
can  never  be  made  perfectly  dry,  uuless  contained  in  some  box,  say  of 
sheet-iron,  excluding  this  vapor. 

Directions  for  heating,  pouring,  cooling  off,  and  finishing  are  the 
same  as  given  for  cheoplastic  work.  We  have  seen  pieces  made  of 
Weston's  alloy  which,  after  cutting  off"  the  gate  and  vents,  were  ready 
for  the  emery-cloth  and  brush-wheels.  This  result  can  be  uniformly 
secured  by  care  in  shaping  the  wax  and  proper  attention  to  tempera- 
ture in  pouring.  These  alloys  have  a  slight  shrinkage,  not  sufficient 
to  break  blocks  or  chip  the  edges,  if  the  directions  above  given  are 
observed.  The  slight  shrinkage  gives  these  plates  an  advantage  over 
vulcanite,  in  point  of  adaptation.  Directions  for  repairs  are  the  same 
as  in  the  cheoplastic  metal.  It  is  also  recommended  to  mend  a  broken 
tooth  by  investing  as  for  gold  soldering;  then  dry  the  piece,  use 
muriate  of  zinc  for  aflux,  and  solder  with  blow-pipe  or  soldering-iron. 
After  melting  one-half  the  pieces  and  disfiguring  the  half  of  the  re- 
mainder, it  will  probably  be  concluded  that  the  seemingly  more  tedious 
process  is  the  shortest.  Still,  we  do  not  object  to  trial  of  the  blow-pipe 
and  soldering-iron ;  experience  is  the  best  of  all  teachers,  perhaps 
because  she  enforces  her  teachings  by  such  hard  blows. 

The  strength  of  the  Wood  or  Weston  metal  permits  its  use  for  par- 
tial pieces,  and  allows  stays  to  be  formed  on  the  plate ;  but  full  clasps 
cannot  be  made,  because  alloys  of  this  class  are  uot  sufficiently  elastic. 
The  form  of  such  plates  will  be  discussed  in  the  next  chapter.  In  pre- 
paring the  above  directions,  we  have  discarded  some  innovations  upon 
Dr.  Blaudy's  process,  as  being  anything  but  improvements :  such,  for  in- 
stance, as  the  recommendation  to  heat  to  210°,  or,  "so  that  it  can  hardly 
be  held  in  the  hand,"  a  flask  containing  teeth  on  to  which  a  metal 
is  to  be  suddenly  poured  at  a  temperature  of  440°.  This  temperature 
may  be  quite  sufficient,  however,  for  some  of  Dr.  Wood's  alloys.  The 
safest  rule  in  all  cases,  except  for  repairs,  is  to  heat  up  to  the  fusion- 
point  of  the  alloy.  As  an  offset  to  this  error,  we  notice  a  good  sugges- 
tion for  removing  small  remnants  of  wax  by  washing  out  with  hot 
water.  It  has  an  advantage  over  the  plan  of  allowing  the  hot  dry 
plaster  to  absorb  the  wax,  in  permitting  examination  of  the  pins  and 
joints,  and  allowing  closure  of  front  joints  with  plaster ;  also,  by  ena- 
bling the  mould  to  be  thoroughly  cleansed  just  before  closing,  it  pre- 
vents the  accidental  retention  of  small  particles  of  plaster,  which  may 
interfere  with  the  flow  of  the  metal. 


ALUMINUM    WORK.  659 


ALUMINUM   "WORK. 

In  answer  to  the  question  constantly  asked  by  students  whether 
aluminum  or  aluminium  is  correct,  we  offer  the  following  explanation 
of  the  spelling  adopted  at  the  head  of  this  section: 

This  metal  is  in  nearly  all  works  on  chemistry  called  Aluminium, 
making  it  similar  in  termination  to  twenty-three  other  metallic  bases 
discovered  by  modern  science,  and  known  by  Latinized  names  ending  in 
ium.  None  of  these,  however,  have  any  practical  value  in  the  Arts  as 
metals,  except  Cadmium,  Magnesium,  Palladium,  Rhodium,  and  Iridium. 
The  last  three  names  are  taken  from  classical  Latin,  the  first  two  are 
Latinized  from  Cadmeia  and  Magnesia.  These  five  metals,  therefore, 
we  would  leave  with  their  chemical  terminations  unchanged ;  the  first  two 
for  euphony,  the  last  three  out  of  respect  for  antiquity.  But  we  prefer 
the  termination  mn  for  the  metallic  base  of  alumina  for  three  reasons  : 
First,  chemical  nom^clature  does  not  demand  m>?i,  since  Molybdenum, 
Platinum,  Arsenicum,  and  all  the  metals  known  to  the  ancients  end  in 
urn  except  Mercurium ;  secondly,  the  same  change  which  makes  cad- 
mium and  magnesium  from  cadmeia  and  magnesia,  makes  platinum 
and  aluminum  from  platina  and  alumina;  thirdly,  because  this  ending 
is  uniform  with  Aurum,  Platinum,  Argentum,  Cuprum,  Zincum,  and 
Stannum,  with  which  useful  group  of  metals  it  has  physical  properties 
in  common,  rather  than  with  the  larger  group  of  metallic  bases,  known 
only  in  the  chemical  laboratory. 

Sir  Humphry  Davy  inferred,  from  his  discovery  of  sodium  and 
potassium,  that  alumina  was  the  oxide  of  a  metallic  base.  This  con- 
jectural metal,  named  Aluminium,  was  subsequently  discovered  by 
Wohler,  but  remained  for  more  than  twenty  years  a  mere  chemical 
curiosity,  until,  in  1854,  St.  Clair  Deville  succeeded  in  manufacturing 
it  in  large  ingots  by  the  action  of  sodium  upon  the  chloride  of  alumi- 
nium ;  but  the  cost  of  metallic  sodium  made  this  an  expensive  pro- 
cess. He  subsequently  obtained  it  by  the  action  of  chloride  of  potas- 
sium upon  the  once  rare  mineral  Cryolite  —  an  alumino-fluoride  of 
sodium,  large  deposits  of  which  have  been  discovered  in  Greenland. 

All  rocks,  except  limestones  and  some  sandstones,  contain  alumina; 
and  it  enters  largely  into  the  composition  of  all  clay  and  slate  rocks ; 
hence,  next  to  oxygen,  which  constitutes  one-half  of  the  globe,  and 
silicon,  which  forms  one-fourth,  alumina  is  the  most  universally  dif- 
fused of  all  metallic  oxides,  and  aluminum  is  the  most  abundant  of  all 
metals.  The  vast  beds  of  iron-ore  become  insignificant  compared  with 
the  ore-beds  of  aluminum.  As  iron  is  now  the  most  useful  as  well  as 
the  most  abundant  of  all  metals,  it  may  not  be  unreasonable  to  antici- 
pate a  time  when  the  extent  and  variety  of  uses  to  which  aluminum 


660  ALUMINUM    WORK. 

vill  one  day  be  applied  shall  he  proportioned  to  the  vastness  of  its  ore- 
beds.  The  present  use  of  aluminum,  in  dentistry  and  in  the  arts  gen- 
erally, bears  a  small  proportion  to  its  future  use,  when  its  properties 
shall  become  developed,  the  manner  of  working  it  better  understood, 
its  metallurgy  simplified,  and  its  relations  to  other  metals  ascertained 
by  experiment.  Its  valuable  qualities  now  known,  and  its  history 
during  the  sixteen  years  just  past,  go  far  to  justify  these  expectations. 
We  shall  give  a  brief  summary  of  the  present  state  of  knowledge  of 
aluminum. 

It  is  the  lightest  metal  known  except  magnesium  (excepting  also,  of 
course,  sodium  and  potassium)  ;  its  specific  gravity  is  2.56  for  cast 
metal  and  2.67  for  hammered  metal,  about  the  weight  of  glass  or  por- 
celain. Its  point  of  fusion  is  somewhere  near  1000°  Fahrenheit.  It 
is  malleable,  laminable,  and  ductile  in  a  high  degree;  has  a  hardness 
equal  to  silver  and  excels  it  in  point  of  tenacity ;  is  eight  times  better 
than  iron  as  a  conductor  of  electricity,  being  nearly  equal  to  silver. 
Unlike  silver,  it  wholly  resists  tbe  action  of  sulphur,  also  of  nitric 
acid,  unless  it  is  boiling.  Sulphuric  acid  does  not  affect  it,  nor  do  the 
vegetable  acids,  as  citric,  oxalic,  and  tartaric.  Its  proper  solvents  are 
hydrochloric  acid  and  chlorine.  It  is  somewhat  affected  by  the  caustic 
alkalies,  soda  and  potash;  also,  perhaps,  by  ammonia  and  quicklime. 
A  solution  of  salt  and  vinegar  is  said  to  affect  it,  possibly  due  to  a 
liberation  of  the  chlorine  in  the  salt. 

Its  record  of  resistance  to  change  by  acid  and  alkali  is  a  very  fair 
one,  and  gives  rise  to  the  conjecture  of  possible  impurity  of  metal,  in 
explanation  of  the  cases  reported  in  which  aluminum  plates  undergo 
change  in  the  mouth.  The  conjecture  is  strengthened  by  the  pecu- 
liarity of  thi&  change ;  it  occurs  in  spots,  seeming  to  indicate  some 
local  impu'rity  or  alloy,  not  by  a  general  discoloration  of  the  plate,  such 
as  we  see  on  eighteen-carat  gold,  or  silver,  and  on  the  stannic  alloys. 
Hence  we  infer  that  a  perfectly  pure  aluminum  plate  will  probably 
resist  the  secretions  of  the  mouth  ;  also  that  it  is  desirable  to  avoid 
placing  in  the  mouth  alloys  of  aluminum  wath  zinc,  tin,  or  cadmium-, 
and  that  alloys  with  gold,  silver,  or  platina  will  prove  less  valuable 
than  the  pure  metal.  The  subject  of  aluminum  alloys  in  connection 
with  the  mouth  and  as  solders  is  an  open  field  of  inquiry,  which  is  at 
this  time  being  diligently  explored  by  Drs.  Keep,  Starr,  Franklin,  and 
others :  these  researches  may  some  day  be  crowned  with  the  discovery 
of  an  aluminum  base-plate  equal  in  all  respects  to  gold  plate,  with  the 
peculiar  advantage  of  its  remarkable  lightness.  Present  experience  is 
unfavorable  to  its  power  of  resisting  the  buccal  secretions. 

Aluminum  plates  are  swaged,  teeth  backed  and  soldered  by  the 
blow-pipe,  just  as  in  gold  work.     The  best  solder  for  this  purpose  is 


ALUMINUM    WORK,  661 

probably  Dr.  Starr's,  containing  seven  parts  aluminum  to  one  of  pure 
tin.  Soldering  is  also  done  with  a  copper  soldering- tool  similar  to  that 
used  by  tinners ;  sometimes  by  the  combined  action  of  both.  But  the 
results  as  yet  reached,  in  the  experiment  of  soldering  aluminum,  da 
not  justify  us  in  recommending  this  form  of  plate^  hence  we  shall  not 
give  any  description  of  the  processes  referred  to,  although  esteeming 
them  highly  as  experiments.  The  swaging  of  aluminum  is  done  just 
as  in  case  of  gold  or  platinum,  except  that  frequent  annealing  is  neces- 
sary. The  annealing  must  be  done  with  extreme  care,^ince  the  fusion- 
point  of  the  metal  is  so  little  above  red  heat  that  the  slightest  excess 
of  heat  will  warp,  blister,  or  melt  the  plate.  The  extreme  lightness 
of  this  metal  permits  the  use  of  a  plate  two  or  three  times  the  thick- 
ness of  gold  plate ;  hence  aluminum  plates  may  be  the  very  strongest 
that  can  be  made  in  any  given  case.  The  best  method  yet  proposed 
for  attaching  the  teeth  to  such  a  plate  is  by  vulcanite,  the  details  of 
which  process  will  be  given  in  the  next  chapter.  It  is  a  peculiarity 
of  pure  aluminum  that  vulcanized  rubber  adheres  to  it  with  great 
tenacity.  A  set  of  well-chosen  block  teeth,  skilfully  arranged,  and 
secured  to  an  accurately  fitting  aluminum  plate,  may  safely  be  offered 
to  the  most  fastidious  and  critical  patient.  It  has,  moreover,  the  great 
advantage  that  "sixty-minute"  dentists  will  not  care  to  imitate  work 
which  takes  "  several "  hours  to  do  even  passably  well. 

Another  form  of  aluminum  work,  and  that  which  has  led  to  the 
present  classification  of  this  metal  under  the  head  of  Plastic  work,  is 
the  moulded  or  cast  aluminum  plate.  Experiments  in  this  direction 
have  been  made  during  the  past  ten  years.  None,  however,  seem  to 
us  to  have  been  conducted  with  such  care  as  those  of  the  late  Dr. 
James  B.  Bean,  of  Baltimore,  who  perished  under  an  avalanche,  in  the 
summer  of  1870,  whilst  ascending  Mont  Blanc. 

Dr.  Bean's  inventive  ingenuity  and  remarkable  -dexterity  are  dis- 
played in  his  well  known  "Interdental  Splint"  for  fracturesof  the  jaw; 
also  in  the  apparatus  hereafter  described,  as  well  as  in  many  valuable 
suggestions  in  dental  mechanics.  In  placing  the  "aluminum  process" 
of  our  lamented  friend  before  the  reader,  we  shall  take  the  liberty  of 
entirely  remodelling  his  paper  now  before  ^s,  omitting  details  already 
given  common  to  other  work ;  avoiding  also  that  minuteness  of  detail, 
which,  however  desirable  in  a  special  pamphlet  of  "  Instructions,"  is 
out  of  place  in  a  general  text-book ;  aiming  to  present  such  a  condensed 
statement  of  the  process  as  will  best  display  its  distinguishing  merits. 
We  shall  also  omit  certain  points,  as  to  the  value  of  which  Dr.  Bean 
had  expressed  to  us  some  doubts,  and  shall  make  several  modifications, 
which,  in  our  last  conversation  with  hiva,  were  ackno^vledged  to  be 
improvements. 


662  CAST    ALUMINUM    PLATES. 

Dr.  Bean's  Process.  —  The  details  of  this  process  should  be  classified 
in  order  to  get  a  clear  idea  of  the  difficulties  to  be  overcome,  and  the 
ingenious  devices  by  which  this  is  accomplished.  Dr.  Bean's  earlier 
experiments  demonstrated  the  inevitable  cracking  of  block  work  in 
any  attempt  to  cast  the  aluminum  in  direct  contact  with  the  teeth ; 
hence  the  plate  is  first  made  fitting  all  the  irregularities  of  the  blocks; 
the  teeth  are  then  slightly  changed  to  suit  the  contracted  size  of  the 
plate.  The  contraction  of  aluminum  is  so  considerable  that  it  inter- 
feres with  correct  adaptation  of  the  plate  in  many  cases ;  hence  a 
plaster  mould  is  taken  and  a  second  model  made,  so  as  to  give  three 
expansions  of  plaster,  as  an  offset  to  this  contraction.  The  lightness 
and  sluggish  flow  of  aluminum  is  another  difficulty;  this  is  overcome 
by  the  height  of  the  conduit,  and  by  the  preparatory  injection  of  gas 
or  hydrogen  into  the  matrix,  with  a  view  to  exclude  the  oxygen  of  the 
air,  supposed  by  Dr.  Bean  to  interfere  with  the  perfect  flow  of  this 
metal. 

The  processes  peculiar  to  Dr.  Bean's  method  are  1.  The  construction 
of  sectional  model  and  mould;  2.  The  manner  of  making  the  matrix, 
arranging  the  flask,  and  pouring  the  aluminum ;  3.  The  mode  of  attach- 
ing the  teeth  to  the  plate.  These  will  be  minutely  described  ;  but  of 
other  operations,  such  as  the  impression,  articulation,  grinding  of  teeth, 
and  finishing,  only  so  much  of  his  description  will  be  given  as  is  pecu- 
liar to  this  method,  or  may  contain  some  valuable  suggestion  not 
before  mentioned. 

In  taking  impressions  for  full  or  for  partial  cases.  Dr.  Bean  always 
used  plaster  in  a  brass  cup,  swaged  for  each  case,  and  coated  with  cot- 
ton fibre  as  described  in  the  chapter  on  impressions.  In  place  of  the 
band,  there  mentioned  crossing  the  plate,  he  often  used  a  stout  wire, 
grasping  it  with  pliers  or  forceps,  if  more  force  was  necessary  in  remov- 
ing the  impression  than  could  be  conveniently  exerted  by  the  fingers. 
In  partial  cases  he  found  that  the  cotton  fibre  prevented  the  total  sepa- 
ration of  pieces  necessarily  broken,  and  made  their  readjustment  more 

easy.  The  impression  is  partly  dried,  then 
varnished  and  oiled;  it  is  then  ready  for 
making  the  first  plaster  model. 

The  impression  cup  is  carefully  surround- 
ed with  a  narrow  strip  of  sheet  wax,  (Fig. 
313,)  softened  and  tacked  to  the  edge  by  the 
aid  of  a  hot  wax-knife.  In  lower  cases,  this 
rim,  on  the  inside,  should  cross  from  ridge 
to  ridge ;  in  partial  cases,  it  should  fill  the 
spaces  corresponding  to  the  natural  teeth. 
The  impression  is  then  filled,  turned  down 


CAST    ALUMINUM    PLATES. 


663 


Fig.  314. 


upon  the  remaining  batter  on  the  plaster-table,  and  moulded  into  shape 
with  the  spatula ;  then  trimmed  with  the  knife  as  usual,  with  slightly 
flaring  sides.  (See  Figs.  315,  318,  and  319.)  Another  method  is  to 
surround  the  impression  with  putty,  clay,  or  paper-pulp,  as  hereto- 
fore described,  and  set  upon  this  a  tin  ring  or  lead  band,  (Fig.  314,) 
curved  so  as  to  give  proper  flare  to 
the  sides  of  the  model ;  then  pour 
the  plaster,  remove  the  rim,  detach 
the  impression,  and  trim  as  before. 
In  deep  upper  arches,  and  in  all 
lower  cases,  the  model  should  be 
made  in  two  halves,  as  described  on  page  553,  by  means  of  the  leaden 
septum  (Fig.  226) ;  otherwise  the  expansion  of  the  central  portion 
(c,  d,  /,  Figs.  318  and  319)  of  the  plaster  mould  will  be  apt  to  break 
the  model. 

It  is  important  that  the  plaster  of  this  model,  and  of  the  mould  next 
to  be  made  upon  it,  shall  have  as  much  expansion  as  possible.  Dr. 
Bean's  experience  was  that  thin  plaster  expands  more  than  a  thick 
batter,  and  quick  plaster  more  than  the  slow-setting :  our  own  expe- 
rience is  that  coarse-grained  plaster  makes  a  stronger  and  more  expan- 
sive model  than  the  fine-grained  variety.  If,  therefore,  model  and 
mould  are  made  of  coarse,  quick-setting  plaster  made  into  a  thin  batter, 
the  extreme  limit  of  expansion  will  be  secured. 

The  model  is  to  be  dried  sufficiently  for  varnishing;  then  coated  with 
shellac  or  sandarach  varnish  until  a  glazed  surface  is  given;  then  well 
oiled,  and  placed  in  position  (Fig.  315)  for  making  upon  it  the  plaster 
mould.     This  must  be  made  in  sections, 
otherwise  mould  and  model  cannot  be 
separated ;  for  the  plaster  mould  will 
not  in  any  case  yield  like   the  sand 
mould,  used  in  swaged  work.     Before 
making  this  mould,  Dr.  Bean  directs 
the  formation  of  the  prominence  for 
the  vacuum  cavity,  expressing  himself 
as  "  decidedly  in  favor  of  shallow  cavi- 
ties, and   some  of  our  best   operators 
are  recommending  none  at  all.     If  this 

principle  holds  good  in  other  kinds  of  work,  it  is  still  more  advisable 
in  aluminum,  on  account  of  the  superior  fit.  The  principal  advantage 
of  the  cavity  in  a  permanent  set  is  in  easily  securing  a  firm  adhesion 
at  first,  consequently  giving  to  the  patient  satisfaction  at  once.  In 
temporary  sets,  the  piece  is  often  held  firmly  by  the  cavity,  long  after 
an  amount  of  absorption  has  taken  place,  that  would  entirely  prevent 


Fig,  315. 


664 


CAST    ALUMINUM    PLATES. 


the  plate  from  being  sustained  without  such  aid.  When  an  air-cham- 
iber  must  be  used,  take  a  piece  of  sheet-lead,  which  should  seldom  be 
thicker  than  one-thirtieth  of  an  inch,  or  about  No.  22,  Stubbs'  gauge. 
Cut  this  to  proper  size  and  shape,  and  press  it  into  place  on  the  model 
by  the  fingers,  and  with  the  aid  of  a  blunt-pointed  burnisher,"  The 
prominence  may  also  be  formed  by  cutting  a  corresjjonding  depression 
in  the  mould  (see  /,  Fig.  317)  ;  this  we  think  the  better  plan,  when 
the  model  is  made  in  two  parts.  As  to  tl>e  propriety  of  using  the  cavity 
at  all,  our  views  are  elsewhere  fully  given ;  a  very  shallow  cavity  in 
plastic  Avork  is  the  least  objectionable  form  of  the  vacuum  cavity. 

For  making  the  mould,  the  model  is  surrounded  by  a  flaring  leaden 
band  (Fig.  314)  or  tin  ring,  curved  as  in  Figs.  316  and  317 ;  if  of  tin, 


Fig.  316. 


Fia.  317. 


it  must  be  closed  with  a  clamp  (not  soldered),  so  as  to  permit  free 
expansion  of  the  plaster.  The  centre  of  the  model,  to  the  top  of  the 
alveolar  ridge,  is  filled  with  a  mass  of  soft  clay  or  putty,  shaped  as 
shown  in  the  sectional  views,  Fig.  318,  cfd,  and  Fig.  319,/.  The  space 
£  g  h  (Figs.  316,  318,  and  319)  is  then  filled  with  plaster,  placing  at 
the  front  and  back  three  tin-foil  septa  (s  s  s);  so  that  the  ring  of 
plaster,  when  hard,  may  be  removed  in  three  parts.  In  Fig,  315,  one 
•of  these  sections  is  shown  in  contact  with  the  model,  the  clay  and 
remaining  sections  being  removed.  If  the  foil-slips  are  irregular  or 
indented,  the  sections  can  be  replaced  with  accuracy ;  also  if  the  back 
part  of  the  model  is  curved  outward,  instead  of  inward  as  in  the  figure, 
only  two  sections  are  required.  The  slips  are  most  conveniently  placed 
by  setting  them  in  the  plaster  batter  while  soft:  it  is  not  essential  that 
they  should  exactly  fit  the  space  between  ring  and  model.  The  inner 
edge  of  the  sections  in  contact  with  the  clay  are  trimmed  with  a 
sloping  face :  see  Figs.  318  and  319,  in  which  e  and  g  are  sectional 
views  of  the  outer  rim,  in  moulds  for  an  upper  and  for  a  lower  piece, 
.Grooves  or  conical  holes  are  cut  in  this  edge ;  and  it  is  varnished  and 


CAST    ALUMINUM    PLATES. 


665 


oiled,  or  else  soaped.     The  model  being  then  cleaned  from  all  trace  of 
clay,  and  again  oiled,  the  outside  sections  are  replaced,  held  together 


Fig.  319. 


by  an  elastic  band,  and  the  central  portion  of  the  model  carefully 
poured.  When  set,  the  outer  sections  (e  g)  are  first  carefully  removed ; 
the  middle  portion  is  then  removed,  except  in  cases  of  deep  arches  or 
undercut,  when  it  will  be  better  to  remove  the  halves  (a  h)  of  the 
model  separately.  Dr.  Bean's  division  of  the  central  part  of  the 
mould  into  three  pieces  (c,  /,  d),  for  such  cases,  is  rendered  totally  unne- 
cessary by  his  jDrevious  division  of  the  model.  Six  pieces  are  more 
difficult  to  keep  in  place  than  three,  are  much  more  troublesome  to 
make,  and  leave  two  unnecessary  seams  (Fig.  317j  on  the  face  of  the 
model.  In  the  plan  suggested,  the  model  is  in  two  parts,  the  mould 
in  three.  The  joints  of  the  model  and  of  the  outer  ring  of  the  mould 
will  be  separated  somewhat  by  the  expansion  of  the  central  portion ; 
in  making  the  second  model  and  matrix  this  separation  will  be  in- 
creased. This  indicates  an  increased  size  of  the  matrix,  which  is  the 
chief  object  in  the  construction  of  the  plaster  mould  just  described. 
Figs.  316  and  317  represent  back  and  face  views  of  an  upper  case 
mould ;  Figs.  318  and  319  represent  sectional  views  of  models  for  a 
double  case. 

After  removal  of  the  model,  the  mould  is  to  be  soaped  or  oiled,  or 
well  varnished  and  oiled,  preparatory  to  making  Model  No.  2  and  the 
Matrix-model.  The  matrix-model,  made  of  plaster  and  pumice-pow- 
der, is  subsequently  to  be  placed  in  the  moulding-flask,  and  forms  part 
of  the  matrix :  model  No.  2  is  its  duplicate,  in  pure  plaster,  for  use 
in  the  manijoulations  of  articulation,  grinding  teeth,  and  formation  of 
wax-plate.  The  matrix-model  cannot  be  thus  used  because  its  compo- 
sition makes  it  soft  and  frail ;  Model  No.  1  will  not  answer  because  it 
is  too  small ;  and  in  the  attempt  to  transfer  the  wax-plate  from  it  to 
the  matrix  either  the  teeth  would  be  disarranged,  or  the  plate  would 
fail  to  go  down  to  its  place. 

Dr.  Bean's  directions  for  articulation,  grinding  of  teeth,  and  shaping 
of  wax-plate  are  substantially  the  same  as  those  given  in  the  next 
chapter  for  vulcanite,  with  a  few  modifications  as  to  the  shape  of  the 
plate  and  the  form  and  treatment  of  the  blocks.  It  is  important  that 
every  precaution,  given  in  a  previous  chapter,  should  be  taken  to  have 


666 


CAST    ALUMINUM    PLATES. 


surfaces  of  each  joint. 


the  articulation  exact,  so  tliat  the  joints  of  neatly-fitted  blocks  may 
not  be  disturbed,  or  the  plate  deranged,  by  any  necessity  for  trial  in  the 
mouth,  preparatory  to  transferring  tlie  plate  from  the  })laster  model  to 
the  matrix-model.  As  before  stated,  no  good  mechanician  has  need  to 
test  his  articulation  or  change  an  arrangement  of  teeth,  ^vhich  it  is  the 
very  purpose  of  "articulation"  to  give  so  accurately  as  to  spare  the 
great  trouble  of  such  change. 

The  best  teeth,  or  blocks,  for  cast  aluminum  plates  are  those  with 
headed  pins  (Figs.  320  and  321).  The  top 
edge  must  be  ground  off  square,  as  in  Fig.  320, 
and  no  metal  allowed  to  lap  over  the  front  of 
the  block  or  tooth ;  also  a  notch  is  ground  on 
each  inner  corner  (see  same  Fig.)  to  allow  a 
septum  of  metal  to  pass  up  between  the  inner 
When  ground  and  fitted,  the  pins  of  each  block 
or  tooth  are  to  be  covered  with  plaster  batter;  this,  when  hard,  is  to  be 
very  neatly  trimmed,  so  as  to  give  continuous  bands  of  plaster  on  each 
block,  slightly  cut  out  between  the  pins  (Fig.  321).  The  design  of 
this  plaster  baad  is  to  give  a  space  between  the  blocks  or  teeth  and 
aluminum  plate,  which  is  afterward  made  continuous  by  drilling  holes 
in  the  metallic  septa:  as  seen  in  Fig.  326,  and  shown  in  section  by 
the  round  spot  in  Fig.  322.  Into  this  continuous  space  the  retaining 
alloy  is  flowed  as  hereafter  to  be  described,  having,  in 
upper  sets,  sufficient  body  to  hold  the  pins  (Fig.  322), 
but  in  lower  sets  a  greater  thickness  (Fig.  323),  when- 
ever it  is  thought  desirable  or  practicable  to  give  weight 
to  the  lower  j^late  by  an  excess  of  the  alloy.  In  Fig. 
326  the  pins  of  the  two  removed  blocks  are  represented 
as  being  yet  covered  with  plaster;  a,  a  are  the  connect- 
ing holes  in  the  septa,  and  h,  h  are  the  small  openings 
into  and  out  of  which  the  metal  is  to  flow. 

When  the  articulating  plates  are  replaced  by  the  delicate 
wax  or  prepared  gutta-percha  plate,  which  determines  the 
thickness  of  the  aluminum  plate,  the  following  precautions 
are  necessary:  "Take  a  suitable  wax  tool,  and  upon  it 
melt  a  small  portion  of  pure  yellow  wax  over  the  lamp  or 
gas  flame ;  this  drop  of  wax  is  now  introduced  behind  the 
blocks,  and,  being  hot,  it  quickly  flows  into  the  most  minute 
portions  of  the  vacant  space  between  them  and  the  plate. 
This  operation  is  repeated,  with  fresh  portions  of  wax,  until  the  whole 
vacant  space  between  the  blocks  and  plate  is  completely  filled.  All 
spaces  or  air-bubbles  under  the  blocks  will  be  filled  up  with  the  solder 
composition,  adding  unnecessarily  to  the  weight  of  the  piece.     When 


Fig.  322. 


323. 


CAST    ALUMINUM    PLATES.  667 

the  teetli  come  away  from  the  temporary  plate,  it  is  desirable  that  they 
should  leave  an  absolutely  accurate  impression  in  the  wax.  The  teeth 
being  fastened  to  the  plate  in  proper  position,  plate  and  teeth  may  now 
be  removed  from  the  articulator  in  order  to  facilitate  further  opera- 
tions. The  modelling  of  the  wax  is  continued  over  the  plaster  invest- 
ment of  the  pins,  so  as  to  completely  cover  it  with  a  sufficient  thick- 
ness,^giving  around  the  necks  and  edges  of  the  teeth  the  exact  shape 
desired  in  the  aluminum  plate.  The  operator  accustomed  to  vulcanite 
W'ork  should  be  reminded  that  he  must  lay  aside  all  his  vulcanite  ideas 
about  modelling  wax ;  the  material  he  is  now  about  to  deal  with  is 
wholly  different  from  that  compound  of  gum  and  sulphur,  which  can 
be  scraped  and  filed  almost  as  easily  as  wood.  The  metal  aluminum 
has,  we  may  safely  say,  five  times  the  strength  of  an  equal  thickness 
of  rubber;  yet  it  can  be  cast,  by  means  of  the  apparatus  here  de- 
scribed, in  plates  as  thin  as  those  ordinarily  used  for  gold  or  silver 
work,  representing  every  minute  pai't  of  the  wax  model,  copying  even 
the  scratches  or  imperfections  accidentally  made  upon  it.  Therefore 
it  is  important  and  necessary  that  great  care  should  be  taken  in  giving 
to  the  wax  model  the  fulness  and  form  desired  in  th%  plates,  and  no 
more  —  particularly  on  the  inside  or  palatine  portion  of  the  model- 
plate  and  along  the  edges  of  the  blocks  —  so  that  there  shall  be  need 
of  but  little  filing  or  scraping,  after  the  plate  is  cast.  The  plaster  over 
the  pins  must  be  covered,  but  no  more  wax  should  be  added  than  is 
necessary  to  give  the  requisite  strength." 

From  the  foregoing  remarks,  it  will  be  seen  that  special  care  is  re- 
quired in  forming  the  wax-plate;  first,  because  of  the  hardness  of 
aluminum,  which  is  not  so  easily  reduced  as  either  vulcanite  or  the 
stannic  alloys  ;  secondly,  because  the  wax  under  the  blocks  gives  shape 
to  the  plate,  there  as  well  as  in  other  parts,  since  the  plate  is  cast  inde- 
pendently of  the  blocks.  Also  it  is  necessary,  in  order  that  the  alumi- 
num may  fit  the  blocks  or  teeth  accurately  on  the  outside  (Fig.  326, 
xx),  and  on  the  inner  festooned  edge  (v  v),  to  prevent  the  retaining  alloy, 
as  far  as  possible,  from  coming  in  contact  with  the  buccal  fluids.  In 
smoothing  the  wax  surface.  Dr.  Bean  (as  also  Dr.  Blandy,  in  the  cheo- 
plastic  process,)  recommends  glazing  it  by  a  quick  jet  of  blow-pipe 
flame.  This  we  consider  unsafe,  and  by  no  means  so  accurate  as  the 
combined  use  of  the  wax-knife,  the  finger,  a  strip  of  oiled  buckskin, 
and  a  common  match  tapered  to  a  very  thin  flat  edge,  for  small  inter- 
stices. 

The  model-plate  is  now  ready  for  removal  from  model  No.  2  to  the 
matrix-model,  to  which  it  must  be  secured  around  the  edges  by  a  little 
wax  applied  with  the  wax-knife,  hot  enough  for  temporary  adhesion  to 
the  plaster.     The  composition  of  this  model  is  the  same  as  for  the  rest 


668 


CAST    ALUMINUM    PLATES. 


Fig.  324. 


Fig. 


of  the  matrix.  Dr.  Bean's  proportions  are,  one  part  by  weight  of 
best  pLaster,  two  parts  of  pumice  powder  (No.  3),  boiling  the  pumice 
before  mixing.  In  pouring  both  model  and  matrix,  use  hot  water  to 
make  the  setting  more  rapid  and  to  give  greater  expan- 
sion to  the  model  (the  pumice  tends  to  retard  its  setting) ; 
add  the  mixed  powder  of  pumice  and  plaster  to  the  water 
(not  water  to  the  powder)  gradually,  so  as  to  completely 
get  rid  of  the  air,  contained  in  all  powders  ;  pour  the  bat- 
ter at  once  while  thin,  so  as  to  have  a  uniform  texture  and 
secure  its  flow  into  every  minute  interstice. 

Brushes  (Fig.  324),  such  as  are  used  for  oiling,  may 
be  used  for  working  plaster  batter  into  small  recesses ; 
but  forgetfulness  to  wash  out  the 
plaster  before  hardening  soon 
spoils  them,  hence  we  prefer  the 
stiff-pointed  wing-feathers  of  small 
fowl.  Another  plan,  elsewhere  re- 
ferred to,  is  to  displace  the  air  by 
water  just  before  pouring,  or  by 
the  use  of  thin  batter.  It  is  best 
to  use  rather  thin  batter  in  all 
cases ;  the  gentle  movement  of  a 
pointed  feather  under  the  surface 
just  after  pouring  will  effectually 
dislodge  every  air-bubble. 

The  Preparation  of  the  Matrix 
Jor  Pouring,  and  precautions  neces- 
sary to  obtain  a  perfect  plate,  are 
the  operations  next  in  order.  We 
shall  first  describe  the  flask  and  its 
appurtenances,  then  the  manner  of 
using  them.  Fig.  325  represents 
Dr.  Bean's  metallic  flask  E,  circu- 
lar in  shape,  perforated  with  holes 
to  facilitate  drying  the  matrix.  It 
is  kept  in  upright  position  by  the 
flask-holder  C,  its  two  halves  held 
together  by  the  thumb-screws  X, 
X.  At  the  top  of  the  flask  are 
three  openings ;  into  the  central 
one  is  fitted  a  fire-clay  gate  A, 
communicating,  by  the  leader  h, 
with  the  plate  to  be  poured,  and 


CAST    ALUMINUM    PLATES.  669 

supporting  a  fire-clay  conduit  B,  which  must  be  exactly  fitted  to  it  by 
grinding  them  together.  Into  the  two  smaller  side  openings  are  fitted 
the  vent-cups  D,  D,  containing  each  a  bunch  of  wires,  to  permit  the 
escape  of  the  gas  Avith  which  the  matrix  is  charged,  just  before  pour- 
ing, and  yet  prevent  the  possibility  of  explosion  by  ignition  of  the  gas 
within  the  flask.  The  wires  also  chill  the  metal  after  it  has  flowed 
through  the  vents,  and  thus  permit  the  head  of  metal  in  the  conduit 
to  act  in  forcing  the  aluminum  into  the  minutest  parts  of  the  matrix. 
The  accessories  of  the  melting  and  pouring  process  are,  a  Avaste-cup 
hung  behind  A,  by  holes  in  two  flanges,  through  which  the  vent-cups  D 
may  pass  when  set  in  the  vents;  a  gas  or  kerosene  stove  for  drying  and 
heating  flask,  with  sheet-iron  box  to  hold  the  flask;  a  Hessian  crucible 
large  enough  to  hold  not  less  than  three  ounces  of  aluminum  ;  crucible 
and  conduit  tongs;  stove  or  furnace  for  melting  metal  and  heating  con- 
duit ;  a  pipe  with  flexible  connection  to  some  gasometer  or  gas-burner. 

With  these  explanations  of  apparatus,  we  proceed  to  the  details  of 
the  operations  of  Investing,  Drying,  and  Pouring  the  Plate.  The 
matrix-model,  with  plate  and  teeth  attached,  is  saturated  with  water, 
then  set,  teeth  upward,  into  half-flask  E,  which  has  just  been  half 
filled  with  pumice-plaster  batter  :  the  model,  sinking  to  the  edge  of  the 
wax,  raises  the  batter  to  the  top  of  the  half  flask.  The  gate  A,  fitted 
into  the  half  opening  before  pouring  the  plaster,  is  held  there  by  a  wire 
twisted  around  the  part  projecting  into  the  flask,  the  ends  of  which 
extending  into  the  batter,  are  firmly  caught  in  it  as  it  sets;  a  little  wax 
at  b  will  prevent  any  plaster  from  entering  the  canal.  The  plaster  sur- 
face E  is  trimmed  with  knife,  spatula,  and  sj)onge,  being  careful  not 
to  injure  the  surface  of  the  jilate  or  derange  the  teeth ;  it  is  then  either 
coated  with  soap-water  or  with  a  layer  of  very  thin  tin-foil.  A  taper- 
ing leader  of  wax  (b)  is  placed  from  the  back  of  the  plate  to  the  gate 
A,  and  two  smaller  ones  (c)  are  attached  to  the  alveolar  part  of  the  wax 
plate,  and  their  ends  slipped  into  the  vents  D,  D,  when  these  are  set  in 
place  to  receive  them. 

When  all  is  in  readi- 
ness for  the  other  half  of 
the  matrix,  proceed  Avith 
great  care  to  remove  the 
blocks  (Fig.  32G),  which 
have  been  left  until  now 
for  the  protection  of  the 
sharp  edges  of  the  wax. 
They  will  readily  come 
away,  bringing  no  wax,  or 
in   any  way  changing  it,  provided  the  plaster-backings   have   been 


670  CAST    ALUMINUM    PLATES. 

varnished  or  well  oiled,  and  the  parts  of  the  block  in  contact  with 
the  wax  also  oiled.  See  that  no  particles  of  plaster  or  other  sub- 
stances are  on  the  wax,  and  correct  any  accidental  injuries  ;  then 
place  the  other  half-flask,  and  fill  with  great  care,  working  the  thin 
batter  with  a  brush  or  feather,  so  that  it  shall  penetrate  every  crevice 
and  be  wholly  free  from  air-bubbles.  Fill  the  flask  flush,  so  that 
in  placing  the  top  the  plaster  shall  fill  the  countersunk  holes  and 
retain  it  firmly.  Set  the  flask  in  the  holder  C,  and  clamp  it  until  it 
has  set ;  then  warm  it  to  about  125°,  remove  the  vents  D,  D,  separate 
the  flasks,  and  carefully  withdraw  the  softened  wax.  To  avoid  the 
danger  of  overheating  the  wax,  we  prefer  warming  the  flasks  in  water 
of  known  temperature.  The  plate  will  often  come  away  entire;  if  too 
soft,  let  it  stiffen  by  cooling.  Minute  portions  of  wax  are  best  removed 
after  hardening  with  cold  water:  it  is  better  to  leave  small  pieces  for 
absorption  into  the  matrix,  than  endanger  the  surface  by  picking  thera 
out.  Dr.  Bean  recommends  oiling  both  the  plate  and  plaster  in  the 
first  half-matrix  before  pouring  the  second ;  but  soap-water  or  thin  foil  is 
better  for  the  plaster  surface,  and  the  wax  surl'ace  is  copied  with  more 
certainty  without  than  with  oil :  the  absorption  of  the  oil  is  no  im- 
provement to  the  matrix. 

The  two  half-flasks  are  now  placed  in  a  small  iron  box  or  oven  over 
a  gas  or  kerosene  stove,  using  the  ordinary  vulcanizing  heat.  The 
flask  should  be  kept  at  about  the  temperature  of  a  laundress'  iron 
until  thoroughly  dry,  which  will  require  from  one  to  four  hours,  ac- 
cording to  the  intensity  of  the  heat.  Cases  that  are  ready  to  dry  in 
the  evening  may  be  left  in  the  heater  all  night,  provided  the  heat  does 
not  rise  above  300°  or  350°.  Any  wax  left  in  the  mould  is  absorbed 
by  the  composition  as  the  flask  is  heated  ;  but  the  heat  should  not  be 
such  as  to  cause  the  wax  to  smoke  or  become  charred,  as  this  would 
make  the  matrix  very  tender :  if  the  heat  were  carried  still  farther,  the 
plaster  might  shrink  in  volume,  and  crack. 

The  best  furnace  for  heating  the  fire-clay  conduit  would  be  one  con- 
structed of  sheet-  or  cast-iron,  lined  with  fire-brick,  having  an  internal 
capacity  of  one  foot  in  length,  six  or  eight  inches  in  width  and  depth. 
The  ordinary  domestic  preserving  furnace  answers  well  for  coke  or 
charcoal  when  provided  with  sufficient  length  of  pipe  to  give  a  good 
draft.  The  furnaces  mentioned  may  be  conveniently  used  in  the  open 
air  by  attaching  two  joints  of  pipe,  or  they  may  be  connected  with  a 
brick  flue.  A  fire  first  built  of  coke  is  preferable  ;  on  this  the  conduit 
is  laid  and  frequently  turned,  so  as  to  heat  up  gradually ;  it  may  then 
be  covered  with  charcoal,  and  occasionally  turned  until  the  coal  is 
ignited,  when  the  cover  of  the  furnace  is  put  on,  and  the  fire  alloAved 
to  burn  until  the  conduit  becomes  red  hot  throughout  its  whole  length. 


CAST    ALUMINUM    PLATES.  671 

At  the  same  time  the  metal  should  be  melted  in  an  ordinary  Hessian 
crucible  placed  in  the  same  fire  with  the  conduit.  An  ordinary  anthra- 
cite grate,  or  anthracite  coal  stove,  is  found  to  answer  well  both  for 
heating  the  conduit  and  melting  the  metal. 

While  the  conduit  and  metal  are  heating,  the  flask  should  be  pre- 
pared for  casting.  Having  become  perfiectly  dried,  each  half  of  the 
flask  in  succession  may  be  grasped  securely  with  a  small  hand-vice, 
and  the  surface  of  the  matrix  heated  up  with  a  sharp,  quick  blow-pipe 
flame,  to  burn  away  any  oil  or  wax  that  may  be  upon  it,  also  to  drive 
off  any  gases  that  might  form  at  the  moment  of  casting  the  metal, 
which  would  cause  it  to  "  blow."  Where  no  oil  or  wax  is  present,  this 
process  may  l)e  omitted,  and  the  two  parts  of  the  flask  pressed  together. 
The  vents  should  now  be  tried  into  their  places  and  immediately  re- 
moved :  if  there  is  suspicion  of  any  loose  particles  of  plaster  in  the 
mould,  the  flask  should  be  opened  and  examined,  and  every  particle 
of  loose  matter  removed  by  blowing,  or  with  a  soft  camel's-hair  brush. 
The  flask,  being  again  closed,  is  placed  in  the  stand  or  holder  in  the 
position  shown  in  Fig.  325,  and  the  thumb-screws  turned  until  the  flask 
is  tightly  closed.  It  might  be  well  to  invert  the  flask  with  a  shaking 
motion,  to  allow  any  loose  particles  to  escape  at  the  gate.  Flask  and 
holder  are  now  placed  over  the  gas  or  kerosene  stove,  and  the  flame 
allowed  to  play  directly  on  the  fire-clay  gate;  by  the  time  this  has 
become  red  hot,  all  should  be  in  readiness  for  casting. 

The  stand  containing  the  flask  is  placed  in  a  shallow  iron  pan  to 
receive  any  overrunning  metal,  and  the  waste-cup  attached,  as  before 
described,  at  the  back  part  of  the  flask  so  as  to  set  level,  and  not  inter- 
fere with  the  gate  or  vents.  The  vents  should  be  also  examined  to  see 
that  they  are  properly  filled  with  the  small  wires,  and  that  there  is  a 
free  passage  of  air  through  them.  The  conduit,  B,  is  now  lifted  from  the 
fire  with  the  tongs,  and  any  dust  or  loose  particles  blown  from  it  by 
means  of  a  tube :  the  end  previously  fitted  is  then  placed  upon  the 
gate  A.  The  flask  should  be  so  placed  that  the  conduit  will  stand  per- 
pendicularly. It  is  taken  from  the  fire  at  a  red  heat ;  the  moment  the 
redness  passes  off*,  a  jet  of  hydrogen  or,  more  conveniently,  of  common 
burning  gas,  is  injected  for  a  half  minute  into  the  conduit  and  matrix, 
escaping  at  the  vents.  The  aluminum  is  then  poured  as  quickly  as 
possible,  meanwhile  placing  a  small  slab  of  fire-clay  over  the  top  of 
the  conduit  to  retain  the  gas. 

Pouring  the  metal  is  the  climax  of  the  foregoing  series  of  operations, 
and  on  it  depends  the  success  or  failure  of  the  whole  work.  The  cru- 
cible should  contain  not  less  than  three  ounces  of  aluminum  in  solid 
pieces:  all  scraps,  or  fragments  of  other  meltings  or  plates,  should  be 
laid  aside  for  refining,  as  hereafter  described.     The  metal  should  have 


672  CAST    ALUMINUM    PLATES. 

attained  a  full  rcil  heat,  but  when  poured  should  be  at  a  dull  red  heat, 
at  which  it  is  quite  fluid.  If  the  metal  is  too  hot,  the  casting  will  be 
rough  and  more  porous,  and  if  too  cool,  delicate  portions  of  the  plate 
or  very  thin  plates  do  not  readily  fill  out.  The  skilful  operator  will 
soon  learn  the  proper  heat  for  perfect  casting.  This  point  is  of  utmost 
importance  in  all  metallic  castings,  but  especially  in  aluminum.  AVlien 
all  is  ready,  the  crucible  is  lifted  from  the  fire,  and  any  loose  particles 
blown  from  the  surface  of  the  metal.  As  the  lip  of  the  crucible  is 
brought  to  the  top  of  the  conduit,  the  fire-clay  cover  is  quickly  re- 
moved, and  the  metal  is  instantly,  quickly,  yet  carefully  poured.  After 
the  first  ti])ping  of  the  crucible,  continue  the  movement  without  cessa- 
tion until  the  whole  conduit  is  filled  to  the  top.  A  skilful  hand  will 
turn  in  the  metal,  and  follow  it  up  with  the  remainder  so  carefully  yet 
rapidly,  that  the  conduit  will  be  filled  to  the  top  from  the  first,  and 
remain  so  without  running  over,  until  the  metal  fills  the  mould  and 
enters  the  vents  with  a  hissing  sound  ;  such  a  method  of  pouring  will, 
in  ninety-nine  cases  in  the  hundred,  produce  a  perfect  casting,  provided 
the  matrix  is  properly  prepared. 

As  soon  as  the  mould  and  conduit  are  full,  if  there  is  no  leakage 
anywhere,  the  crucible  is  returned  to  the  fire ;  after  the  lapse  of  ten 
or  fifteen  seconds  the  conduit  is  grasped  with  the  tongs,  and  by  a  dex- 
terous movement  is  detached  from  the  gate  and  instantly  held  over  the 
waste-cup,  into  which  the  still  fluid  metal  drops.  After  a  slight  tap 
on  the  flask  or  pan  to  remove  any  remaining  metal,  the  conduit  is 
returned  to  the  fire  to  cool  gradually.  As  soon  as  the  conduit  is  re- 
moved, while  the  casting  is  yet  hot,  the  vents  D,  D,  should  be  grasped 
with  the  hand,  shielded  by  a  cloth,  and  forcibly  twisted  around  until 
they  come  away.  This  they  will  easily  do  if  not  too  tightly  put  in, 
breaking  off  the  vent  leaders,  and  bringing  away  the  portion  of  metal 
that  has  gone  into  the  cylinders  and  among  the  wires.  The  flask  should 
now  be  left  to  cool. 

"When  cold,  open  the  flask  and  remove  the  plaster,  softening  in  water 
if  necessary ;  cut  ofi"  the  gate,  vents,  and  all  surplus  metal  on  the 
edges  of  the  plate  with  a  jeweller's  saw :  then  proceed  to  adjust  the 
blocks  or  teeth.  These  will  not  fit  the  aluminum  as  they  did  the 
wax -plate;  first,  because  of  shrinkage  of  the  plate; 
"  ■  "'  secondly,  because  of  minute  irregularities  in  the  metallic 
surface,  which  cannot,  in  all  cases,  be  prevented.  The 
tools  for  this  adjustment  are:  a  set  of  small  chisels, 
which  can  be  made  of  old  excavators  (Fig.  327)  ;  a  half- 
round  file  (the  finest  of  rubber  files  or  coarsest  of  gold- 
plate  files)  ;  the  lathe  for  retouching  the  porcelain  joints  •, 
and  some  red  paint  and  a  small  brush  with  which  to  ascertain  the  in- 


CAST    ALUMINUM    PLATES. 


673 


Fig.  328. 


terferiflg  points  necessary  to  be  removed.  Beginning  (Fig.  328)  with 
a  molar  block  M,  first  removing  the  plaster,  which  in  the  figure  is 
represented  as  still  covering  the  pins,  fit  the  outer  edge,  filing  away- 
surplus  or  overlapping  metal ;  paint  surface  Y  of  the  block,  and  apply 
it  to  the  plate ;  the  resist- 
ing points  on  the  metallic 
surface  Y  will  be  colored, 
and  must  be  cut  away. 
Continue  this  until  the 
inner  (V)  and  outer  (X) 
edges  of  the  plate  are  ex- 
actly adapted.  The  bi- 
cuspid block  B  is  fitted 
in  the  same  manner,  ex- 
cept that  the  side  next  the 
molar  block,  and  perhaps 
that  block  also,  must  be  touched  lightly  on  the  corundum-wheel,  to 
accommodate  the  reduced  size  of  the  arch,  caused  by  contraction  of 
the  aluminum.  This  second  jointing  will  often  enable  the  operator  to 
make  lines  of  union  so  exact  as  scarcely  to  be  detected.  In  this  way 
all  the  blocks  or  gum  teeth  are  to  be  adapted,  giving  special  attention 
to  the  outer  (X,  X,  X)  and  inner  (V,  V,  V)  lines  of  union  between 
the  metal  and  porcelain :  the  metallic  surface  should  also  at  this  time 
be  finished  along  these  edges,  ready  for  the  polishing  wheel.  Then 
remove  all  the  blocks,  and  drill  the  communicating  holes  a,  a  in  the 
metallic  septa.  See  also  Fig.  322,  showing  position  of  the  hole  in  the 
septum.  In  drilling  use  oil,  and  remember  that  the  slowest  motion; 
of  the  foot-lathe  is  the  best  for  drilling,  as  rapid  motion  is  best  for- 
polishing.  Holes  or  undercuts  may  also  be  made  in  the  thicker' 
parts  of  the  metal  surface  Y,  Y,  as  retaining  points  for  the  soldering 
alloy. 

Scraping  and  polishing  the  plate  is  the  next  step,  differing  little,  if 
at  all,  from  the  methods  used  in  polishing  other  plates.  Scrapers 
should  be  very  sharp,  and  cut  better  if  the  surface  is  oiled.  Emery- 
cloth  should  also  be  oiled  ;  it  works  better  and  lasts-  longer.  Scotch- 
stone  is  often  used  in  place  of  the  cloth,  and  gives  an  excellent  surface.. 
Fine  files  are  apt  to  clog,  and  require  the  use  of  a  scratch-brush.  Dr.. 
Bean  finished  his  work  with  flour-emery  on  felt,  leather,  or  bristle 
wheels.  If  the  wax-plate  is  carefully  made,  very  little  cutting  of  the 
aluminum  will  be  necessary.  Cleanse  the  plate  with  soap  and  brush, 
to  remove  all  trace  of  polishing  materials  ;  then  attach  the  teeth  again 
with  a  very  little  mucilage  or  wax,  wiping  the  edges  X  and  V,  TFig.  328,) 
and  being  careful  that  no  excess  of  wax  or  gum  shall  be  between  the- 
43 


674 


CAST    ALUMINUM    PLATES. 


surfaces  Y,  Y,  where  the  metal  is  to  run.     The  piece  is  now  ready  to 
invest  for  the  Soldering  Process. 

Take  a  tin  or  sheet-iron  split  ring  (X)  about  two  inches  deep,  held 
together  with  a  movable  clamp  (Fig.  329J,  and  pour  in  pumice-plaster 

batter  to  the  height  c ;  then  fill  the 
^'^-  ^-^-  palatine  side  of  the  plate  with  the 

same  and  set  it  upon  c,  with  the 
teeth  upward,  having  first  attached 
over  the  holes  b,  b  (Fig.  328)  two 
small  wax  cylindrical  gates/  (Fig. 
329)  about  an  inch  long.  Con- 
tinue pouring  the  batter  over  plate 
and  teeth  until  the  teeth  are  cov- 
ered, or  up  to  the  line  between  c  and 
d,  being  careful  not  to  derange  the 
latter  nor  the  wax  gates.  Spread 
the  projecting  points  of  the  wax 
gates,  with  a  wax-knife,  around 
the  opening,  and  place  over  them 
the  metallic  gates  a,  b  ;  then  com- 
plete the  pouring  of  the  layer  of 
batter  e,  allowing  the  gates  to  pro- 
ject slightly.  Place  the  ring  and 
its  contents  in  the  oven  of  a  kitchen 
stove  or  in  the  above-mentioned 
iron  box,  over  a  gas  or  kerosene 
stove,  and  dry  for  three  or  four 
^^  hours  at  300°,  or  thereabouts. 
"Warm  the  "  pressure  "  gates  or  conduits  A,  B,  set  them  in  the  gates 
a,  b,  and  pour  the  soldering  alloy. 

The  hardest,  toughest,  and  most  fusible  of  Dr.  "Wood's  alloys  will 
answer  for  this  purpose.  The  work  should  be  heated  until  a  small 
piece,  laid  on  the  plaster,  fuses;  the  metal  should  be  poured  as  soon  as 
fully  melted.  "With  these  precautions,  if  the  work  is  also  slowly 
cooled,  the  most  delicate  block  will  not  be  cracked.  Use  either  con- 
duit for  a  gate,  and  pour  until  the  metal  rise^  to  the  top  of  both  ;  then 
set  in  a  cool  place  until  the  entire  ring  is  quite  cold.  If  the  small  gate 
and  vent  are  not  obstructed  by  plaster,  and  the  work  has  been  pro- 
perly heated  up  and  poured  at  the  right  temperature,  the  flow  of  the 
metal  is  certain ;  if,  also,  the  operator  is  not  guilty  of  the  great  folly 
of  attempting  to  open  the  piece  while  warm,  he  will  find  no  cracked 
.blocks. 

"When  the  flask  is  cold,  remove  the  ring  X ;  then  cut  away  the  plas- 


CAST    ALUMINUM    PLATES.  675 

ter  at  the  back  sufficiently  to  expose  the  rods  of  metal  /,  and  cut 
through  them  with  a  saw  or  file;  the  conduits,  etc.,  may  then  be  re- 
moved without  danger  of  breaking  ofi"  the  rods  /  in  a  way  to  injure 
the  plate  at  joints  a,  b  (Fig.  329).  These  points  are  the  only  places 
where  the  solder  is  exposed  to  view,  provided  the  blocks  have  been 
accurately  jointed  and  well  fitted  to  the  plate  along  the  inner  and 
outer  lines  X,  X  and  V,  V  (Fig.  328).  It  may  be  drilled  out  at  these 
points,  and  an  aluminum  wire  or  screw  inserted  and  dressed  off  evenly 
with  the  surface.  In  the  same  way  minute  holes  in  the  plate  may  be 
mended ;  but  larger  defects,  in  a  cast  plate,  make  a  new  one  necessary. 

For  a  lower  plate,  the  process  is  the  same  as  for  an  upper,  unless  it 
is  designed  to  give  it  the  weight  so  desirable  in  such  pieces.  To  do 
this  it  is  necessary  to  increase  the  size  of  the  plaster  cov- 
ering of  the  pins  (a  Fig.  330) ;  thus  making  the  aluminum 
plate  a  mere  shell  d,  on  the  inside  and  over  the  ridge, 
meeting  the  porcelain  gum  c,  which  forms  the  front  of  the 
shell.  Dr.  Bean  suggests  that  this  extra  space  shall  be 
given  by  placing  a  roll  of  clay,  a,  behind  the  teeth  and 
over  the  wax-plate  d  d.  If  made  of  plaster,  its  removal 
would  derange  the  wax,  unless  it  is  made  in  sections,  or, 
after  being  made  continuous,  is  broken  at  the  block-joints.  If  there  is 
plaster  over  the  pins  only,  as  in  Fig.  322,  the  clay  a  can  easily  be 
withdrawn,  and  small  particles  washed  out  after  the  blocks  c  are  re- 
moved, without  injury  to  the  shell  of  wax  d,  d.  This  aluminum  shell 
may  answer  well  in  those  cases  where,  from  extensive  absorption,  a 
very  deep  plate  is  required,  which,  if  made  entirely  of  any  of  the 
stannic  alloys,  might  be  objectionably  heavy.  But  in  the  majority 
of  cases  a  base  made  entirely  of  these  alloys  would  answer  fully  as 
well,  if  not  better,  unless  objected  to  by  the  patient. 

Repairs  of  broken  blocks  or  teeth  are  best  done  by  melting  out  all 
the  soldering  alloy ;  then,  after  replacing  the  new  tooth,  invest  as  before 
described  (Fig.  329),  and  pour  fresh  alloy.  The  trouble  is  but  little 
greater,  as  the  investing  process  must,  in  any  event,  be  repeated,  and 
the  result  will  be  much  more  satisfactory.  Repairs  of  the  plate  will 
seldom  be  called  for,  owing  to  the  great  strength  of  the  metal ;  but  if 
required,  the  only  satisfactory  repair  will  be  a  new  plate;  possibly  a 
crack  might  be  repaired  by  riveting  over  it  a  piece  of  aluminum,  but 
the  plan  is  not  recommended. 

The  following  is  Dr.  Bean's  method  of  refining  aluminum  scrap, 
which  v/ill  be  found  useful  to  workers  in  this  metal :  "  Aluminum  is 
not  injured  by  frequent  melting,  provided  there  are  no  impurities  in- 
troduced ;  on  the  contrary,  it  is  rendered  purer  by  repeated  melting  in 
a  clean  crucible,  using  no  flux.     Even  in  the  cleanest  crucible  there 


676  CAST    ALUMINUM    PLATES. 

is  always  considerable  dross  left  behind,  consisting  of  the  thin  tough 
film  of  oxide  that  forms  on  the  surface  of  the  melted  mass,  more  or 
less  mixed  with  pure  metal.  In  casting  an  aluminum  plate  this  dross 
and  all  small  scraps  of  metal  should  be  carefully  excluded  from  the 
crucible ;  the  metal  is  so  light  that  these  thin  films  of  oxide  readily 
mix  with  the  metal  and  cause  defects  in  the  casting.  For  the  same 
reason,  pumice-powder,.charcoal,  and  other  such  matter,  should  be  care- 
fully excluded.  All  such  dross  and  scraps  must  be  laid  aside  and 
carefully  kept  from  mixture  with  other  metals,  until  a  sufficient  quan- 
tity has  accumulated  for  the  following  process  of  refining,  by  which 
nineteen-twentieths  of  pure  metal  may  be  recovered  : 

"Take  a  Hessian  crucible  capable  of  containing  all  the  scraps,  etc. ; 
fill  it  with  coarse  Turk's  Island  salt,  cover  with  a  piece  of  clay  or  sheet- 
iron,  and  place  it  on  the  fire  until  heated  to  a  cherry  red,  to  fuse  the 
salt.  Put  the  dross  and  scraps  into  the  melted  chloride  of  sodium, 
and  raise  the  mass  to  a  bright  red  heat,  until  all  has  been  thoroughly 
melted.  The  crucible  is  now  lifted  from  the  fire  and  the  metal  poured 
out  into  ingots:  the  waste-cup  which  accompanies  the  aluminum  appa- 
ratus serves  well  as  an  ingot-mould.  When  all  that  can  be  obtained 
in  this  way  has  been  poured  out,  return  the  crucible  to  the  fire,  and 
heat  again  to  a  bright  red  ;  stir  the  mass  with  a  soapstone  pencil,  and 
let  it  rest  for  a  few  moments  in  the  fire;  then  remove,  cool  for  a  while, 
and  plunge  it  into  a  vessel  of  water.  The  crucible  is  of  course  unfit 
for  any  future  use;  the  water  dissolves  the  salt  from  the  mass,  leaving 
globules  of  aluminum,  varying  in  size  from  that  of  a  musket-ball  to 
the  smallest  sized  shot.  These  should  be  collected  and  again  melted 
in  a  clean  crucible,  forming  an  ingot  of  pure  metal.  By  pursuing  this 
course  there  is  little  loss  in  the  use  of  the  metal  in  the  dental  labora- 
tory ;  but  as  there  is  great  danger  of  introducing  fragments  of  other 
metals,  such  as  tin  and  zinc,  this  should  be  carefully  guarded  against 
by  rejecting  all  filings  and  very  small  scraps." 

The  foregoing  process  of  Dr.  Bean  overcomes  the  sluggish  flow  of 
aluminum,  by  hydrostatic  pressure  of  fluid  metal  in  the  conduit.  This 
conduit  is  about  six  inches  in  length,  and  is  represented,  as  are  the 
other  parts  of  his  apparatus  in  Figs.  325  and  329,  one-half  the  full 
size.  Others  have  attempted,  before  and  since  Dr.  Bean's  invention, 
to  meet  this  difficulty  by  injecting  the  metal  in  a  pasty  or  in  a  fluid 
state,  by  apparatus  more  or  less  complex.  We  think  the  hydrostatic 
principle  more  simple  and  free  from  the  danger  of  injuring  parts  by 
excessive  injecting  force.  Granted  that  such  force  is  unnecessary,  so  is 
the  sledge-hammer  violence  which  splits  gold  plates  in  swaging,  and  the 
leverage  which  breaks  the  screws  of  vulcanizers,  cracks  and  displaces 
blocks  and  opens  their  joints  in  the  packing  of  rubber;  yet  the  fre- 


CAST    ALUMINUM    PLATES.  677 

quency  of  these  accidents  attests  the  tendency  to  substitute  brute  force 
for  skill,  and  makes  it  desirable,  whenever  practicable,  to  have  a  self- 
limiting  power  rather  than  one  which  may  (and  hence  certainly  will) 
be  abused. 

Divesting  Dr.  Bean's  process  of  three  complications  which  are  not 
adopted  by  others,  it  becomes  as  simple  as  any  we  have  heretofore  seen. 
These  are:  1.  The  enlargement  of  the  model;  2.  The  casting  of  the 
plate  separately  from  the  blocks ;  3.  The  use  of  gas  before  pouring. 
The  first  might  be  omitted  in  small  mouths  or  those  covered  with  soft 
membrane ;  or  it  might  be  done  in  other  less  accurate  ways,  as,  for  in- 
stance, by  coating  the  outside  of  the  ridge  with  a  thin  layer  of  plaster. 
The  second  might  be  omitted  in  case  of  plain  teeth,  also,  perhaps,  in 
case  of  single  gum  teeth,  provided  the  joints  are  slightly  separated  by 
paper  to  allow  for  contraction  of  the  metal ;  but  blocks  will  inevitably 
crack  if  subjected  to  the  contractile  force  of  aluminum. .  The  third 
might  perhaps,  in  all  cases,  be  omitted,  trusting  to  proper  heating  of 
matrix  and  metal  for  a  successful  pouring. 

Dr.  Bean's  mode  of  attaching  the  blocks  to  the  plate  is  not,  in  our 
opinion,  as  unexceptionable  as  his  mode  of  making  the  plate  itself, 
for  the  following  reasons.  The  blocks  will  seldom  be  fitted  to  the  plate 
(along  the  edges  X,  X,  V,  V,  Fig,  326),  and  cannot  be  fitted  to  each 
other,  with  such  accuracy  as  entirely  to  exclude  the  buccal  fluids. 
Hence  galvanic  action  is,  to  some  extent,  inevitable ;  inducing  change, 
II  ot  in  the  electro-negative  aluminum,  but  in  the  electro-positive  alloy. 
Two  results  may  follow :  an  unpleasant  taste,  which  the  alloy  alone 
would  not  occasion ;  displacement  of  the  teeth,  by  the  oxide  accumu- 
lating between  the  two  metals.  For  these  reasons  we  should  incline  to 
prefer  attachment  of  the  blocks  by  vulcanite,  with  some  modification 
of  the  plate  to  permit  blocks  and  plate  to  be  brought  together  in  the 
vulcanizing  flask.  The  details  of  such  a  combination  will  be  given  in 
the  next  chapter. 

In  concluding  this  section,  we  repeat  that  the  use  of  Aluminum  in 
Dentistry  is  of  recent  origin,  the  properties  of  the  metal  undeveloped, 
and  its  most  appropriate  manipulations  as  yet  undetermined.  Al- 
though experiments  thus  far  indicate  a  want  of  durability,  they  reveal 
properties  which  should  stimulate  to  renewed  effort  in  overcoming 
acknowledged  difficulties.  Taking  lesson  from  the  injury  which  the 
cheapness  and  facility  of  vulcanite  have  inflicted  upon  Prosthetic 
Dentistry,  we  may  possibly  find  in  aluminum  a  dental  base  possessed 
of  an  unsurpassed  combination  of  excellences;  requiring,  however,  for 
their  development  an  amount  of  time,  care,  and  skill  that  will  exclude 
it  from  the  practice  of  those  who  are  doing  such  discredit  to  their  voca- 
tion.    We  should  regard  this  exclusion  as  one  of  its  highest  reccm- 


678  VULCANO-PLASTIC    WORK. 

mendations  to  tlie  notice  of  all  who  seek,  by  the  excellence  of  their 
work,  to  do  honor  to  their  Profession. 

VTJLCANO-PLASTIC  WORK. 

Under  this  name  are  included  all  vegetable  materials  which  have 
been,  or  may  hereafter  be,  incorporated  with  sulphur,  iodine,  or  other 
substances,  for  the  develo^^ment  of  those  peculiar  properties,  so  w^ell 
known  in  Hard  Rubber.  Inspissated  linseed-oil,  amber,  and  gum 
copal  have  thus  been  experimented  with,  but  with  results  thus  far  very 
unsatisfactory.  They  are  here  mentioned,  because  it  is  by  no  means 
improbable  that  among  the  vegetable  oils,  resics,  or  gums  now  known 
or  to  be  discovered,  there  will  be  found  one  which  shall  excel  any  yet 
known,  in  those  remarkable  qualities  imparted  by  sulphur  to  the  resin- 
ous gums.  Gutta-percha  and  Caoutchouc.  These  differ  from  some  other 
resius,  in  an  opacity  which  follows  them  through  their  combinations 
with  sulphur,  making  it  impossible  to  obtain  even  a  tolerable  imita- 
tion of  mucous  membrane.  Possibly  some,  as  yet  unknown,  vulcan- 
izable  transparent  resin  may  be  found,  carrying  into  its  combinations 
enough  of  translucency  to  give  that  peculiar  life-like  animation  which 
now  characterizes  porcelain-gum  colors  alone.  The  history  of  caout- 
chouc teaches  us  that  it  is  not  impossible  we  may  be  in  daily  use  of 
some  such  gum  or  resin.  The  only  compounds  of  gum  (more  strictly, 
resin)  and  sulphur  that  have  been  tried  to  any  extent  are  Corallite  and 
Vulcanite — the  trade  names  of  sulphurated  gutta-percha  and  sulphur- 
ated caoutchouc ;  also  spoken  of  as  sulj)hide  of  caoutchouc,  because  the 
new  properties  developed  by  the  union  are  such  as  make  it  appear  to 
be  a  true  chemical  compound,  and  not,  like  the  vermilion,  etc.,  often 
incorporated  with  it,  a  mechanical  mixture. 

Corallite.  —  Gutta-Percha  is  the  resinous  exudation  of  a  forest  tree, 
the  Isonandra  Gutta,  found  extensively  in  Sumatra,  Borneo,  and  the 
Malayan  Peninsula.  It  was  first  brought  to  the  notice  of  Europeans 
by  Dr.  Montgomerie,  of  Bengal,  in  1842,  and  in  a  few  years  attracted 
much  attention,  for  those  valuable  properties  which  have  since  made  it 
so  indispensable  to  the  dentist.  Twelve  years  ago  experiments  were 
made  with  it  in  combination  with  sulphur.  Combined  with  half  its 
weight  of  sulphur,  and  the  compound  then  mixed  with  half  its  weight 
of  vermilion,  it  formed  a  substance  known  as  "Corallite,"  which  har- 
dened under  the  same  conditions  as  Vulcanite,  and  of  which  it  promised 
to  become  a  formidable  rival. 

Unfortunately,  one  property  of  crude  gutta-percha  followed  it  into 
this  combination  —  its  tendency  to  become  brittle.  It  is  Avell  known 
that  sheets  of  this  substance,  whether  the  pure  crude  gum  or  that  pre- 
pared for  dental  use  by  large  admixture  of  foreign  matter,  will  become 


VULCANITE.  679 

in  time  so  brittle  as  to  break  almost  at  a  touch.  The  vulcanized  gutta- 
percha has  the  same  property  in  less  marked  degree,  but  quite  enough 
so  to  be  fatal  to  its  pretensions  as  a  rival  of  vulcanite.  Hence  coral- 
lite  is  no  longer  avowedly  used,  and  even  its  name  is  almost  forgotten. 
So  persistent  is  this  injurious  property  that  it  will  affect  any  rubber 
compounds  with  which  it  may  be  mixed.  Any  suspicion  of  the  pres- 
ence of  gutta-percha  should  condemn  sulphurated  caoutchouc  for  den- 
tal use :  this  last-named  gum,  however,  may  be  brittle  and  worthless 
from  admixture  of  other  substances  besides  gutta-percha,  as  will  be 
hereafter  stated. 

VULCANITE. 

Caoutchouc,  formerly  known  as  Elastic-resin,  and  still  more  univer- 
sally known  as  India-rubber,  was  discovered  by  certain  French  Acade- 
micians, in  Cayenne,  in  the  year  1735.  For  many  years  its  only 
known  value  was  as  an  eraser  of  lead-pencil  marks.  Dr.  Priestley, 
the  distinguished  discoverer  of  oxygen,  in  the  preface  to  his  work  on 
Perspective,  published  in  1770,  speaks  thus  of  it:  "Since  this  work 
was  printed  off,  I  have  seen  a  substance  (no  name  is  given  for  it) 
excellently  adapted  to  the  purpose  of  wiping  from  paper  the  marks  of 
a  black-lead  pencil.  It  must  therefore  be  of  singular  use  to  those  who 
practise  drawing;  It  is  sold  by  Mr.  Nairne,  mathematical-instrument 
maker,  opposite  the  Eoyal  Exchange.  He  sells  a  cubic  piece  of  about 
half  an  inch  for  three  shillings,  and  says  it  will  last  several  years." 
It  was  still  many  years  after  this  that  it  was  confined  to  this  use,  and 
to  the  making  of  rubber  shoes  and  bottles  by  South  American  and 
East  Indian  natives,  who  formed  them  on  clay  moulds  from  the  fresh 
exudation  of  the  Siphonia  cahuca,  Jatropa  elastica,  or  Fieus  elastiea. 
Upon  discovery  of  a  solvent,  its  uses  were  extended  by  bringing  to  bear 
the  skilled  labor  of  civilization ;  but  the  fact  of  its  becoming  hard  and 
rigid  (yet  not  brittle)  at  48°  greatly  limited  its  value.  The  principal 
solvents  of  caoutchouc  are  spirits  of  turpentine,  bisulphide  of  carbon, 
benzol,  ether,  chloroform,  naptha,  and  the  essential  oils. 

Mr.  Charles  Goodyear's  discovery  of  the  remarkable  effects  of  sul- 
phur in  combination  with  caoutchouc  has,  since  1840,  extended  the 
application  of  this  gum  to  an  almost  infinite  variety  of  uses.  In  cer- 
tain proportions  and  at  certain  temperatures,  the  sulphur  does  not 
much  impair  the  remarkably  elastic  and  flexible  property  of  the  native 
gum,  but  preserves  it  at  low  temperatures.  Subsequent  experiments 
led  to  the  discovery  of  Hard-rubber,  which  at  first  was  made  into 
combs,  buttons,  etc.  It  was  thus  used  for  a  number  of  years  before 
its  application  to  dental  purposes.  This  was  first  attempted  as  early  as 
1853.     Mr.  Bevan,  a  former  employee  of  the  Goodyear  Company,  Dr.. 


680  VULCANITE. 

Putnam,  of  New  York,  and  Dr.  Mallctt,  of  New  Haven,  were  the  first 
persons  known  to  the  writer  as  engaged  in  these  experiments  :  possibly 
others  were  at  the  same  time  thus  occupied.  But  owing  to  the  exceed- 
ingly cumbrous  vulcanizing  apparatus  (Dr.  Putnam's  weighing  twelve 
hundred  pounds),  and  the  absence  of  that  knowledge  of  the  material 
and  those  appliances  for  its  manipulation  which  experience  alone  could 
give,  it  made  very  slow  progress  fur  the  first  few  years.  It  has  been 
estimated  that,  in  1858,  not  more  than  three  hundred  dentists  made 
any  use  of  it ;  in  1863  it  was  conjectured  by  Dr.  Franklin  (then  den- 
tal agent  for  the  American  Hard  Rubber  Company)  that  nearly,  if  not 
quite,  three  thousand  employed  it  in  their  practice.  In  1870,  it  is 
doubtful  if  there  are  three  hundred  in  the  whole  profession  who  have 
not  made  more  or  less  use  of  it. 

Hard-rubber  possesses,  when  prepared  in  greatest  perfection,. many 
qualities  which  fit  it  for  use  as  a  base-plate.  It  is  impervious  to  the 
buccal  secretions  and  unchanged  by  them  ;  it  has  very  considerable 
strength,  great  lightness,  and,  when  properly  vulcanized,  a  high  degree 
of  elasticity.  For  some  purposes  in  prosthetic  dentistry  it  has  no  equal, 
and  for  some  few  it  is  indispensable ;  but  the  merit  of  superior  adapta- 
tion is  shared  by  other  plastic  substances,  and  for  many  cases  we  have 
shown  that  the  fit  of  an  old-fashioned  gold  plate  is  much  to  be  pre- 
ferred. The  annoyance  of  numberless  patents  and  the  cheapness  of 
the  material  are  two  serious  objections  to  its  extensive  use  by  those 
who  regard  dentistry  as  a  profession  rather  than  as  a  trade.  These 
points  are  elsewhere  considered. 

Dental  vulcanite  is  usually  incorporated  with  vermilion  to  give  it  a 
color  more  generally  acceptable  than  the  dark  brown  of  the  simple 
sulphurated  gum.  But  rubber,  sulphur,  and  vermilion  are  all  opaque 
substances,  and  can  never  themselves,  or  by  combination  with  other 
materials,  be  made  to  assume  any  resemblance  to  the  natural  gum, 
which  porcelain  alone  has,  thus  far,  been  able  to  imitate.  The  incor- 
poration of  such  substances  for  this  purpose  has  no  other  effect  than 
seriously  to  impair  the  strength  of  the  material.  Experiments  in  vul- 
canite are  much  more  troublesome  than  those  with  stannic  alloys,  and 
probably  few  will  take  the  trouble  of  making  them.  From  an  ex- 
tended series  of  very  careful  experiments,  by  Prof.  Wildman,  we  con- 
dense the  following  statements : 

Caoutchouc,  two  parts;  sulphur,  one  part;  form  a  dark-brown  rub- 
ber which  is  the  strongest  of  the  vulcanites.  Of  all  additions  for 
modification  of  color,  purest  vermilion  is  best;  it  withstands  heat,  re- 
sists the  action  of  sulphur,  and  has  an  intensity  of  color  that  soonest 
overcomes  the  darkness  of  the  rubber.  Being  a  sulphuret,  it  appears 
jto  have  much  less  efiect  in  weakening  the  texture  of  the  sulphide  of 


VULCANITE.  681 

caoutchouc  than  au  equal  quantity  of  any  other  substance ;  yet  it  does 
diminish  its  strength  in  proportion  to  its  use.  English  deep  red  and 
American  Hard  Rubber  Company's  red  contain,  by  weight,  two  parts 
sulphide  of  caoutchouc  and  one  part  of  vermilion.  There  are  no  better 
varieties  of  red  vulcanite  than  these,  so  long  as  they  are  honestly  pre- 
pared. To  the  red  and  brown  rubbers  white  oxide  of  zinc  or  white 
clay  are  added,  in  proportions  varying  from  .20  to  .57  per  cent.,  to  pro- 
duce grayish-white  or  pink  rubber.  Of  these  the  best  is  Ash  and  Sons' 
pink  rubber  (S.  P.),  containing  gum  sulphur  and  vermilion,  in  same 
proportion  as  English  deep  red,  with  one-fourth  this  weight  of  white 
oxide  of  zinc,  added  to  tone  the  deep  color.  Black  rubber  is  made  by 
adding,  to  six  parts  of  the  brown  sulphide,  from  two  to  four  parts  of 
ivory  black.  For  the  details  of  these  experiments,  and  much  other 
valuable  information,  the  reader  is  referred  to  Prof  Wildman's  mon- 
ograph "  Instructions  in  Vulcanite,"  which  should  be  in  possession  of 
all  who  work  in  this  material. 

In  the  selection  of  rubbers  we  unhesitatingly  decide  in  favor  of 
the  brown  vulcanite,  not  from  any  absurd  idea  of  the  injurious  action 
of  vermilion,  which  we  shall  presently  show  to  be  perfectly  harmless, 
but  because  of  its  superior  lightness  and  strength.  We  are  not  justi- 
fied in  sacrificing  these  valuable  qualities  for  the  sake  of  colors,  which 
not  only  have  no  greater  aesthetic  harmony  with  the  mouth,  but  which, 
by  the  brilliancy  of  their  color,  attract  attention  to  this  defect.  We 
use  white  platinum  and  aluminum  and  yellow  gold  ;  ivory  in  old  times 
soon  darkened,  and  a  tobacco  chewer  will  blacken  any  vulcanite  plate. 
Why  not,  then,  use  a  brown  base-plate  from  the  beginning?  If  the 
vermilion  rubber  is  used,  let  it,  by  all  means,  have  its  natural  rich 
mahogany  color,  and  not  the  glaring  brilliancy  with  which  students 
delight  to  invest  their  specimens.  This  does  very  w,eli  in  show-cases, 
and  is  eminently  adapted  to  those  captivating  exhibitions  of  high 
Art,  where  a  lovely  wax  face  opens  and  closes,  revealing  alternately  an 
aching  void  and  acheless  grinders ;  but  in  the  mouth  such  bright 
colors  are  monstrous  violations  of  good  taste. 

Vermilion,  combined  with  rubber,  cannot  have  any  deleterious  efiect. 
In  no  case  coming  under  our  observation,  have  w^e  seen  a  single  symp- 
tom of  local  or  constitutional  action  peculiar  to  vulcanite,  except  a  sen- 
sation of  heat :  this  we  take  to  be  an  electric  action  due  to  the  fact  that 
rubber,  like  sealing-wax,  is  a  powerful  negative  electric.  It  is  common 
to  brown,  red,  pink,  and  white  rubbers,  and  there  is  no  remedy  for  it. 
It  is  not  a  constant  symptom :  some  patients  never  feel  it,  some  often, 
some  occasionally  —  dependent,  perhaps,  upon  the  state  of  the  electric 
element  entering  into  the  composition  of  Vital  force. 

Pure  sulphuret  of  mercury  is  reckoned  by  Orfila  as  medicinally 


682  VULCANITE. 

inei't.  Fumigation,  by  vaporizing  the  mercury,  gives  it  a  medicinal 
activity ;  but  this  requires  a  temperature  of  600°  Fahrenheit.  There- 
fore, for  the  development  of  constitutional  symptoms,  we  must  have  the 
presence  of  arsenic  or  of  red  lead  as  impurities  of  the  suljihuret,  or 
the  existence  of  free  mercury. 

First,  as  to  the  impurities  of  arsenic  or  red  lead ;  they  are  not  found 
in  pure  vermilion.  But  even  if  present,  such  poisonous  impurity  would 
be  rendered  harmless,  because  completely  invested  by  an  insoluble 
coating  of  India-rubber.  A  piece  of  vulcanite  is  impervious  to  the 
fluids  of  the  mouth  ;  hence  no  part  of  its  substance  can  be  dissolved, 
and  thus  taken  into  the  stomach.  Any  supposed  medicinal  action 
must,  therefore,  come  from  such  minute  particles  as  may  possibly  be 
worn  off  the  lingual  surface  near  the  teeth,  where  bread-crusts  or  other 
hard  particles  of  food  impinge.  White,  gray,  and  pink  rubbers  have 
so  large  a  proportion  of  foreign  matter  that  they  are  easily  abraded ; 
but  in  the  pure  red  rubbers  we  have  thus  an  almost  infinitesimally 
small  quantity  of  vulcanite  taken  into  the  stomach,  one-third  of  which 
is  inert  vermilion,  adulterated  (we  will  suppose)  with  three  per  cent, 
of  arsenic  and  this,  coated  with  a  layer  of  rubber,  which,  as  previously 
stated,  is  insoluble  in  water,  alcohol,  alkalies,  or  weak  acids.  This 
very  minute  trace  of  arsenic,  even  if  divested  of  its  envelop  of  rub- 
ber, would  have  a  purely  homoeopathic  (and,  by  consequence,  not  poi- 
sonous) action ;  while  if  encased  in  rubber,  which  pervades  every  part 
of  the  material,  it  is  absolutely  inert.  The  same  may  be  said  of  the 
less  poisonous  adulteration,  red  lead. 

Secondly,  as  to  the  mercury,  the  researches  of  Prof.  Johnston,  with 
the  microscope,  and  Prof.  Mayer,  by  chemical  analysis,  have  failed  to 
discover  the  slightest  trace  in  samples  of  the  rubber  used  by  us  for 
several  years.  Prof.  Wildman  found  sulphur  sublimed  during  vul- 
canization, but  not  the  smallest  trace  of  mercury.  We  have  failed  by 
any  mechanical  force  to  press  out  any  globules,  nor  have  we  ever,  in 
any  manipulations,  seen  the  slightest  particle  of  this  metal,  or  been 
able  with  the  microscope  to  detect  it  upon  the  surface  of  any  finished 
piece.  This  question  of  the  presence  of  free  mercury  in  the  vulcanized 
material  may  perhaps  require  a  more  extended  series  of  experiments. 
It  is  the  only  agent  that  can  possibly  exert  any  deleterious  action 
upon  the  system.  That  its  presence  is  rare  is  proven  ;  that  it  is 
never  found  can  be  confidently  asserted  or  denied,  only  after  the 
extended  observations  recommended,  —  the  observers,  however,  being 
careful  not  to  confound  the  minute  crystals  of  sulphur  with  globules 
of  mercury,  as  some  have  done. 

Impressions  for  vulcanite  work  may  be  taken  in  plaster,  wax,  or 
gutta-percha.     The  minute  accuracy  of  plaster  is  not  so  essential  in 


VULCANITE.  683 

swaged  work,  since  the  very  fine  lines  of  the  model  are  partly  lost  in 
the  die,  and  could  not  be  impressed  on  the  plate ;  but  in  the  vulcan- 
ite the  faintest  scratch  is  faithfully  copied.  The  finest  plaster  must  be 
used,  and  stirred  until  all  air  bubbles  are  removed.  The  absolute  neces- 
sity of  plaster  impressions,  in  most  partial  cases  where  vulcanite  is 
used,  led  us  to  devise  the  method  elsewhere  described  of  taking  im- 
pressions with  gutta-percha  cups.  The  advantages  of  a  partial  plaster 
impression  thus  obtained  are :  first,  the  exact  shape  of  the  outside  of 
the  teeth  adjoining  the  space  to  be  filled  permits  correct  adjustment 
upon  the  model ;  secondly,  the  accurate  shape  of  the  inside  of  the 
molars  and  bicuspids,  at  the  point  where  wax  impressions  drag,  allows 
the  stays  or  half-clasps  to  be  closely  fitted  to  the  teeth.  But  it  must 
be  borne  in  mind,  that  partial  impressions  in  plaster  and  partial  pieces 
in  vulcanite  demand  for  their  success  the  utmost  care  and  nicety  of 
manipulation,  a  care  which  the  result  will  fully  reward.  The  absolute 
non-contraction  of  rubber  may  make  wax  or  gutta-percha  a  better 
impression  material  for  full  sets  than  plaster ;  in  fact,  we  recommend 
plaster  less  often  for  full  vulcanite  plates,  than  for  base-plates  of  any 
other  material ;  while  in  partial  cases,  for  reasons  just  given,  we  prefer 
its  almost  exclusive  use. 

Vulcanite  models  require  no  particular  shaping,  except  the  extension 
of  the  back  part  an  inch  or  more,  so  that  the  model  itself  may  serve 
as  one-half  of  the  articulator.  This  not  only  saves  time  and  plaster, 
but  gives  more  accurate  results,  since  there  is  no  transfer  of  the  teeth 
and  wax-plate  to  a  new  model.  When  the  teeth  are  set  in  the  wax- 
plate,  the  model  is  then  separated  with  a  saw  from  the  back  part  and 
placed  in  the  flask.  In  double  sets  the  back  part  of  one  model  is 
smoothed,  and  the  T-shaped  groove  cut  and  soaped,  or  covered  with 
thin  foil ;  the  extension  of  the  other  model  is  left  rough,  and  when  the 
articulating  plates  are  made,  the  models  are  set  into  their  respective 
plates  and  the  space  at  the  back  part  filled  with  plaster.  Partial 
models,  containing  a  number  of  teeth,  require  no  other  antagonizer 
than  a  model  made  from  a  simple  impression  in  wax  of  the  lower  teeth, 
which  will  fit  the  irregularities  of  the  teeth  of  the  upper  model. 
Models  for  vulcanite  may  be  coated  with  very  dilute  soluble  glass,  but 
no  other  varnish  is  admissible.  The  writer,  in  1858,  sent  his  earliest 
experiments  in  rubber  to  Dr.  Putnam,  of  New  York,  to  be  vulcanized. 
The  doctor  wrote  to  know  "what  the  varnish  was  which  prevented  the 
rubber  from  sticking."  It  was  this  soluble  glass,  used  originally  for 
the  purpose  of  hardening  the  surface  to  prevent  injury  from  subsequent 
manipulations. 

Antagonizing  plates  are  made  by  moulding  a  piece  of  gutta-percha 
over  the  model,  kept  very  wet  to  prevent  adhesion.     The  central  part 


684  VULCANITE. 

should  be  not  less  than  one-eighth  of  an  inch  thick,  to  give  stiffness  to 
the  plate ;  the  rim  on  the  ridge  should  be  the  exact  length  of  the  teeth 
required,  and  trimmed  very  carefully  on  the  outside  to  give  the  proper 
fulness.  The  gutta-percha  should  be  first  worked  into  a  ball,  using 
from  one  to  two  sheets,  according  to  the  size  of  the  mouth  ;  then,  press- 
ing from  the  centre  outward,  the  articulating  rim  is  formed  at  the  same 
time  that  the  material  is  turned  over  the  ridge.  It  is  quickly  done, 
will  not  injure  the  most  delicate  ridge,  and  gives  a  plate  as  unyielding 
as  any  gold  plate.  In  a  lower  set,  the  rim  may  be  stiffened  with  a  piece 
of  heavy  iron  wire.  In  a  full,  or  nearly  full,  upper  set,  the  impress 
of  the  lower  teeth  is  to  be  received  in  a  thin  rim  of  wax  set  on  the 
gutta-percha.  In  a  double  set,  the  rims  are  trimmed  till  they  touch 
uniformly,  and  then  their  relation  marked  by  decided  indentations 
across  the  line  of  contact.  It  is  quite  possible,  with  these  gutta-percha 
plates,  to  take  the  articulation  in  every  case  with  such  absolute  accu- 
racy that  no  trial  of  the  teeth  is  necessary,  nor  any  grinding  of  the 
teeth  upon  inserting  them  in  the  mouth.  Metallic  articulating  plates, 
swaged  for  the  case,  are  much  more  troublesome,  and  are  no  better. 
The  usual  method  of  making  them  of  sheet  gutta-percha,  wax,  or  tin- 
foil can  never  give  one  that  full  confidence  in  his  articulation,  which 
enables  him  habitually  to  dispense  with  the  trial  of  the  piece  after 
grinding.  As  vulcanite  articulations  are  often  taken,  it  would  be  as 
well  simply  to  look  at  the  mouth  and  guess  at  them. 

The  modern  articulator,  Avith  its  various  motions,  is  in  fact  the  out- 
growth of  incorrect  articulation.  It  is  the  substitution  of  mechanism 
for  skill,  of  guess-work  for  certainty.  We  suggest  to  our  friend,  Dr. 
White,  who  is  so  ready  to  meet  all  the  wants  of  the  profession  —  and 
what  one  more  universal  than  want  of  skill? — that  he  should  get  up  a 
set  of  "impressions"  for  full  upper  or  lowercases.  The  lower  jaw 
would  require  about  ten  varieties,  the  upper  jaw  about  thirty.  With 
these  and  a  good  patent  articulator,  a  choice  assortment  of  sets  of 
teeth  might  be  kept  on  hand,  being  careful  of  course  to  select  the 
"  favorite  style  of  teeth."  We  should  not  be  compelled  to  use  the 
"  Ready  Rubber ; "  for  this,  by  the  inventor's  own  confession,  takes 
fully  "one  hour,  after  taking  the  impression,  to  complete  the  work." 
With  the  work  already  made,  one-fourth  of  this  time  will  be  ample. 
Ready-made  impressions  would  be  the  climax  and  crowning  glory  of 
cheap  dentistry.  Guess-work  selection  of  teeth  and  guess-work  artic- 
ulation are  its  rules ;  why  not  guess  once  more  and  enlarge  the  sphere 
of  its  usefulness  ? 

Preparatory  to  the  selection  and  grinding  of  teeth  or  blocks,  the 
thick  articulating  plates  must  be  removed,  and  the  model  covered  with 
thin  druggist's  foil,  and  the  space  inside  the  ridge  filled  with  a  mass 


VULCANITE. 


685 


Fig.  331. 


of  soft  wax,  pressed  out  until  it  meets  the  probable  inside  line  of  the 
teeth  to  be  fitted :  this  afibrds  a  much  firmer  support  to  the  teeth 
during  grinding  than  the  usual  practice  of  using  the  thin  wax  or 
gutta-percha  matrix-plate.  The  top  and  outside  of  the  ridge  are  left 
covered  with  foil  alone.  AYhen  blocks 
like  Fig.  331  are  to  be  ground,  passing 
over  front  of  ridge  and  surmounted  with 
a  rubber  band,  it  is  essential  that  the 
block  shall  not  quite  touch  the  model  at 
any  point :  this  contact  is  prevented  by- 
placing  between  the  foil-plate  and  the  model  a  strip  of  foil,  having 
four,  six,  or  eight  thicknesses,  as  may  be  desired.     But  when  blocks 

Fig.  338. 


such  as  Figs.  333,  334,  or  teeth,  like  Fig.  332,  are  ground,  resting  di- 
rectly upon  the  gum,  with  no  rubber  above  or  under  the  upper  part 
of  the  gum,  the  thin  foil  is  retained  only  during  the  process  of  grind- 
ing, so  as  to  receive  the  paint  used  in  accurate  fitting  of  blocks ;  the 
foil  is  then  removed  and  the  plaster  scraped,  so  as  to  slightly  bed  the 
front  blocks  or  teeth  in  the  natural  gums.  As  the  teeth  are  ground, 
they  should  be  tacked  to  the  wax  mass  with  softened  or  melted  wax. 

In  grinding,  the  greatest  care  must  be  taken  to  make  close  joints; 
but  the  fitting  of  the  base  requires  none  of  the  accuracy  demanded  in 
fitting  gold  plates,  except  when  the  tooth  is  to  be  set  directly  upon  the 
gum.  It  is,  however,  a  mistake  to  suppose  that  a  space  of  half  an 
inch  can  with  perfect  impunity  be  left  between  the  teeth  and  plate ; 
for  vulcanite  has  a  slight  shrinkage  on  cooling.  Unlike  the  shrinkage 
of  metal,  which  is  irresistible,  that  of  vulcanite  is  controlled  by  the 
matrix,  so  that  it  results  in  no  change  in  the  shape  of  the  plate.  This 
is  proved  by  the  closeness  with  which  it  is  seen  to  adhere  to  the  model 
on  opening  the  matrix.  But  it  takes  place  in  the  direction  of  the 
thickness  of  the  plate.  If,  therefore,  a  large  bulk  of  material  is  inter- 
posed between  the  teeth  and  ridge,  it  will  shrink  perceptibly  either 
from  the  ridge  or  from  the  teeth  ;  in  the  first  case  impairing  the  fit  of 
the  piece,  in  the  latter  case  loosening  the  hold  of  the  rubber  upon  the 


686  VULCANITE. 

tooth.  Thick  musses  of  vulcanite  are  also  apt  to  be  porous  or  honey- 
combed, owing  probably  to  the  evolution  of  sulphur.  That  sulphur 
is  evolved  in  all  cases  is  evident  from  the  staining  of  the  plaster,  black- 
ening of  the  flasks  and  inside  of  the  vulcanizer,  and  from  the  peculiar 
smell  whenever  there  is  escape  of  steam.  We  sometimes  find  it  makes 
the  rubber  porous,  especially  in  lower  cases,  in  spite  of  every  precau- 
tion taken  to  prevent  it.  It  is  not  impossible  that  subsequent  modifi- 
cations in  the  time  and  manner  of  vulcanizing  may  correct  this  and 
several  other  difficulties  attendant  on  the  hardening  of  thick  masses 
of  rubber;  meanwhile  it  is  safer  to  avoid  all  unnecessary  thickness  of 
material.  Many  cases  will  permit  the  use  of  a  stout  aluminum  wire 
behind  and  under  the  pins,  running  along  the  incisors  and  bicuspids; 
if  so,  it  will  reduce  the  bulk  of  rubber  and  strengthen  the  piece.  We 
often  run  a  heavy  platinum  wire  or  strip  of  doubled  plate  behind  the 
entire  arcli  in  lower  sets,  to  add  to  their  weight  and  strengthen  them; 
when  carefully  done  it  makes  a  very  strong  piece,  and  removes  the 
objection  of  lightness,  which  prevents  the  use  of  rubber  in  many  lower 
cases. 

When  the  teeth  or  blocks  are  ground,  and  the  joints  and  outside 
fitting  carefully  examined  with  a  Coddington  lens  or  some  other  strong 
magnifying-glass,  the  next  point  is  to  make  guiding  grooves  or  holes 
in  the  plaster  articulator  below  the  teeth ;  then  place  the  lead  band 
and  pour  the  temporary  investing  rim,  as  has  been  already  described 
in  the  investment  of  teeth  for  gold  plate,  preparatory  to  backing  (see 
page  596).  If  it  is  a  partial  piece,  we  often  prefer  to  make  this  rim 
with  a  roll  of  gutta-percha,  previously  wetting  the  model  to  prevent 
its  adhesion.  An  elastic  band  or  string  will  hold  this  rim  in  place, 
■while  the  wax  is  being  removed  and  substituted  by  the  matrix-plate, 
that  is,  the  wax-plate  which  is  to  be  replaced  by  the  rubber.  The  use 
of  the  rim  permits  an  examination  of  the  blocks  or  teeth  on  the  inner 
side,  and  the  correction  of  any  irregularity  in  the  pins  or  in  the  inner 
edge  of  porcelain  where  it  meets  the  rubber,  also  the  grinding  off  of 
any  point  where  a  block  may  come  unnecessarily  near  the  model. 

A  small  roll  of  soft  wax  is  then  to  be  pressed  against  the  pins  and 
model,  holding  the  rim  firmly  to  prevent  the  slightest  displacement  of 
the  blocks.  A  wax  matrix-plate  is  then  slightly  softened  and  pressed 
gently  over  the  face  of  the  model  and  the  other  wax  up  to  the  tooth. 
Be  careful  not  to  thin  the  w'ax  unequally,  and  yet  to  press  it  into  all 
the  natural  irregularities  of  the  model,  and  to  bring  out  the  tra- 
cings of  the  rugse  and  the  central  raphe.  If  the  first  wax  is  trimmed 
so  as  to  just  clear  the  tips  of  the  pins  and  have  a  slight  curve  where  it 
joins  the  model,  very  little  trimming  of  the  wax-plate  will  be  neces- 
sary when  blocks  are  used.     This  method  also  enables  the  operator  to 


VULCANITE.  687 

know  exactly  the  thickness  of  the  plate  at  all  points.  Gutta-percha 
does  not  answer  so  well  as  wax,  as  it  cannot  so  readily  be  smoothed 
where  it  joins  the  blocks.  After  using  the  wax-knife  around  the  edges, 
it  is  well  to  go  over  the  surface  with  a  strip  of  oiled  buckskin. 

The  wax-plate  should  vary  in  thickness  from  No.  14  to  No.  18, 
gauge-plate,  Fig.  208,  according  to  the  depth  of  the  palatine  arch. 
Vulcanite  cannot  safely  be  reduced  to  the  thinness  of  gold  or  aluminum 
plates,  or  even  of  the  best  stannic  alloys.  The  elasticity  of  the  best  made 
vulcanite  is  often  thought  to  justify  great  thinness  of  plate,  and  this 
may  be  allowed  in  some  partial  pieces ;  but  in  full  sets,  or  where  many 
teeth  lie  grouped  together,  elasticity,  with  thinness  such  as  permits 
bending  of  the  plate,  is  very  apt  to  cause  opening  of  joints  or  break- 
ing of  blocks.  Elasticity  of  vulcanite  lessens  the  chance  of  injury 
from  an  accidental  fall ;  but  as  an  element  of  strength,  it  is  princi- 
pally valuable  as  improving  its  rigidity  and  toughness;  and  the  plate 
of  all  full  sets  should  be  thick  enough  to  be  unyielding  under  the  force 
of  mastication. 

When  the  inside  wax-plate  has  been  completely  finished,  the  outside 
plaster  rim  is  removed,  having  provided  for  its  easy  removal  by  a 
break  or  section  opposite  the  incisors.  Again  examine  all  joints  with 
the  glass  to  see  that  they  have  not  been  accidentally  opened ;  then 
apply  one  or  more  strips  of  wax  to  give  the  required  form  of  edge, 
outside  the  ridge  and  above  the  blocks.  Plain  or  gum  teeth  or  blocks, 
resting  directly  on  the  gum,  must  of  course  have  no  wax  in  front  of 
incisors,  canines,  and  first  or  even  second  bicuspids ;  in  all  such  cases 
be  careful,  just  before  investing  in  the  flask,  to  see  that  the  teeth  set 
closely  down  upon  the  model.  Vulcanite  blocks  have  a  shoulder  de- 
signed to  receive  the  margin  of  the  external  rubber  band :  when  the 
blocks  have  been  chosen  with  such  care  that  no  grinding  of  the  upper 
edge  is  necessary,  this  gives  the  best  finish.  But  it  often  happens  that 
the  exigencies  of  the  case  require  thinning  or  shortening  of  the  blocks ; 
a  thin  edge  of  wax  should  then  slightly  overlap  the  blocks.  If  the 
porcelain  edge  has  sufficient  thickness,  it  is  sometimes  a  good  plan  to 
bevel  it :  the  rubber  may  then  be  finished  continuously  with  the  por- 
celain, and  yet  have  a  retaining  edge.  It  is  well  to  pass  a  very  fine 
"  corundum  slab  over  the  gum  just  before  placing  the  wax  rim ;  it  re- 
moves accidental  roughness  and  makes  the  finishing  process  easier. 
Superfluous  wax  should  be  avoided  outside  as  well  as  inside ;  but  every 
undercut  must  be  filled,  else  there  will  be  danger  of  breaking  thin 
or  prominent  ridges  in  separating  the  matrix.  Outside  surplus  is 
more  easily  removed  than  inside ;  hence  there  is  no  objection  in  run- 
ning the  wax  further  up  on  the  ridge  than  the  finished  plate :  but 
unnecessary  thickness  is  to  be  avoided  for  reasons  before  given. 


688  VULCANITE. 

If  the  original  model  has  been  extended  for  articulation,  carefully 
remove  the  plate  and  saw  off  this  portion  of  the  model,  and  trim  so  as 
to  fit  the  half-flask  in  which  it  is  to  be  set.  This  trimming  done,  re- 
place the  plate,  and  fasten  it  around  the  edges  with  a  hot  wax-knife. 
It  is  now  ready  for  the  vulcanizing  flask. 

All  forms  of  teeth  may  be  used  with  the  vulcanite  base  and,  unlike 
most  other  work,  may  be  used  again  and  again.  Continuous-gum  teeth 
can  be  sti'ongly  and  handsomely  arranged,  provided  the  patient  shows 
but  little  of  the  tooth.  Single  teeth,  plain  or  gum,  require  either  to 
be  backed  with  gold  strips  and  soldered,  or  simply  to  have  the  pins 
lengthened.  For  this  purpose  heavy  platiua  wire,  say  No.  20,  should 
be  cut  into  lengths  from  one-fourth  to  three-fourths  of  an  inch  long, 
set  between  the  pins  in  the  required  direction  and  soldered  with  pure 
gold.  We  also  used,  in  1858,  when  the  assortment  of 
rubber  teeth  was  very  imperfect,  plate  teetli  backed  with 
a  narrow  platina  strip,  very  similar  to  Fig.  335,  taken 
from  Prof.  Wildraan's  monograph.  The  projecting  tang 
strengthens  the  rubber  in  case  of  isolated  teeth,  and  may 
be  serrated  with  a  file  ;  but  we  had  a  pair  of  forceps 
with  serrated  beaks,  which  did  this  better  and  more  quickly  than  the 
file.  It  is  now,  however,  rarely  necessary  to  resort  to  these  expedi- 
ents, unless  when  required  to  replace  by  rubber  attachment  some  favor- 
ite plate  tooth  which  has  loosened.  Occasionally  some  one  or  more 
under  teeth  strike  so  closely  against  the  gum  as  almost  to  touch :  if 
rubber  is  used  in  such  cases,  these  teeth  must  be  plate  teeth,  with  the 
usual  soldered  gold  backing,  having  a  serrated  extension  into  the 
rubber. 

The  assortment  of  vulcanite  teeth  now  ofiered  to  the  profession  is, 
in  variety  of  color,  size,  and  shape,  such  as  to  meet  almost  every  pos- 
sible case.  In  fact,  we  doubt  if  the  manufacturer's  esthetic  skill  in 
making  is  not  sometimes  in  advance  of  the  dentist's  sesthetic  taste  in 
selecting.  Certainly  the  stiflT  uniformity  and  monotonous  expression 
which  so  frequently  meet  the  eye  is  an  injustice  to  the  jlreseut  high 
development  of  the  dento-ceramic  art.  In  the  next  chapter  we  shall 
illustrate  by  wood-cuts,  kindly  lent  to  us  by  Dr.  S.  S.  White,  some  of 
P      pi,;  the  delicate  forms  which  so  exactly  imitate  Nature. 

Fig.  336,  and  the  four  preceding  cuts,  will  give  a  cor- 
rect idea  of  the  special  form  and  shape  of  the  pins  of 
vulcanite  teeth,  as  manufactured  by  Dr.  White. 

Vulcanizers  and  Flads. — A  sixteen    horse-power 
boiler,  communicating  by  twenty  feet  of  pipe  with  a 
cubical  steam-chest,  measuring  about  thirty  inches  in 
breadth,  length,  and  depth,  was  the  vulcanizer  of  1857.     A  coal-stove. 


VULCANITE.  689 

surmounted  by  two  cast-iron  reservoirs  (each  having  about  eight  hundred 
inches  capacity)  communicating  by  two  short  pipes,  with  safety-valve, 
stop-cocks,  etc.  attached,  was  the  "Improved  Vulcanizer"  first  used  by 
the  writer,  requiring  from  four  to  six  hours'  time  for  vulcanizing. 
Steam-  and  water-chests  were  next  made  in  one,  with  a  perforated  shelf 
or  diaphragm  ;  for,  until  the  accidental  slipping  of  a  flask  into  the 
water,  the  writer  supposed,  in  common  with  others,  that  steam  alone 
would  harden  the  rubber.  The  next  and  most  important  modifications 
were  the  substitution  of  rolled  copper  for  cast-iron  and  of  gas-  or  al- 
cohol-flame for  coal ;  this  is,  substantially,  the  vulcanizer  of  the  present 
day.  It  consumed  from  three  to  five  gills  of  alcohol,  would  hold  four 
flasks,  and  had  the  then  universal  flat  packing  (not  in  a  gpoove),  which 
always  leaked  somewhat,  and  was  liable  occasionally  to  blow  out.  The 
safety-valve  was  still  thought  essential,  and  vulcanizing  required  at 
least  three  hours. 

It  is  important  to  notice,  in  all  these  vulcanizers,  the  length  of  tim-j 
required  to  do  what  may  now  be  done  in  less  than  two  hours.  Thi.s 
was  due  to  two  causes, —  extent  of  metallic  surface  exposed  to  the  sul- 
phurous vapor,  and  leakage  at  the  packing;  both  conspiring  to  rob  the 
rubber  of  its  sulphur,  and  thus  to  retard  vulcanization.  The  modern 
packings  (except  Whitney's),  if  carefully  handled,  may  be  kept  steam- 
tight  for  two  years  without  renewal.  If  flasks  and  the  interior  of  vul- 
canizers could  be  made  to  retain  a  porcelain  coating,  the  time  of  vul- 
canizing would  be  doubtless  quickened.  When  aluminum  becomes  as 
cheap  as  its  ore  is  abundant,  we  shall  have  the  best  of  all  metals  for 
vulcanizer  and  flasks,  unless  the  metal  itself  has,  by  that  time,  sup- 
planted vulcanite  as  a  dental  base-plate.  Our  practice  since  1860  has 
beeu  to  keep  all  flasks  heavily  coated  inside  and  out  with  shellac  var- 
nish, colored  with  vermilion  to  show  when  the  varnish  was  wearing 
off":  a  fresh  coat  was  needed  about  every  third  or  fourth  heating.  Be- 
sides protecting  the  flasks,  it  kept  the  hands  clean  in  the  operation  of 
packing  the  rubber.  We  should  think  some  lacquer  might  be  found 
capable  of  resisting  sulphurized  steam  at  340° ;  if  so,  it  would  be  a 
great  improvement  in  flasks. 

Later  improvements  in  the  vulcanizer  have  reference,  First,  to 
strength  ;  and  we  consider  none  safe  unless  subjected  to  a  hydrostatic 
pressure  of  275  pounds  per  square  inch,  or  a  steam  pressure  of  400°. 
One  allowance  in  this  margin  of  safety  is  for  the  incorrigible  care- 
lessness of  a  large  mass  of  practitioners.  In  careful  hands,  a  safe 
margin  is  200  pounds  hydrostatic  pressure,  or  375°  steam  test.  Se- 
condly, to  compactness  of  form ;  the  two-flask  vulcanizer  being,  in  our 
judgment,  the  only  one  that  should  be  used.  Tliirdly,  to  facility  in 
removing  the  cover  and  maintaining  the  integrity  of  the  packing,  to 
44 


690 


VULCANITE. 


which  reference  will  be  made  again  when  comparing  different  vulcan- 
izers.  Fourthly,  to  modes  of  applying  heat :  gas  and  kerosene  heaters 
are  now  almost  universally  used  ;  yet  for  cleanliness,  safety,  and  uni- 
formity, none  are  comparable  with  Dr.  Franklin's  alcohol  lamp.  But 
each  heating  consumes  nearly  five  cents'  worth  of  alcohol,  and  either 
this  or  "  temperance  "  principles  would  seem  to  interfere  with  its  use ; 
we  used  a  Franklin  lamp  wheu  alcohol  was  six  dollars  per  gallon,  and 
should  give  it  the  preference  regardless  of  price.  Fifthly,  to  regis- 
tration of  temperature  and  safety-valve  provisions.  A  lamp  which, 
like  Franklin's,  cau  by  no  forgetful ness  or  neglect  raise  the  heat  be- 
yond a  certain  point,  and  yet  which  has  no  valves,  screws,  or  levers 
for  this  purpose,  is  the  best  of  all  safety-valves.  Thermometers  are 
good  regulators  so  long  as  they  remain  unbroken ;  but  a  steam-gauge 
is  the  safest,  most  durable,  and  best  for  use  in  a  permanent  laboratory, 
as  will  be  hereafter  explained. 

Fig.  337. 


Fig.  338. 


Of  flasks  there  are  several  varieties,  all  open  to  some  objections. 
The  best  is  Snowden  and  Cowman's  flask,  (Fig.  337).     Next  to  this  we 

prefer  the  Star  flask ;  but  it  is  too  shallow, 
and  has  flask-bolts,  which  we  consider  un- 
necessary encumbrances.  The  essentials  of 
a  good  flask  are  :  1.  It  must  have  depth  and 
width  for  the  largest  cases ;  2.  Both  ends 
should  be  separate,  for  greater  convenience 
of  placing  model  in  either  ring;  3.  The 
guide-flanges,  about  one-quarter  of  an  inch 
long,  should  work  straight  and  true,  be 
strong,  and  yet  not  unnecessarily  break  the 
regularity  of  inside  and  outside  surfaces ; 
cover-flanges  may  be  very  short ;  4.  Inside 
and  outside  should  present  as  unbroken  a 
surface  as  possible,  for  facility  in  removing 
and  cleaning  ofi'  surplus  plaster.  Both 
rings  should  taper,  partly  to  give  greatest 
breadth  to  the  line  of  junction,  partly  for 
easier  delivery  of  plaster. 


VULCANITE. 


691 


We  offer  the  following  outline  sketch  (Fig.  338)  to  any  manufacturer 
who  may  see  proper  to  use  it.  Rings  (A)  one-eighth  inch  thick ;  depths 
five-fourths  and  three-fourths  inch ;  shape  either  an  equilateral  spherical 
triangle  (B),  with  radii  of  three  inches  from  centres  a,  a,  -a,  or  having 
the  two  front  curves  with  radii  of  two  and  one-quarter  inches  from 
centres  x,  x,  whichever  may  be  found  to  suit  the  largest  number  of 
cases  without  waste  of  plaster:  we  prefer  the  first  form.  Rounded 
flanges  (B)  on  the  upper  ring  fit  into  half-circular  notches  at  a,  a,  a. 
In  A  t^  is  a  front  view  of  flange  not  reaching  to  bottom  of  groove, 
which  is  filed  straight,  as  seen  at  a,  a.  Flask-covers  one-sixth  inch 
thick  (top  one  slightly  smaller),  with  a  small  lug  fitting  into  a  shallow 
notch  at  the  three  corners;  each  cover  to  have  three  holes,  counter- 
sunk on  outside.  These  holes,  full  of  plaster,  will  keep  covers  in 
place  and  will  help  in  drying  the  matrix,  if  used  for  metallo-plastic 
work.  Covers  and  centre  joint  to  be  notched  (e)  to  prevent  mis-match- 
ing of  parts  of  different  flasks.  A  sheet-iron  or  malleable  iron  band, 
tightened  with  a  wooden  or  iron  wedge,  will  hold  the  parts  together 
after  removal  from  the  flask-clamp.  A  small  stout  spring,  v,  is  useful 
in  giving  a  constantly  acting  power  to  the  clamp ;  but  a  piece  of  pure 
rubber  packing,  about  an  inch  thick,  will  prove  still  better  for  this 
purpose. 

Fig.  339  represents  one  of  the  small  vulcanizers  of  Dr,  Hayes,  of 
Buffalo,  which  claimed  at  one  time  to 
vulcanize  a  piece  in  forty  minutes,  at 
320°,  with  only  one  ounce  of  alcohol. 
As  to  whether  one  or  ten  ounces  of  al- 
cohol are  consumed  is  a  matter  of  sec- 
ondary consideration.  Not  that  unne- 
cessary extravagance  is  commendable, 
but  dental  art  has  suffered  much  from 
that  spirit  of  economy  in  the  laboratory 
which  puts  thirty-three  per  cent,  of  alloy 
in  gold  plate  and  thinks  more  of  petty 
saving  in  material,  than  of  making  work 
which  shall  prove  creditable  both  to  the  profession  and  to  the  practi- 
tioner. This  vulcanizer  may  be  used  with  or  without  water.  Dr. 
Hayes'  original  idea  was  to  have  the  oven  so  small,  and  the  packing 
so  absolutely  steam-tight,  as  to  require  no  other  moisture  than  what 
the  damp  plaster  supplies.  This  is  well  enough  so  long  as  the  top  is 
always  properly  adjusted ;  but  since  leakage  from  wrong  adjustment 
is  the  rule  rather  than  the  exception,  even  with  the  best-made  vulcan- 
izers, it  is  better  in  all  cases  to  fill  with  water.  The  tightness  of  pack- 
ing, and  the  small  surface  for  action  of  the  sulphurated  vapor,  explains 


Fig,  339. 


692 


VULCANITE. 


the  shortness  of  time  required  for  vulcanizing  in  this  oven,  as  com- 
pared with  previously  mentioned  apparatus.  Dr.  Hayes'  more  recent 
directions  are  to  heat  with  full  flame  up  to  280°  ;  then,  at  the  rate  of 
1°  per  minute,  up  to  320°,  at  which  to  keep  it  for  ten,  fifteen,  or  twenty 
minutes,  as  the  quality  of  the  ruboer  may  require.  Dr.  Hayes'  alcohol 
lamp,  represented  in  Fig.  340,  accompanying  this   oven  is  intended 

to  be  automatic ;  but  it  is  much  less 
simple  than  Dr.  Franklin's,  hereafter  de- 
scribed. His  oven  is  well  made,  and  is 
very  strong,  but  rather  small.  Although 
we  never,  under  any  circumstances,  vul- 
canize more  than  one  piece  at  a  time,  we 
prefer  to  place  the  one  flask  in  the  centre 
of  a  two-flask  heater.  Dr,  Hayes'  next 
size  (Fig.  341)  is  much  to  be  preferred. 

Dr.  Hayes'  two-flask  Iron-clad  oven  and  Whitney's  two-flask  vulcan- 

izer  are  favorite  forms  of 
Fig.  341.  Fio.  342.  Fig.  343.  apparatus.        The     latter 

(Fig.  342)  is  a  handsome 
vulcanizer,  but  has  a  se- 
rious objection  in  the  gr^eat 
liability  to  derangement 
of  the  packing,  in  unscrew- 
ing the  top.  The  former 
(Fig.  343)  overcomes  this 
by  having  an  outside  screw- 
cap,  with  three  set-screws 
to  tighten  the  inner  cover 


Fig.  344. 


Fig.  345, 


VULCANITE.  693 

which  holds  the  packing :  it  is  also  very  strong  Prof.  Kichardson 
describes  a  vulcanizer  (Fig.  344)  invented  by  Dr.  James,  of  Cincin- 
nati, the  top  of  which  is  very  easily  placed  and  removed.  Messrs. 
Snowden  and  Cowman  made  a  similar  one  several  years  since,  with  a 
clamp  having  two  instead  of  three  arms.  It  is  a  simple  and  safe  way 
of  securing  the  top,  provided  the  clamp  is  of  best  wrought-iron  with- 
out flaw.  In  a  boiler  of  four  inches  diameter,  the  inside  pressure  upon 
tbe  top  at  342°  is  1508  pounds,  consequently  there  is  a  strain  of  1320 
pounds  on  the  clamp. 

The  vulcanizer  used  by  us  with  greatest  satisfaction  was  that  of  Dr. 
Franklin  (Fig.  345) :  the  resumption  of  its  manufacture,  in  connection 
with  his  alcohol  lamp,  would  prove  a  benefit  to  the  profession.  The 
screws  are  quickly  tightened  or  loosened  by  a  rod  about  the  size  of  an 
excavator,  using  only  the  force  of  the  thumb  and  forefinger,  as  shown 
in  the  figure.  They  are  loosened,  but  never  removed;  the  top  being 
lifted  by  turning  it,  so  as  to  bring  the  loosened  screw-heads  into  the 
hollow  space  between  them. 

Registration  of  Temperature.  —  Franklin's  vulcanizer  was  originally 
designed  to  act  without  a  mercurial  thermometer,  upon  the  theory  that 
several  grades  of  fusible  metal  would  form  a  correct  gauge  of  temper- 
ature. After  a  series  of  very  careful  experiments,  we  are  satisfied  that 
the  indications  of  the  fusible-metal  test  are  uncertain,  usually  to  the 
extent  of  5°,  often  of  10°.  Steam-gauges  are  the  most  uniform  regis- 
ters, as  compared  one  with  another ;  hence,  if  generally  adopted,  it 
would  enable  operators  to  compare  results  with  more  satisfaction. 
Moreover,  the  index-hand,  moving  over  a  four-inch  dial-plate,  gives 
more  accurate  indications  of  pressure  (hence  temperature)  than  a  small 
tube  on  which  one-eighth  of  an  inch  marks  a  variation  of  10°.  The 
gauge,  with  its  syphon-tube,  may  be  set  directly  over  the  centre  of  the 
cover,  or  it  may  be  secured  against  the  wall  near  the  vulcanizer,  and 
permanently  attached  to  the  top  of  any  vulcanizer  except  AVhituey's.  In 
Fig.  345  it  should  be  attached  at  the  knob.  If  the  joint  of  steam-pipe 
passing  to  the  wall  is  twelve  or  eighteen  inches  long,  this  will  give  spring 
enough  for  loosening  the  screws;  then,  by  removing  the  two-inch  block 
on  which  the  vulcanizer  is  placed,  it  may  be  slightly  turned  and  with- 
drawn from  the  top,  which  remains  permanently  attached  to  the  pipe. 
If  Hayes'  oven  (Fig.  343)  is  used,  the  pipe  should  pass  through  the 
opening  in  the  screw-collar  and  be  permanently  fastened  in  the  cover. 
The  steam-pipe  should,  under  this  arrangement,  be  supported  by  a  wire 
or  bracket,  to  sustain  the  weight  of  the  cover.  Such  an  attachment 
to  Whitney's  vulcanizer  will  require  a  steam-tight  collar,  to  permit  the 
unscrewing  of  the  top ;  but  all  movable  steam-joints  are  apt  to  leak, 
and  leakage  in  a  vulcanizer  materially  affects  the  result.     Another 


694 


VULCANITE. 


plan,  applicable  to  any  vulcanizer,  is  to  insert  a  steara-valve  in  the  cover, 
and  immediately  over  this  a  screw  coupling.  By  disconnecting  this, 
the  entire  vulcanizer  is  detached  ;  if  well  packo;l  and  carefully  han- 
dled, this  coupling  may  be  kept  steam-tight  for  a  long  time.  The  pipe 
connecting  with  the  gauge  should  incline  toward  the  cover,  to  permit 
the  condensed  steam  to  return  to  the  boiler.  The  stop-cocks  immedi- 
ately below  the  gauge  must  be  shut  off  at  the  end  of  vulcanizing,  before 
disconnecting  the  heater ;  else  the  sudden  removal  of  pressure  will  be 
apt  to  derange  the  delicate  machinery  of  the  gauge. 

For  vulcanizers  which  are  moved  from  place  to  place,  the  compact- 
ness of  the  mercui'ial  thermometer  will  give  it  the  preference.  In  Fig. 
345,  it  should  occupy  the  place  of  the  knob.  The  best  thermometers 
have  a  metallic  case  to  protect  from  injury  when  not  in  use;  but 
most  thermometers  are  broken  from  other  causes  than  this  casing  pro- 
tects against,  —  pi'incipally  by  careless  handling  of  the  cover.  The 
delicate  glass  bulb  will  resist  a  very  great  pressure  from  without,  if 
steadily  and  uniformly  applied,  as  in  case  of  steam  ;  but  any  sudden 
shock  causes  the  contained  mercury  to  act  like  a  hammer  on  the  inner 
surface.  Thousands  of  thermometers  are  thus  broken  in  transitu,  al- 
though most  carefully  packed  in  cotton  ;  hundreds  are  broken  by 
blows  on  the  vulcanizer,  or  by  careless  removal  of  the  cover:  very 
few  owe  their  first  fracture  to  steam  pressure. 

The  following  tables,  carefully  collated  from  experiments  of  the 
French  Academy,  the  Franklin  Institute,  Ure,  Dalton  and  others,  will 
serve  as  a  guide  in  the  use  of  either  the  steam-gauge  or  the  mercurial 
thermometer  : 

No.  1. 


Pressure  per  Square  Inch. 

Temperature. 

Inches  of 
Mfercury, 

Atmos- 
pheres. 

Pounds. 
Avjoirdupois. 

15 

30 

45 

60 

75 

90 
105 
120 
135 
150 

180 
210 
240 
270 
300 
330 
360 

Scale, 
Fahrenheit. 

Differences. 

30 
60- 
90 
120 
150 
180 
210 
240 
270 
300 

360 
420 
480 
540 
600 
660 
720 

1 

2 
3 
4 
5 
6 
7 
8 
9 
10 

12 
14 
16 
18 
20 
22 
24 

212° 
250° 
275° 
294° 
309° 
321° 
332° 
342° 
352° 
360° 

374° 

387° 
398° 
409° 
419° 
428° 
486° 

88° 
25° 
19° 
15° 
12° 
11° 
10° 
10° 
8° 

14° 

13° 
11° 
11° 
10° 
9° 
8° 

No. 

2. 

Pounds. 

Temper- 
ature. 

63 

300° 

73 

310° 

80 

315° 

87 

320° 

95 

325° 

102 

3.^0° 

110 

335° 

117 

340° 

124 

345° 

131 

350° 

VULCANITE.  695 

In  TableNo.  1,  the  first  column  indicates  amount  of  pressure  per  square 
inch,  in  inches  of  mercury  contained  in  an  open  tube ;  it  must  not  be 
confounded  with  the  fourth  column,  which  gives  indications  of  tempera- 
ture, by  the  expansion  of  mercury  in  a  closed  tube.  The  second  col- 
umn gives  pressure,  a's  reckoned  by  atmospheres.  The  third  column 
gives  the  most  usual  mode  of  registering  pressure  by  pounds  avoirdu- 
pois, and  corresponds  to  the  dial-plate  of  steam-gauges.  Strictly 
speaking,  the  pressure  of  one  atmosphere  is  about  four  ounces  less  than 
fifteen  pounds.  We  have  therefore  given,  in  Table  No.  2,  a  more 
accurate  calculation  of  the  relation  of  steam-gauge  and  thermometer 
indications  within  the  limits  of  vulcanizing  heat,  for  the  guidance  of 
those  who  wish  to  change  from  one  to  the  other,  or  who  wish  to  com- 
pare the  published  results  of  different  operators. 

The  fifth  column  of  Table  No.  1  is  designed  to  show  the  increasing 
ratio  of  pressure  at  high  temperatures.  Increase  of  pressure  from  1 
atmosphere  to  2  requires  38°  of  heat ;  from  4  atmospheres  to  5,  only 
15°  ;  from  9  atmospheres  to  10,  only  8°  ;  from  23  atmospheres  to  24, 
only  4°.  Thus  an  increase  in  temperature  which,  at  212°,  would  give 
only  fifteen  pounds  additional  pressure^  would,  at  424°,  (twice  that  tem- 
perature,) give  130  pounds  and,  at  average  vulcanizing  heat,  about 
fifty  pounds  pressure  on  every  square  inch.  In  connection  with  this  fact 
it  must  be  remembered :  1.  That  if  vulcanizers  are  tested  by  hydro- 
static pressure,  a  steam  heat  of  250°  lessens  their  tensile  strength  nearly 
one-eighth  ;  2.  That  corrosion  of  the  sulphurated  vapor  gradually 
weakens  the  vulcanizer ;  3.  That  the  margin  of  safety,  in  mechanics, 
is  never  less  than  one-half  the  estimated  strength  of  material.  Hence 
any  vulcanizer  that,  from  possible  carelessness,  can  be  heated  to  360° 
is  dangerous,  unless  previously  subjected  to  a  hydrostatic  test  of  three 
hundred  pounds,  or  to  a  steam  pressure  of  400°  Fahrenheit. 

Dr.  Lawrence,  in  a  report  to  the  Mass.  Dental  Association,  in  1865,. 
says:  "Most  vulcanizers  are  now  made  of  sheet  copper  one-sixteenth 
of  an  inch  thick,  having  a  tensile  strength  of  1,875  pounds.  Such  a 
vulcanizer,  four  inches  in  diameter,  will  sustain  only  150  pounds 
pressed,  or  363°  temperature.  ...  If  only  half  the  estimated  strength 
can  safely  be  utilized,  the  operator,  vulcanizing  at  320°  with  such  a 
boiler,  is  in  hourly  jeopardy  of  life  and  limb."  The  gradual  weaken- 
ing of  vulcanizers  may  possibly  be  arrested  by  tinning  them  on  the 
inside,  since  sulphur  has  no  action  upon  that  metal ;  but  we  do  not  know 
how  far  the  tinning  process  may  weaken  the  tenacity  of  copper,  or 
how  soon  the  friction  of  flasks  may  wear  it  off.  Iron  flasks  are  often 
tinned,  but  the  rust  of  the  iron  soon  strikes  through  tin.  A  tin  coat- 
ing on  brass  flasks  is  more  durable,  and  prevents  loss  of  sulphur  in  the 
rubber  by  exposing  less  surface  to  its  action.  We  have  referred  else- 
where to  other  methods  of  preventing  this  action. 


696 


VULCANITE. 


Vulcanizing  Lamp.  —  Alcohol  is,  in  our  judgment,  the  only  burning 
fluid  suitable  for  a  vulcanizer.     Those  who  think  otherwise  can  readily 
procure  kerosene  stoves  and  lamps,  description  of  which  is  unnecessary. 
Pi     345  Fig.  346  represents  a   simplified 

form  of  Dr.  Franklin's  Safety- 
Lamp.  The  circular  reservoir  c, 
three  inches  in  diameter  and  one 
inch  high,  is  connected,  by  small 
tubes,  with  cylinders  A,  B,  which 
are  three  inches  distant  from  res- 
ervoir, the  bottom  of  which  is 
extended  to  support  cylinders  and  connecting  tubes.  A  and  B  con- 
tain wicks  made  of  finest  wire-gauze  rolled  up.  A  is  about  three- 
sixteejiths  inch  in  diameter,  B  about  one-eighth  inch,  extending  to 
bottom  of  cylinders,  and  projecting  as  high  as  may  be  necessary  for 
the  required  size  of  flame.  The  reservoir  is  divided  unequally  in 
about  the  same  proportion.  The  two  feet,  D,  by  tilting  the  reservoir, 
insure  the  flow  of  alcohol  into  the  tubes  and  cylinders. 

The  adjustment  and  action  of  the  lamp  are  as  simple  as  its  construc- 
tion. Suppose  it  is  required  to  raise  the  heat  from  boiling  point  (212°) 
to  342°  in  fifty  minutes,  and  keep  it  steadily  at  that  point  for  twenty- 
five  minutes.  Place  about  two  ounces  of  alcohol  in  each  compartment, 
and  light  both  wicks.  If  240°  is  reached  in  less  than  fifty  minutes,  wick 
A  projects  too  high;  if  it  requires  more  than  fifty  minutes,  a  larger  wick 
must  be  substituted:  once  adjusted,  it  acts  uniformly  in  subsequent 
heatings.  Remove,  with  a  small  sponge,  the  alcohol  left  in  compart- 
ment A,  and  accurately  measure  it.  This  gives  the  exact  amount  con- 
sumed, by  using  which,  in  subsequent  heatings,  the  wick  A  will  die  out 
when  the  temperature  reaches  340°,  or  117  pounds  pressure.  Small 
wick  B  continues  to  burn  for  twenty-five  minutes  longer,  at  the  end  of 
which  time  alcohol  in  this  compartment  is  sponged  out  and  measured. 
If  wick  B  does  not  maintain  the  heat  or  overruns  it,  adjustment  of  its 
length  is  necessary.  The  quantity  of  alcohol  used  in  a  two-flask 
Franklin  vulcanizer,  (Fig.  345,)  for  the  time  and  temperature  above 
given,  will  be  about  two  ounces;  the  larger  wick  consuming,  in  fifty 
minutes,  slightly  more  than  the  smaller  one  in  seventy-five  minutes. 
It  is  evident  that  any  adjustment  of  wicks  and  alcohol  can  be  made 
to  suit  any  time  or  rate  of  vulcanizing.  It  is  equally  evident  that, 
with  such  a  lamp,  overheating  or  explosion  is  absolutely  impossible. 

But  neither  this  nor  any  other  arrangement  is  strictly  automatic : 
there  are  too  many  disturbing  elements  in  the  operation  of  heating,  to 
permit  the  careful  mechanician  to  intrust  to  any  machinery  what  can 
only  be  with  certainty  done  by  his  own  watchfulness.     Five  or  ten 


VULCANITE.  697 

minutes  before  the  desired  point  (220°,  230°,  or  240°)  is  reached,  the 
vulcanizer  must  be  closely  watched :  any  excess  of  alcohol  must  be 
sponged  out,  or  else  the  wick  withdrawn ;  any  slight  deficiency  can  be 
applied  directly  to  the  heater  on  a  small  sponge,  or  in  a  spoon  made 
for  the  purpose.  Just  before  the  vulcanizing  is  completed,  the  lamp 
must  be  again  watched,  to  see  that  it  does  not  die  out  a  moment  too 
soon  or  burn  a  minute  beyond  the  time.  To  correct  irregular  action 
of  the  lamp  from  defective  alcohol,  or  from  variations  of  temperature 
in  the  room,  we  cover  the  vulcanizer  with  an  extra  tin  jacket,  sus- 
pended from  the  ceiling.  By  raising  or  lowering  this,  the  radiation  of 
heat  is  increased  or  diminished ;  thus  giving  an  extremely  delicate 
adjustment  without  disturbing  the  lamp,  after  its  wicks  have  once  been 
set  for  a  given  system  of  vulcanizing. 

Making  Matrix,  Removing  Wax,  and  Packing  the  Rubber. — The  model 
of  a  full  set  is  placed  in  the  shallow  half,  A,  of  the  flask  (Fig.  347), 

Fig. 347. 


with  wax-plate  and  teeth  attached,  as  before  described.  The  model 
must  be  saturated  with  water,  to  prevent  the  too  rapid  setting  of  the 
plaster-batter  with  which  the  flask  is  partly  filled,  and  which,  on  plac- 
ing the  model,  rises  to  edge  of  flask  and  edge  of  the  wax-plate.  As  soon 
as  this  has  become  moderately  firm,  trim  smoothly  up  to  the  model 
with  spatula  and  sponge ;  then  soap  this  surface,  or  varnish  and  oil  it, 
or  cover  it  Avith  tin-foil.  Mix  a  fresh  lot  of  rather  stiS"  batter,  and 
brush  it  carefully  over  the  wax  and  into  all  the  intei'stices  of  the 
teeth.  Then  place  the  upper  half-flask  C,  and  quickly  pour  the  bat- 
ter, stirring  it  well  with  a  feather  into  the  space  between  the  teeth 
and  sides  of  the  flask.  Set  on  the  cover  D,  and  apply  the  clamp  B. 
Before  it  fully  hardens,  wash  off"  the  plaster  with  a  sponge,  from  the 
outside  of  the  flask,  and  let  it  get  quite  hard  before  separating  the  two 
halves.  The  object  of  making  the  batter  stiff"  is  to  give  it  greater  hard- 
ness, for  support  of  the  blocks  under  pressure  of  packing.  These  are 
often  displaced,  and  the  joints  opened  under  moderate  pressure;  be- 
cause, first,  the  batter  is  too  thin,  and,  secondly,  time  is  not  allowed  for 
it  properly  to  Jiarden  before  packing.  The  flask  should  be  set  in  water 
at  about  120°,  for  five  minutes  before  separation,  so  that  in  case  of 
undercut  or  of  a  thin  or  prominent  ridge,  there  shall  be  no  danger  of 


698  VULCANITE. 

breaking  the  model.  Remove  the  wax  carefully,  according  to  direc- 
tions given  in  the  chapter  on  Metallo-plas^tic  work ;  being  careful  to 
keep  all  the  wax  that  is  removed.  The  flasks  will  then  present  the 
appearance  shown  in  Fig.  337  ;  the  model-half  E  separating  from  the 
teeth  and  wax  contained  in  the  dental-half  H.  Should  the  joints  not 
be  very  closely  fitted,  place  a  little  dry  plaster  over  each,  and  touch 
with  a  drop  of  water  or  diluted  soluble  glass,  and  when  hard,  trim  off 
the  surplus  plaster.  Some  prefer  to  pack  with  tin-  or  gold-foil.  With- 
out some  such  precaution,  the  rubber  will  press  into  open  joints,  and 
present  an  unsightly  appearance;  of  course,  closely-ground  joints  are 
preferable  to  any  of  these  expedients:  but  neither  the  tightest  joints, 
nor  any  precautions  will  avail,  if  strong  pressure  is  used  in  packing, 
for  this  invariably  opens  the  joints  and  admits  the  gum. 

In  partial  cases,  or  where  no  vulcanite  is  required  outside  the  arch 
and  above  the  teeth,  the  deep  half  H  must  be  used  for  the  model ;  so 
that  the  plaster  aroinid  the  teeth  may  come  nearly  or  quite  level  with 
the  edge  of  the  flask.  The  teeth  are  thus  firmly  fixed  in  their  exact 
position,  and  resist  displacement,  which  the  separation  of  the  flasks  or 
the  pressure  of  the  rubber  might  possibly  occasion.  In  this  way, 
should  the  flasks  chance  not  to  come  perfectly  together,  the  result  will 
be  an  extra  thickness  of  plate,  but  no  disi)lacement  of  teeth.  We 
consider  this  use  of  the  deep  half  of  the  flask,  in  all  partial  cases,  as 
of  utmost  importance.  The  teeth  are  never  disturbed  in  their  posi- 
tion on  the  model  given  them  in  the  wax-plate  ;  also,  there  is  no 
breaking  of  plaster  teeth  or  splitting  of  the  model  by  pressure  of  the 
rubber. 

It  is  desirable  in  all  cases,  and  quite  essential  in  most,  that  the 
flasks  should  come  perfectly  together.  This  is  accomplished  by  atten- 
tion to  three  points :  1.  Softening  the  rubber  ;  2.  Using  a  proper  quan- 
tity; 3.  Having  vents  for  the  surplus.  First.  For  softening  the  rubber, 
use  a  deep  covered  saucepan,  capable  of  holding  the  flask-press  and 
containing  two  or  three  inches  of  water.  When  the  flask  is  thoroughly 
heated  by  the  steam,  the  rubber  is  placed  on  the  cover  of  the  saucepan, 
or  on  a  small  shelf  attached  to  the  inside  of  the  saucepan:  then,  while 
soft,  let  it  be  packed,  with  the  help  of  a  pointed,  stick,  into  the  dental 
half  of  the  matrix.  Arcund  the  teeth  the  rubber  may  be  packed  in 
the  form  of  very  narrow  strips  with  a  flattened  point  of  hard  wood, 
somewhat  as  foil  is  inserted  into  the  cavity  of  a  tooth.  The  remainder 
is  packed  either  in  large  strips  or  in  one  piece  cut  to  the  shape  of  the 
■wax-=plate. 

Secondly.  It  is  important  to  use  the  proper  quantity  of  rubber :  too 
little  vulcanite  spoils  the  piece ;  too  much  requires  a  pressure  which 
may  break  the  blocks,  displace  the  teeth,  and  force  rubber  into  the 


VULCANITE. 


699 


joints;  or  else  requires  a  long  time  for  a  safe  degree  of  pressure  to 
bring  the  flask  together.  In  some  cases  the  quantity  can  be  correctly 
found,  by  having  the  sheets  of  vulcanite  exactly  as  thick  as  the  wax- 
plate,  removing  the  latter  as  carefully  as  possible  and  marking  off  its 
size  on  the  former.  But  for  some  irregularly  shaped  cases  and  most 
lower  cases,  the  following  simple  method  will  be  found  better.  Let  the 
plate  be  entirely  of  wax ;  remove  it  all  from  the  matrix,  and  roll  it 

Fig.  348. 


into  a  sheet  the  thickness  of  the  rubber ;  make  the  rubber  a  little 
larger  than  the  wax;  then  cut  into  conveniently  sized  strips  and  pack, 
putting  most  at  those  points  where  the  wax  was  thickest.  Starr's 
measuring-glass,  which  determines  the  quantity  of  rubber  by  "dis- 
placement," is  a  convenient  instrument  for  this  purpose. 

Thirdly,  Since  the  error  in  quantity  should  always  be  on  the  safe 
side  of  excess,  provision  must  be  made  for  the  escape  of  this  surplus  by 
cutting  vents,  that  the  halves  of  the  matrix  may  come  together  with- 
out too  great  pressure.  Fig.  348,  taken  from  Prof.  Wildman's  mono- 
graph, is  a  fine  illustration  of  the  best  method  of  cutting  these  vents. 
The  radiating  vents  might,  however,  stop  at  the  circular  groove,  taking 
care  to  make  this  large  enough  for  any  possible  excess  of  rubber.  If 
these  leaders  are  too  large  next  the  plate,  the  rubber  may  not  pack  so 


700  VULCANITE. 

firmly  as  is  desirable  ;  also  the  generation  of  gas,  while  vulcanizing, 
may  force  rubber  too  freely  into  the  groove,  and  so  make  it  porous. 

The  best  form  of  flask-press  is  that  of  Messrs.  Snowden  and  Cowman, 
Fig.  349  (to  whom  we  would  here  also  acknowledge  our  indebtedness 
ior  the  illustrations  of  their  Impression  cups  on  page  539,  and  of  their 
well-known  Foot-lathe,  Fig.  256).     As  soon  as 
f '"•  ^^^-  the  rubber  is  packed,  the  halves  of  the  flask  are 

carefully  brought  together,  placed  in  the  press, 
and  a  moderate  force  applied :  the  press  and 
flask  are  then  placed  in  the  heater.  A  piece  of 
pure  "rubber-packing,"  about  an  inch  thick, 
placed  under  the  screw,  will,  as  before  stated, 
insure  a  constantly  acting  force  whilst  in  the 
heater.  Avoid  using  the  full  power  of  even  one 
hand  upon  the  lever;  if  the  vents  are  free,  and 
great  excess  of  material  is  avoided,  moderate 
pressure  acting  steadily  in  the  heater  will  safely 
bring  any  flask  together  in  from  ten  to  forty 
minutes.  In  all  cases  use  a  flask -press  (Fig.  349),  discarding  the 
small  screw-bolts  attached  to  most  flasks  in  present  use  :  they  cannot 
give  the  spring-like  compression  of  a  press,  are  easily  mislaid,  make 
cleansing  of  flasks  diflScult,  and  are  altogether  such  a  nuisance  that  we 
are  at  a  loss  to  understand  their  popularity.  Clean  flasks  are  essential 
to  successful  packing ;  for  soiled  fingers  stain  the  rubber,  which  inter- 
feres with  perfect  union  of  the  pieces  ;  hence  all  apparatus,  handled  in 
packing,  should  be  so  simple  in  form  as  to  be  readily  cleaned  ;  also,  it 
is  well  to  keep  them  constantly  covered  with  a  coating  of  varnish. 

There  are  three  ways  to  make  the  vulcanite-plate  separate  readily 
from  the  model.  1.  Trusting  to  the  dilute  soluble  glass,  originally 
used  to  harden  and  protect  the  surface  of  the  model.  2.  Collodion 
varnish,  applied  just  before  packing  :  this  will  sometimes  peel  off  in 
places,  by  motion  of  the  pieces  of  adhesive  gum  ;  it  should  be  applied 
in  a  thin  layer.  3.  Gilding  the  surface  with  bookbinders'  foil :  this 
adheres  to  the  finished  plate,  but  is  not  unsightly.  The  use  of  tin-foil, 
afterward  removed  by  muriatic  acid,  is  a  plan  much  inferior  to  the 
other  three.  Melted  wax,  oil,  and  gum-  or  resin-varnishes  must  be 
carefully  kept  from  penetrating  plaster  surfaces  next  to  the  vulcanite, 
as  they  more  or  less  injure  it. 

Time  of  Vulcanizing. — When  the  halves  of  the  flask  are  brought 
into  contact,  it  is  taken  from  the  press,  set  in  a  small  band  or  clamp 
to  keep  the  parts  together,  and  at  once  placed  in  the  vulcanizer;  which 
is  then  filled  with  boiling  water,  the  cover  adjusted,  lamp  lighted,  and 
time  reckoned  from  the  moment  of  closing  the  cover. 


VULCANITE.  701 

The  time  occupied  in  heating  up  and  vulcanizing  varies  with  differ- 
ent operators.  Drs.  Mallett,  Putnam  and  other  early  experimenters 
vulcanized  for  six  hours  or  more.  By  gradually  raising  the  heat  and 
reducing  the  size  of  the  vulcanizers,  they  subsequently  vulcanized  in 
four  hours  at  310°  Fahrenheit.  Dr.  Franklin  recommended  bringing 
the  heat  in  one  hour  up  to  310°,  directing  that  it  should  be  kept  steadily 
at  that  point  for  two  and  a  half  or  three  hours.  His  later  experi- 
ments demonstrated  that,  if  one  hour  is  taken  to  raise  slowly  to  300°, 
and  another  full  hour  to  raise  steadily  and  gradually  to  330°,  five  min- 
utes longer  will  complete  the  vulcanizing.  As  thermometers  vary 
much,  and  the  rubber  used  also  varies,  the  best  plan  is  for  every  one  to 
vulcanize  trial  pieces  until  the  required  hardness,  toughness,  and  elas- 
ticity are  obtained.  It  should  curl  under  the  scraper  like  horn,  permit 
bending  at  an  angle  of  at  least  45°,  and  return  to  its  original  shape 
unchanged. 

Prof  Wildman  recommends,  for  red  rubber,  thirty  minutes'  to  sixty 
minutes'  time  in  heating  up  to  320°,  and  keeping  at  that  point  from 
sixty  to  ninety  minutes ;  time  of  raising  heat  varying  according  to 
thickness  of  the  mass  of  rubber;  time  of  maintaining  heat  varying 
with  kind  of  rubber,  vulcanizer,  and  thermometer.  He  says  that 
brown  rubber  requires  slower  heating  up  than  red,  but  the  same  time 
of  maintaining  heat;  that  pink  rubber  may  be  safely  heated  more  rap- 
idly than  red,  and  kept  at  320°  for  only  three-fourths  or  one-half  the 
time.  He  also  says  that,  to  prevent  porousness  from  evolution  of  gas, 
"the  heat  should  be  raised  slowly  and  the  rubber  should  be  under 
strong  pressure."  Dr.  Lawrence  maintains  the  heat  at  320°  for  sixty 
minutes ;  Prof.  Richardson,  at  340°  for  forty-five  minutes,  or  at  320° 
for  sixty  to  eighty  minutes,  occupying  not  less  than  forty-five  min- 
utes in  bringing  the  heat  up  to  the  vulcanizing  point.  Dr.  Hayes 
advises  rapid  heating  to  280°,  then  gradually  for  forty  minutes  up  to 
320°,  at  which  keep  from  ten  to  twenty  minutes. 

In  a  very  large  proportion  of  vulcanite  pieces,  the  full  strength  of 
the  material  is  lost  by  overheating  ;  in  others,  by  the  opposite. error  of 
giving  too  much  elasticity  and  throwing  undue  strain,  in  full  cases, 
upon  the  blocks  and  the  rim  of  rubber  behind  them.  If  some  of  the 
time  spent  in  polishing  up  vulcanite  and  bringing  out  the  offensively 
glaring  brilliancy  of  its  color  were  devoted  to  careful  management  of 
the  vulcanizer,  to  making  proper  record  of  heatings,  so  as  to  arrive  at 
uniform  results,  and  to  the  cultivation  of  those  habits  of  accuracy 
which  alone  can  give  success,  there  would  be  fewer  broken  pieces  re- 
turned to  the  laboratory  for  repair. 

The  following  table  of  cases,  selected  from  Prof.  Austen's  vulcan- 
izing record,  extending  over  a  period  of  seven  years,  from  1858  to 


702 


VULCANITE. 


1865,  will  illustrate  the  effect:  (1)  of  the  size  of  vulcanizers,  (2)  of 
tight  packing,  (3)  of  increase  of  temperature. 


Starting 
Point. 

Time. 

VlLCANIZING 

Point. 

Time. 

Total 
Time. 

o 

H.     M. 

0 

H.     M. 

n.  M. 

1 

62 

3 

800 

2  30 

5  30 

2 

62 

2  30 

310 

2 

4  30 

3 

62 

2 

310 

2 

4 

4 

72 

2 

320 

1  80 

3  30 

5 

72 

1   30 

320 

1  80 

3 

6 

72 

1  30 

830 

1 

2  30 

7 

212 

1  10 

330 

1 

2  10 

8 

212 

1  15 

340 

30 

1  45 

9 

212 

1 

340 

40 

1  40 

10 

212 

1  10 

342 

15 

1  25 

11 

212 

1 

342 

20 

1  20 

12 

212 

50 

342 

25 

1  15 

In  all  these  cases  the  vulcanized  rubber  was  of  good  quality,  as  re- 
spects hardness,  toughness,  and  elasticity.  The  first  four  cases  were 
vulcanized  in  a  cast-iron  vulcanizer  over  an  anthracite  coal  stove, — 
the  first  two  in  a  double  chest,  three  gallons  each,  the  last  two  in  a  sin- 
gle chest  of  three  gallons'  capacity.  Experiments  No.  2  and  No.  3 
show  the  effect  of  this  reduced  size;  and  all  four  show  the  effect  of  loss 
of  steam  unavoidable  in  this  form  of  apparatus.  The  next  three  cases 
were  done  in  a  copper  boiler,  with  iron  flange  and  top,  and  old  style  of 
packing  and  safety-valve,  having  capacity  of  one  gallon.  Experi- 
ments No.  4  and  No.  5  show  effect  of  this  further  reduction  in  size; 
while  Nos.  6  and  7  show  the  gain  by  starting  from  boiling  point  in- 
stead of,  as  heretofore,  from  the  temperature  of  the  room.  This  has  the 
further  advantage  of  enabling  the  operator  to  transfer  his  pieces  at 
once  from  the  packing-boiler  to  the  vulcanizer,  without  endangering 
the  blocks  by  sudden  change  of  temperature.  The  last  five  cases  were 
done  in  a  perfectly  steam-tight  two-flask  Franklin  vulcanizer  (Fig. 
345),  capacity  about  two  quarts ;  gauge,  a  thermometer ;  lamp,  such 
as  delineated  in  Fig.  346 ;  safety-valve,  none.  These  last  experi- 
ments show  the  effect  of  small  and  steam-tight  boilers ;  also  the  rapidly 
increasing  action  of  high  temperature.  It  will  be  noticed  that  the 
duration  of  heat  at  the  vulcanizing  point  is  modified  by  the  time  taken 
to  reach  that  point.  In  comparing  the  last  three  cases.  No.  12  was 
done  in  the  shortest  time ;  but  No.  10  is  a  much  better  time,  because 
more  slowly  raised.  It  should  be  remembered,  in  comparing  these 
cases  with  each  other,  or  with  the  results  of  other  operators,  that  due 
allowance  must  be  made  for  differences  in  thermometers  and  kinds  of 
rubber :  the  last  five  were  registered  with  the  same  thermometer,  but 
each  of  the  previous  cases  with  a  different  one.  All  were  made  from 
the  American  Hard  Rubber  Company's  rubber. 


VULCANITE.  703 

The  following  inferences  are  drawn  from  the  series  of  cases  out  of 
which  the  table  above  given  is  selected.  High  temperature  will  give 
as  good  results  as  low,  if  care  is  used  in  heating  up  slowly  :.  heating 
one  hour  and  thirty  minutes  to  342°,  and  at  once  cooling  off,  will  prob- 
ably give  as  tough  rubber  as  case  No.  10.  Slow  heating  and  a  per- 
fectly tight  vulcanizer  full  of  water,  with  flask  well  bound  together 
and  vents  not  too  free,  are  the  best  safeguards  against  porous  rubber. 
If  the  flask  is  forty  to  sixty  minutes  in  the  packing-boiler,  it  requires 
five  minutes  less  time  to  vulcanize  ;  the  same  allowance  should  be  made 
if  the  case  is  slowly  cooled  ofi*:  in  the  last  five  cases  the  vulcanizer 
was  set  at  once  into  cold  water.  Two  half-heatings  make  tougher  rub- 
ber than  one :  for  instance,  if  case  No.  10  were  brought  up  to  342°  in 
one  hour  and  ten  minutes,  and  kept  there  five  minutes,  then  cooled 
down  to  250°  or  212°,  and  again  raised,  in  forty  or  sixty  minutes,  up 
to  342°,  and  kept  there  another  five  minutes,  the  rubber  would  be  much 
tougher.  This  inference  is  drawn  from  the  extreme  toughness  of  some 
cases,  in  which  a  second  heating  was  necessary ;  but  two  full-timed 
heatings  make  a  brittle  material.  There  seems  to  be  a  point  beyond 
which,  if  rubber  twice  passes,  it  becomes  inevitably  brittle ;  hence  no 
confidence  can  be  placed  in  the  old  material  of  a  repaired  piece.  Two 
flasks  in  the  same  vulcanizer  cannot  give  the  same  results:  loss  of  heat 
by  radiation  is  greatest  from  the  cover,  and  the  supply  of  heat  is  from 
below ;  hence,  necessarily,  the  lower  half  of  the  oven  is  hotter  than 
the  upper.  Uniformity  of  texture  can  be  obtained,  therefore,  only  by 
vulcanizing  one  piece  at  a  time.  One  who  is  systematic  in  the  arrange- 
ment of  his  work  will  separately  vulcanize  the  pieces  of  a  double  set 
in  very  nearly  the  same  time  required,  if  both  are  done  at  once ;  for 
one  piece  may  be  in  the  oven,  while  the  other  is  in  preparation  for  it. 

Removal  from  Vulcanizer,  and  Finishing. — Upon  expiration  of  the 
time  detei-mined  upon,  the  flame  is  to  be  at  once  extinguished :  the 
vulcanizer  may  be  cooled  gradually  as  it  stands,  or  rapidly  by  the 
escape  of  the  steam,  or  by  setting  the  lower  three-fourths  of  the  vul- 
canizer in  cold  water.  The  last  method  of  rapid  cooling  is  pi'eferable; 
running  the  heat  five  min,utes  longer  than  when  slow  cooling  is  prac- 
tised. Letting  off  steam  is  a  very  disagreeable  process,  and  makes  the 
plaster  of  the  flasks  very  hard  to  cut  out.  Flasks  may,  with  perfect 
safety,  be  cooled  by  setting  the  vulcanizer  in  snow  or  pounded  ice,  if 
desired  ;  but  in  no  case  should  the  flasks  themselves  be  cooled  by  con- 
tact with  cold  water,  as  some  might  chance  to  penetrate  to  the  blocks 
and  crack  them.  The  flask  should  be  opened  and  the  piece  removed 
from  its  plaster  investment,  within  two  or  three  hours  after  vulcanizing. 
After  that  time  the  plaster  assumes  a  sand-like,  granular  state,  and 
adheres  with  great  tenacity  to  the  plate,  no  matter  what  separating 


704 


VULCANITE. 


varnish  may  be  used.  Tapping  the  edges  of  the  flask,  after  separation, 
will  dislodge  their  contents  in  mass :  the  plaster  can  then  be  trimmed 
from  the  piece,  taking  cure  that  it  is  perfectly  cold.  The  adherent 
plaster  in  the  dental-half  of  the  flask  can  easily  be  washed  from  the 
piece  with  a  stiff"  brusii ;  but  the  model-half  leaves  a  coating  that 
clings  very  tenaciously,  unless  means  are  taken  to  prevent  it:  soluble 
glass,  a  dilute  ethereal  solution  of  collodion,  or  a  layer  of  thin  foil, 
have  been  already  mentioned  as  the  proper  preventives. 

The  process  of  finishing  is  more  troublesome  than  in  the  case  of  gold 
work,  unless  great  cave  is  used  in  the  formation  of  the  wax-plate. 
Several  sizes  of  round  and  half-round  flies  are  necessary  for  finishing 
up  the  edges  and  convex  surfaces ;  for  the 
concave  surfaces,  scrapers,  graving-chisels, 
and  curved  files.  Lathe-burrs  and  file-cut 
wheels  will  be  found  very  useful,  if  there  is 
to  be  much  reduction  of  thickness.  Figs. 
350  and  351  represent  one  of  each,  as  made 
by  Dr.  White,  the  burrs  in  sets  of  four  and 
the  wheels  in  sets  of  three.  Sufficient  thick- 
ness must  be  left  in  the  body  of  the  plate  for 
strength,  but  the  edges  should  be  chamfered 
off.  A  pair  of  callipers  (Figs.  308,  309)  are 
required  to  measure  the  thickness  of  the 
plate,  if  it   is   to   be  reduced   by  files  and 


Fig.  350. 


Fig.  351. 


scrapers.  Some  operators  next  use  sand-paper  or  emery-cloth ;  others 
use  pumice-stone  on  cork-wheels ;  we  very  decidedly  prefer  Scotch- 
stone.  The  third  step  is  the  use  of  rotten-stone  (not  tripoli,  which 
cuts  with  too  keen  a  grit),  either  on  a  brush-wheel  with  tallow  or  oil, 
which  is  the  more  rapid  process,  or  on  a  stick  of  some  hard  wood  with 
Avater,  which  is  the  more  cleanly.  A  little  oxide  of  zinc  on  a  soft 
wheel,  or  on  the  finger,  will  give  a  brilliant  finishing  polish,  but  is  not 
essential,  as  the  rotten-stone  can  be  made  to  polish  very  highly.  After 
trying  the  piece,  and  finding  that  no  part  of  the  edge  requires  altera- 
tion, a  bright  surface-color  may  be  given  by  placing  the  piece  in  alco- 
hol and  exposing  to  the  sun's  rays  for  six  or  twelve  hours.  Some 
regard  this  as  an  improvement:  it  certainly  does  not  injure  the  quality 


VULCANITE.  705 

of  the  plate,  but  the  original  mahogany  color  of  the  vulcanite  is  in 
much  better  taste  than  the  bright  vermilion  tint  thus  given.  In  fin- 
ishing partial  cases,  it  will  pi-event  accident  if,  after  filing  the  edges,  a 
lump  of  gutta-percha  is  fitted  to  the  palatine  surface  of  the  plate:  the 
subsequent  operations  can  be  conducted  more  rapidly  and  with  less 
danger,  in  delicately-shaped  pieces.  Vulcanite  is  softened  by  heat ; 
hence  a  piece  is  sometimes  bent  by  revolving  the  brush-wheel  too  rap- 
idly. A  piece  that  has  been  in  any  way  bent  or  warped  may  be  re- 
stored by  heating  either  in  boiling  salt  water,  or  in  oil  to  about  250°. 
While  soft,  it  may  be  bent  with  the  fingers ;  but  as  this  guess-work 
method  is  hazardous,  it  is  much  better  to  bind  it  down  upon  a  model, 
and  heat  to  the  point  of  softening. 

A  modification  of  the  vulcanite  process  was  patented,  in  1868,  b} 
Dr.  Stuck :  for  a  minute  description  of  the  process,  the  reader  is  re-- 
ferred  to  instructions  furnished  by  him.  Briefly  described,  it  is  the 
vulcanizing  of  rubber  between  two  polished  tin-foil  plates,  the  articu- 
lating plate  being  formed  upon  a  block-tin  model  made  directly  from 
the  impression.  The  plate  comes  out  highly  polished,  provided  the 
tin-foil  has  been  carefully  burnished  into  shape.  On  the  palatine  sur- 
face, this  polish  is  objectionable ;  hence  we  should  prefer  to  vulcanize 
directly  upon  the  block-tin  model,  the  granulated  surface  of  which  is 
better  for  adhesion.  The  plate,  thus  made  smaller  than  the  mouth  by 
the  shrinkage  of  the  tin,  would,  in  most  cases,  fit  better ;  the  difiiculty 
is  in  removing  the  finished  plate  from  the  metal  in  case  of  a  deep  arch 
or  slight  undercut.  A  second  peculiarity  of  Dr.  Stuck's  plates  is  their 
elasticity,  compared  with  pieces  as  ordinarily  prepared,  and  vulcanized 
in  the  same  oven.  This,  we  suggest,  is  due  to  the  retention  of  the  sulphur 
by  the  foil-plates  on  either  side.  We  think  these  elastic  plates  are 
usually  made  too  thin,  under  the  idea  that  elasticity,  like  rigidity, 
compensates  for  diminished  thickness.  This  method,  though  open  to 
some  objection,  is  worthy  of  careful  investigation  by  every  worker  in 
vulcanite. 

Repairing  and  Refitting  Plates. — Vulcanite  work  maybe  repaired 
by  removing  the  broken  tooth  or  block,  cutting  dovetails  in  the  rub- 
ber, and  then  fitting  the  new  teeth,  arranging  the  wax,  and  vulcan- 
izing as  at  first.  Instead  of  cutting  dovetails,  which  are  often  disfig- 
uring and  sometimes  impracticable,  a  liquid  preparation  may  be  used, 
known  as,  Dr.  Welch's  Rubber-Solder,  and  sold  by  Snowden  and  Cow- 
man, of  Baltimore.  The  surface  of  the  old  plate  should  be  brushed 
over  with  it  just  before  packing.  The  adhesion  is  so  pei'fect  that  the 
plate  will  break  through  old  or  new  rubber  sooner  than  separate.  Be- 
fore filing  out"  the  old  rubber,  the  part  of  the  plate  under  the  broken 
teeth  should  be  filled  with  plaster  and  then  removed^  so  as  to  preserve 
45 


706  VULCANITE. 

the  shape  of  the  ridge,  in  ease  the  process  of  repair  requires  that  the 
plate  shall  be  cut  entirely  through  at  this  point:  it  is  to  be  replaced 
before  applying  the  wax.  The  second  heating  darkens  the  old  rubber 
and  makes  it  more  brittle:  full  cases  may  admit  of  one,  possibly  two, 
such  heatings.  Partial  cases  should  be  repaired  by  rei>lacing  the  entire 
plate  with  new  rubber;  although  many  repair  as  in  full  pieces.  We 
decidedly  prefer,  in  both  full  and  partial  cases,  the  entire  replacement 
of  the  rubber.  In  doing  this,  there  are  various  ways  of  securing  the 
correct  relation  of  the  teeth  to  the  new  model.  To  replace  a  broken 
partial  or  full  plate,  the  teeth  being  uninjured  —  attach  the  broken  parts 
firmly,  by  resinous  cement,  on  the  lingual  surface ;  soap  the  rubber, 
or  very  slightly  oil  it,  and  make  a  new  model :  then  surround  it  with 
a  plaster  rim,  as  explained  on  page  596,  coming  fully  to  the  edges  of 
the  teeth.  Remove  the  resinous  cement  from  lingual  side  of  the  plate, 
and  take  a  plaster  copy  of  this  surface  and  of  the  inside  of  the  teeth  ; 
beino-  careful,  in  partial  cases,  to  slope  the  plaster  so  that  it  may  be 
readily  drawn.  The  plaster,  now  enveloping  the  piece,  is  in  three  or  in 
four  parts :  remove  the  plaster  from  the  lingual  surface ;  remove  the 
rim  in  one  or  in  two  pieces ;  then  carefully  remove  the  plate  from  the 
model.  Soften  the  rubber-plate  and  remove  the  teeth ;  replace  the 
plaster  rim  around  the  model  and  set  the  teeth  or  blocks  in  j)osition, 
pressing  a  little  wax  under  each,  to  keep  it  in  place.  Now  set  model, 
rim  and  teeth  in  the  half-flask,  first  soaking  in  water,  to  prevent  too 
quick  set-ting  of  the  batter.  Soap,  or  cover  with  foil,  the  plaster  sur- 
face; then  saturate  and  put  in  place  the  remaining  lingual  piece  of 
plaster :  set  the  other  half-flask,  and  pour  the  remaining  half-matrix. 
Separate  flask,  pick  out  the  pieces  of  wax :  the  case  is  then  ready  for 
packing  and  vulcanizing.  By  this  process  the  new  plate  has  the  exact 
shape  of  the  old  one,  and  there  is  no  necessity  for  moulding  a  new 
wax-plate.  If  the  plate  is  of  such  form  as  to  endanger  the  model  in 
detaching,  soften  it  by  cautious  use  of  the  blow-pipe  flame. 

If  a  new  tooth  or  block  is  required,  let  this  be  first  fitted,  and  wax 
properly  shaped  around  it;  then  proceed  as  above.  But  if  some  modi- 
fication in  the  shape  or  thickness  of  the  plate  is  required,  do  not  fill 
the  lingual  surface  with  plaster ;  but,  after  making  model  and  rim, 
remove  plate,  reset  teeth,  adjust  a  new  wax-plate,  and  then  proceed  as 
in  a  new  piece.  If  the  vulcanite  rim  outside  and  above  the  teeth  needs 
modification,  the  plaster  rim  must  be  removed  and  wax  placed  there 
also,  as  in  a  new  piece. 

If  the  teeth  are  to  be  reset  because  of  change  from  absorption,  or 
because  of  some  inaccuracy  in  the  fit  of  the  plate,  it  will  perhaps  be 
best,  in  most  cases,  to  proceed  just  as  for  a  new  piece,  grinding  the 
joints  again  for  any  change  of  arrangement.     Sometimes  re-jointing 


VULCANITE.  707 

the  blocks  may  be  saved  by  bedding  their  cutting  edges  and  cusps  in 
a  gutta-percha  rim,  before  detaching  from  the  plate :  this  will  permit 
their  adjustment  to  the  new  wax-plate,  in  a  continuous  arch.  Some- 
times the  old  plate  may  with  advantage  be  used  as  an  impression  cup, 
by  roughening  the  rubber,  and  using  a  very  thin  layer  of  wax  or  plas- 
ter, whichever  best  suits  the  case.  In  making  the  model,  extend  it 
backward,  as  before  described  under  Articulation  of  Plastic  Work. 
Before  removing  the  piece  complete  the  articulator,  making  the  plaster 
cover  the  edges  and  crowns  of  the  teeth  one-eighth  inch.  By  setting 
the  blocks,  when  removed  from  the  old  plate,  into  their  depressions  on 
the  articulator,  the  exact  relation  of  blocks  to  the  model  is  preserved: 
also,  if  the  plaster  of  the  impression  is  made  accidentally  too  thick, 
the  articulator  may  be  slightly  closed.  The  wax-plate  is  arranged  first 
on  the  outside;  the  half-articulator  is  then  removed,  and  the  inner  part 
of  the  plate  shaped.  The  articulating  portion  is  then  cut  off,  the  model 
set  in  the  flask,  and  the  process  completed  in  the  usual  manner. 

Gold,  platina,  or  aluminum  plates  may  also  be  re-fitted  to  suit  a 
mouth  changed  by  absorption.  Perforate  the  plate  with  holes  about 
size  No.  22  (Fig.  208),  -countersunk  on  lingual  side,  regularly  arranged 
and  about  a  half-inch  apart.  Fill  the  lingual  surface  between  teeth 
with  plaster ;  remove  this  when  hard  and  make  countersinks  in  it, 
opposite  each  hole  in  the  plate.  Set  the  plate  on  model  and  fasten  it 
with  wax  around  the  entire  edge :  then  place  in  half-flask  as  usual. 
Replace  the  countersunk  pieces  of  plaster  and  pour  second  half-matrix  r 
this  piece  of  plaster  and  the  wax  around  the  edge  prevent  the  batter- 
of  the  matrix  from  getting  between  plate  and  model.  Separate  flask,, 
cut  vents,  put  in  a  sheet  of  prepared  rubber  of  proper  size,  press  ma- 
trix together  and  vulcanize.  The  impression  may  be  taken  in  the 
usual  cups  or  in  the  plate  itself,  and  with  either  plaster  or  wax,  as  the 
case  may  require :  if  taken  in  the  plate,  cleanse  this  carefully  after 
making  the  model.  The  adhesion  of  the  rubber  may  be  increased  by 
cutting  the  palatine  surface  of  the  metallic  plate  with  a  sharp  graver: 
it  should  be  carefully  cleansed  just  before  packing  the  rubber. 

Partial  pieces  can  usually  be  retained  by  stays  and  the  fit  of  the 
plate.     If  clasps  are  called  for,  these  may  be  made  of-  rubber  alone, 
if  the  clasps  are  short  and  the  rubber  elastic ;  or  of  rubber  strength- 
ened by  a  gold  wire,  which  is  to  be  curved 
around  the  clasp-tooth  just  before  packing.  ^^^-  ^'^^• 

A  gold  clasp  may  also  be  fitted  and  re-  ^^^^^^.^^.^^^      /'tj^^^ 
tained  in  the  rubber  either  by  a  project-  W^'^^^^^p     '^l^J 
ing  slip  of  the  same  metal  or  by  soldering  ^    '^^"^       ^    ^fr 
into  it  one  or  two  platina  pins.     Fig.  352,      "^^^^^  '%=^:^ 

taken  from  Prof.  Wildman's  monograph, 


708 


VULCANITE. 


represents  these  two  forms  of  clasp:  but  in  cases  requiring  clasps,  we 
very  decidedly  prefer  a  gold  plate.  The  larger  size  of  vulcanite  plates 
necessary  for  strength  will,  usually,  secure  adhesion,  with  the  help  of 
stays  or  half-clasps :  in  none  of  these  cases  do  we  consider  the  vacuura- 
cavity  of  any  service. 

Combination  of  Vulcanite  tvith  Metallic  Plates.  — Blocks  or  gum  teeth 
may  be  secured  to  gold  plate  by  vulcanite  instead  of  by  soldering. 
Blocks  having  a  porcelain  gum  on  the  inside,  finished  to  the  plate  and 
having  a  hole  in  the  base  opposite  each  tooth,  present  a  very  handsome 
appearance  when  attached  to  gold  plate  by  vulcanite,  and  may  be 
made  very  secure.  The  hole  should  be  of  good  size  (from  Nos.  12  to 
15,  Fig.  208),  but  must  not  come  so  near  the  translucent  front  of  the 
tooth,  as  to  permit  the  color  of  the  rubber  to  darken  it.  In  this  and 
the  subsequent  modes  of  attachment,  the  swaging,  articulation  and 
grinding  of  blocks  is  done  as  usual,  except  that  there  is  less  necessity 
for  close  fitting  to  the  plate  than  in  case  of  soldered  work.  The  tem- 
porary plaster  rim,  elsewhere  described,  must  in  all  cases  be  used,  so 
as  to  permit  removal  and  correct  replacement  of  teeth.  In  case  of  the 
blocks  just  described,  press  each  block  into  place  over  a  thin  layer  of 
wax  on  the  gold  plate.  The  wax  projection,  made  by  each  hole,  shows 
where  to  drill  the  plate  for  the  pins:  then  remove  plate,  drill  holes  and 
solder  roughened  or  headed  pins  into  the  plate,  opposite  each  hole ; 
fasten  the  blocks  temporarily  with  wax,  then  invest  in  the  vulcanizing 
flask,  so  that  on  separating  the  matrix,  the  plate  shall  come  away  in 
one  half,  the  teeth  in  the  other.  Fill  the  holes  with  rubber,  and  place 
a  strip  over  the  base  of  the  blocks ;  warm  and  replace  the  two  halves 
of  the  matrix,  and  vulcanize.     Vulcanite  blocks,  such  as  those  in  Figs. 


Fig.  353. 


353  and  354,  made  by  Dr.  S.  S.  White,  may  be  very  firmly  attached  to 
metal  plates  by  some  one  of  the  five  methods  represented  in  Fig.  355, 
Set  the  teeth  or  blocks  in  the  temporary  plaster  rim  and  distinctly 
mark  a  line  around  the  ridge,  just  under  the  head  of  the  pins  (C); 


VULCANITE.  709 

mark  across  this  line  the  position  of  each  pin  (a,  b,  e,  d)  ;  then  remove 

blocks  and  prepare  the  plate  for  the  different  plans  of  retaining  the 

vulcanite.    1st.  For  an  alu- 

,    ,         ,  .  ,  Fig.  355. 

mmum    plate   which    can 

have  no  soldered  pins,  drill 
a  row  of  small  holes  on  the 
line  between  the  pins:  set 
it  in  the  counter-die  and, 
with  a  tapering  punch,  en- 
large each  hole,  with  the 
projecting  burr  next  the 
tooth  (C,  c).  Let  each  hole  be  not  smaller  than  No.  20  (Fig.  208).  In 
some  cases  a  smaller  set  of  holes  may  be  punched  or  drilled  in  the 
outer  edge  above  the  gum  (C).  Swage  the  plate  again,  to  correct 
the  effect  of  this  punching;  then  place  it  on  model,  replace  blocks, 
arrange  wax,  and  prepare  for  vulcanizing.  2d.  Arrange  the  plate 
firmly  on  a  piece  of  charcoal,  set  small  cups  of  gold  or  platina  on 
the  line,  between  the  pins  (A,  a),  with  a  small  piece  of  solder  at 
each,  and  solder  them  all  at  one  heating.  3d.  Or  drill  small  holes 
on  the  line,  between  the  pins  of  the  teeth  (B,  h),  and  insert  headed 
platina  or  gold  pins,  and  solder  them.  4th.  Or  drill  two  holes  between 
the  tooth-pins  (E,  e)  and  insert  a  loop:  only  one  hole  is  really  neces- 
sary, as  the  other  end  of  the  loop  may  be  shortened  so  as  just  to 
touch  the  plate,  to  which  the  solder  will  attach  it.  5th.  Lastly,  a 
■jvire  may  be  bent  in  a  series  of  waves  (tZ),  so  as  to  pass  under  each 
tooth-pin  (or  just  behind  it,  if  the  pin  is  too  close  to  the  plate,  but  never 
over  it)  and  rise  from  the  plate,  between  the  pins.  Adjust  this  wire 
accurately,  with  the  blocks  in  place ;  mark  the  points  of  contact ;  then 
lemove  plate  and  solder  the  wire.  The  last  four  methods  are  appli- 
cable to  gold  and  platinum,  which  admit  of  soldering.  In  soldering, 
no  plaster  investment  must  be  used,  and  the  plate  must  have  a  good 
support  on  the  charcoal :  with  these  precautions,  careful  soldering  will 
not  warp  or  spring  the  plate.  If  sprung,  the  pins  and  loops  make  it 
necessary  to  cut  a  deep  groove  in  the  lead  counter-die  before  attempt- 
ing to  swage. 

After  completing  either  of  the  five  plans  here  described,  re-adjust 
the  teeth  in  the  plaster  rim  and  fasten  them  in  place  with  wax, 
trimmed  to  the  shape  required  for  the  vulcanite ;  then  invest  in  the 
flask  and  vulcanize  as  before  described.  By  avoiding  excess  of  rub- 
ber, using  only  so  much  as  is  necessary  to  conceal  the  pins  or  loops, 
the  vulcanite  band  may  have  a  very  neat  appearance.  Some  dentists 
partly  conceal  the  rubber  by  an  inside  and  outside  band ;  but  if  con- 
cealment is  necessary,  we  should  prefer  to  do  it  by  the  form  of  blocks 


710  VULCANITE. 

above  given.  If  the  inside  band  is  used,  the  simplest  method  is  to 
mark  the  line  of  its  position ;  then,  by  skilful  use  of  the  hammer,  a 
strip  of  gold  can  be  paned  and,  with  the  pliers,  bent  so  as  to  have  a 
uniform  slope  and  a  close  fit :  a  file  will  be  necessary  over  small  promi- 
nences :  this  method  of  paniug  is  simpler  than  either  swaging  a  band 
or  first  making  a  lead  or  tin  pattern.  If  cast  aluminum  plates  are 
used,  as  made  by  Dr.  Bean's  process,  it  is  only  necessary  to  drill  holes, 
as  many,  and  of  such  size,  as  may  be  thought  necessary,  in  that  part 
of  the  plate  next  the  blocks :  they  may  pass  through  to  the  palatine 
surface  if  necessary,  and  be  countersunk.  It  is  very  important  to 
ascertain,  by  trial,  that  the  closely  fitting  edge  of  aluminum  does  not 
interfere  with  the  teeth,  in  separating  and  replacing  the  flask. 

This  is  an  extremely  useful  and  important  application  of  vulcanite. 
It  loses  one  of  the  peculiar  advantages  claimed  for  vulcanite,  the  accu- 
rate fit  of  the  plate;  but  it  makes  very  strong  work,  and  is  more 
cleanly  than  ordinary  swaged  work,  because  all  interstices  are  com- 
pletely closed.  It  also  gives  a  shape  behind  the  teeth  more  conform- 
able to  the  natural  shape  of  the  teeth  and  gum.  It  obviates  two  of 
the  principal  objections  urged  against  vulcanite  —  thickness  of  the 
plate  and  contact  of  the  rubber  against  the  gum  and  tongue.  It  dis- 
penses with  that  accurate  grinding  of  the  base  of  blocks,  required  in 
ordinary  gold  work,  and  obviates  the  risks  of  the  soldering  process.  It 
is  applicable  to  full  sets,  or  to  partial  sets  where  the  teeth  are  in  groups 
of  three  or  more.  .  It  is  best  repaired  by  removing  the  entire  vulcanite 
attachment;  but  those  who  patch  up  old  rubber  plates  can,  with  greater 
impunitv,  patch  the  "combination  work;"  since  the  strength  of  the 
piece  depends  mainly  on  the  plate,  the  brittleness  of  second  heating 
is  of  less  moment.  Another  argument  in  its  favor  is,  that  it  makes 
available  to  gold-dentists  the  beautiful  forms  of  rubber  blocks,  without 
identifying  them  with  that  class  of  rubber-dentists  who,  by  accommo- 
dating the  style  of  their  work  to  the  cheapness  of  the  material,  have 
brought  much  discredit  upon  dental  mechanism. 

Vulcanite  for  Irregularity  and  Pivot  Teeth.  —  Of  the  peculiar  adap- 
tation of  the  vulcanite  material  to  the  correction  of  irregularity  men- 
tion has  been  made  in  the  chapter  on  that  subject.  No  further  special 
directions  are  required,  except  on  two  points :  first,  to  have  the  plaster 
which  makes  the  model  perfectly  smooth  and  free  from  air-bubbles; 
secondly,  to  coat  the  teeth  before  vulcanizing  with  soluble  glass  or  col- 
lodion solution.  Attention  to  these  two  points  will  give  a  plate  which, 
if  the  impression  is  correct,  will  fit  the  teeth  with  most  perfect  accuracy. 

It  remains  briefly  to  refer  to  the  application  of  vulcanite  to  the 
pivoting  of  teeth.  Several  excellent  methods  are  described  in  Prof. 
Richardson's  work.     The  following  method  admits  of  variation  to  suit 


VULCANITE.  711 

a  metal  pivot,  rubber  pivot,  or  the  usual  hickory  pivot  —  Prepare  the 
root  as  directed  in  the  fifth  chapter,  being  careful  to  drill  the  canal 
with  utmost  uniformity  and  smoothness.  Have  a  set  of  very  smooth 
aluminum  pins  about  a  half-inch  long,  to  suit  the  canals  made  by  dif- 
ferent sized  drills :  select  one  which  will  fit  accurately  into  the  root, 
yet  can  be  easily  removed,  and  press  it  to  the  bottom  of  the  canal,  let- 
ting it  project  below  the  root  a  fourth  of  an  inch.  Carefully  take  a. 
plaster  impression  of  the  root  and  two  adjoining  teeth  in  a  small  wax 
or  tin -foil  cup :  when  quite  hard,  break  it  in  the  line  of  the  arch,  and 
remove.  The  pin  may  come  with  the  plaster  or  remain  in  the  tooth : 
sometimes  the  break  in  the  plaster  will  be  just  at  the  pin;  but  when 
pressed  together  the  hole  will  be  entire.  Into  this  hole  place  the  pin, 
if  yet  in  the  tooth.  Soap  this  impression  and  make,  with  great  care, 
a  model,  using  the  finest  plaster:  when  the  plaster  has  fully  set, 
remove  the  impression  piecemeal,  so  as  not  to  iujure  the  model,  which 
should  then  be  hardened  with  dilute  soluble  glass. 

The  model,  with  its  projecting  aluminum  pin,  is  now  ready  for  fit- 
ting and  attaching  the  tooth;  this  may  be  retained  —  1.  By  a  hickory 
pivot:  in  which  case  select  a  plate  or  rubber  tooth,  which  will  not  inter- 
fere with  the  pin ;  fit  it  to  the  root,  the  front  edge  alone  touching ;  arrange 
the  wax,  and  set  in  flask  for  vulcanizing.  When  finished,  draw  the 
aluminum  pin  ;  in  the  hole  insert  a  compressed  hickory  pivot,  and  pro- 
ceed as  with  a  porcelain  pivot  tooth.  There  are  three  advantages  in 
this  kind  of  pivot  tooth :  it  fits  the  root  accurately,  canals  in  root  and 
tooth  are  of  same  size,  and  are  also  exactly  in  line  —  three  points  which 
cannot  always  be  secured  in  an  ordinary  porcelain  pivot  tooth.  If  a 
plate-tooth  is  used,  a  loop  or  hook  must  be  soldered  to  the  tooth-pins, 
passing  around  the  aluminum  pin.  2.  By  a  metallic  pivot :  in  which 
case  fit  a  crown  to  the  root  as  before.  If  an  aluminum  pivot  is  pre- 
ferred, the  one  already  in  the  plaster  may  be  retained,  the  projecting 
part  roughened  with  a  file,  and  the  wax  then  arranged  and  the  piece 
prepared  for  vulcanizing.  If  a  gold  pivot  is  preferred,  carefully  draw 
the  aluminum  pin  and  replace  with  a  gold  one  of  exactly  the  same 
size,  3.  By  a  vulcanite  pivot:  in  which  case  a  plain  vulcanite  tooth 
may  be  used,  first  carefully  drawing  the  aluminum  pin :  then  set  a 
small  wire  in  the  hole,  extending  downward  behind  the  tooth,  to 
strengthen  the  pivot.     Apply  wax,  and  prepare  for  vulcanizing. 

Lining  the  root-canal  with  a  gold  cylinder,  filling  a  conical  cavity 
with  foil,  or  any  other  preliminary  preparation  of  the  root,  does  not 
modify  the  processes,  just  described  ;  but,  among  the  advantages  of  the 
vulcanite  pivot  tooth,  is  the  readiness  with  which  it  fits  an  irregular 
surface :  hence  a  root  hollowed  by  decay  need  not  be  filled,  provided 
there  is  sufficient  length  of  sound  root  for  the  canal.     Another  advan- 


712  VULCANITE. 

tage  is  the  firmness  given  by  the  close  fitting  of  the  rubber  to  the  base 
of  the  root.  After  the  root  is  prepared  and  the  tooth  selected,  the 
whole  work  can  be  done  in  the  absence  of  the  patient.  Two,  three,  or 
four  teeth  can  be  prepared,  with  slight  modification  of  details,  in  the 
same  way  ;  but  four  or  six  teeth  should  be  set  as  plate-pivots,  allowing 
a  slight  projection  of  the  rubber  into  the  two  strongest  roots,  to  give 
steadiness  to  the  piece. 

Directions  to  Patient. — Upon  the  completion  and  insertion  of  a  vul- 
canite piece,  the  patient  should  be  cautioned  to  cleanse  it  thoroughly 
at  least  once  a  day ;  also  to  keep  it  in  water  when  not  worn  in  the  mouth. 
Extreme  cleanliness  is  advisable  in  all  kinds  of  artificial  work,  and 
many  patients  need  no  such  direction  :  the  special  necessity  for  care, 
in  the  case  of  vulcanite,  arises  from  the  tenacity  with  which  the  mucous 
secretions  adhere  to  the  surface  if,  from  neglect,  they  are  allowed  to 
collect  upon  it.  This  coating  is  most  apt  to  collect  at  those  points 
where  the  friction  of  the  tongue  and  of  the  food  does  not  remove  it: 
the  same  care  is  necessary  for  its  daily  removal,  as  is  required  to  keep 
the  natural  teeth  in  good  order.  There  is,  however,  this  difierence  be- 
tween cleanliness  of  the  teeth  and  of  the  plate :  that  while  both  are 
essential  to  purity  of  the  mouth,  the  secretions  have  no  chemical  action 
upon  the  plate,  as  they  have  upon  the  teeth. 

One  point  affecting  the  durability  of  vulcanite  plates  has,  perhaps, 
not  been  determined  by  a  sufficient  experience.  It  is  well  known  that 
silver  and  eighteen-carat  gold  undergo  a  change  in  the  mouth,  which 
causes  them  to  become  more  or  less  brittle :  such  is  not  the  case  with 
twenty-carat  gold  and  with  platina.  The  change  in  these  cases  is  partly 
the  effect  of  mastication,  acting  as  do  the  repeated  blows  of  swaging ; 
partly  a  galvanic  action  between  the  molecules  of  the  alloyed  metal. 
A  similar  but  much  more  rapid  change  takes  place  in  the  gutta-percha 
which  is  used  for  impressions;  also  in  the  vulcanized  gutta-percha  and 
in  all  those  preparations  of  vulcanized  rubber,  with  which  foreign  sub- 
stances are  largely  mixed,  for  the  purpose  of  modifying  the  brown  or 
red  color.  The  broAvn  rubber,  being  purer,  will  probably  retain  its 
toughness  and  elasticity  longer  than  the  red  rubber.  We  have  some 
specimen  pieces  of  red  rubber  which  seem,  at  the  end  of  twelve  years, 
to  possess  their  original  strength ;  and  we  know  of  one  partial  piece  that 
has  been  worn  constantly  for  ten  years,  which  has  never  been  repaired 
and  seems  as  strong  as  when  first  made.  This  point,  however,  requires 
the  collected  experience  of  many  observers,  during  a  period  of  many 
years,  carefully  distinguishing  between  the  brittleness  of  over-baking 
or  twice  vulcanizing,  and  that  which  may  supervene,  as  the  result  of 
certain  molecular  changes  in  the  substance  of  the  material.  It  is  a 
change  which,  unlike  the  galvanic  action  in  gold  and  silver  plate,  may 


VULCANITE.  713 

not  require  the  presence  of  the  buccal  fluids ;  but  which  will  probably 
take  place  alike  out  of  the  mouth  as  in ;  for  such  is  shown  to  be  the 
case  with  gutta-percha. 

It  may  not  be  amiss  to  give,  briefly,  the  present  status  of  the  vul- 
canite process.  Upon  the  abstract  subject  of  patents,  or  the  validity 
of  special  patent-rights,  it  is  not  necessary  to  express  any  opinion  :  this 
is  purely  a  question  of  law  and  political  economy,  with  which  dental 
teaching  has  nothing  to  do.  But  there  are  ethical  questions  of  graver 
import  than  any  patent-right,  involved  in  the  consideration  of  this  sub- 
ject. The  Goodyear  patents,  held  outside  of  dentistry,  do  not  in  any 
way  compromise  its  status  as  a  liberal  profession,  except  in  so  far  as 
the  injudicious  course  of  such  patentees  may  tempt  members  of  the  pro- 
fession to  violate  the  acknowledged  rights  of  others,  in  their  resistance 
against  supposed  extortion.  So  far  as  the  consequent  increased  cost 
of  vulcanite  work  is  concerned,  the  Goodyear  patentees  would  have 
conferred  a  very  decided  benefit  upon  dentistry  if,  instead  of  office- 
rights  or  a  tarifi"  on  practice,  they  could  have  so  arranged  that  the 
cost  of  vulcanite  material  in  a  full  dental  plate  should  in  no  case  have 
been  less  than  ten  dollars.  They  would  thus  have  prevented  —  the 
substitution  of  rubber  for  gold,  solely  because  cheaper,  without  regard 
to  its  fitness  to  the  case ;  the  cheapening  of  skill,  simply  because  exer- 
cised on  a  cheap  material ;  the  degradation  of  skilled  labor,  because 
thus  inadequately  compensated ;  the  bad  repute  of  the  material  itself, 
notwithstanding  its  invaluable  properties,  because  associated  with  pro- 
fessional practices  which  are  undermining  the  very  foundations  of 
Dentistry. 

Dentists  themselves  have  inflicted  on  their  profession  a  far  more 
serious  injury,  in  the  way  they  have  used  the  hard  rubber,  than  any 
number  of  Goodyear  patents  could  do.  We  consider  the  legion  of 
petty  patents,  taken  out  by  the  members  of  a  so-called  liberal  profes- 
sion, as  infinitely  more  demoralizing.  It  has  come  to  such  a  pass  that 
a  skilful  and  ingenious  mechanician  can  scarcely  put  into  practice  some 
simple  yet  original  idea,  without  stumbling  over  one  of  these  patents. 
It  was  only  a  few  days  since  that  we  saw  the  advertisement  of  a  patent, 
that  gave  "  wonderful  perfection  "  to  the  fit  of  plates :  it  was  a  simple 
expedient,  likely  to  occur  to  any  thoughtful  worker ;  one  which  we  had 
tried  ten  years  ago  and  given  up,  because  unnecessary.  We  merely 
cite  this,  in  illustration  of  a  class  of  patents  which  are  fast  becoming 
an  intolerable  nuisance.  Great  discoveries,  like  that  of  Charles  Good- 
year, are  legitimate  subjects  for  protection  by  patent-right ;  but  pro- 
fessional men,  practising  a  noble  art  and  calling  themselves  men  of 
science,  have  not  a  right  to  protect  by  patent  every  petty  invention  or 
supposed  discovery. 


714  VULCANITE. 

"  Against  the  use  of  the  vulcanite  it  is  urged  :  1.  That  it  has  de- 
graded the  art  by  the  extent  to  which  it  has  introduced  clieap  work, 
aud  by  the  ease  with  which  its  peculiar  manipulations  are  performed. 
2.  That  its  medicinal  action  upon  the  system  is  such,  as  to  render  it  an 
unfit  material  to  be  put  into  the  mouth.  3.  That  it  produces  an  un- 
pleasant burning  or  heating  sensation  in  the  raucous  membrane,  and  a 
permanent  sponginess  of  the  gums,  not  attendant  on  the  wearing  of 
metallic  plates.  4.  That  the  mucous  secretions  require  more  care  for 
their  removal  from  the  surface  of  the  plate,  than  most  patients  are  in 
the  habit  of  giving;  hence  the  liability  of  the  piece  to  become  un- 
pleasant. 5.  That  to  give  the  necessary  strength  requires  a  thickness 
of  plate,  that  is  clumsy  and  interferes  with  distinctness  of  enunciation. 

6.  That  the  work  becomes  brittle  in  the  course  of  a  few  years.  7. 
That  it  is  troublesome  to  repair  in  such  a  way  as  to  maintain  its  orig- 
inal strength. 

"  In  favor  of  the  use  of  vulcanite  it  is  urged  :  1.  That  the  absolutely 
perfect  aud  unfailing  accuracy  of  its  adaptation  to  the  model  places 
it,  in  this  important  respect,  before  every  other  material  in  use  for  den- 
tal plates.  2.  That,  being  perfectly  impervious  to  fluids  and  insoluble, 
it  is  a  pure  and  harmless  material.  3.  That,  being  devoid  of  all  gal- 
vanic action,  it  is  more  agreeable  to  patients  than  soldered  and  alloyed 
plates.  4.  That  it  has  none  of  the  wearing  action  of  metal  upon  teeth 
against  which  it  becomes  necessary,  in  partial  cases,  to  bring  it  in  con- 
tact. 5.  That  the  great  lightness  of  the  material  makes  it  veiy  pleas- 
ant to  the  patient,  and  permits  the  filling  out  of  deficiencies  in  the 
ridge  with  the  least  possible  addition  to  the  weight  of  the  piece.  6. 
That  this  lightness,  together  with  its  peculiar  elasticity,  lessen  greatly 
the  danger  of  accidental  breakage  of  either  teeth  or  plate;  thus  making 
it,  when  properly  constructed,  the  strongest  of  all  dental  substitutes. 

7.  That  the  plastic  properties  of  the  vulcanite  and  the  readiness  with 
which  it  may  be  moulded  and  hardened  against  any  surface,  however 
irregular,  give  it  a  wider  range  of  applicability  than  any  other  substance 
used  in  dentistry," 

Comment  upon  these  arguments,  copied  from  the  edition  of  1863,  is 
here  unnecessary ;  our  views  may  be  gathered  from  the  section  itself. 
We  have  much  enlarged  and  modified  the  original  chapter,  adapting 
it  to  the  present  requirement  of  vulcanite  practice,  and  aiming  to  give 
the  subject  a  fulness  of  exposition  commensurate  with  its  importance 
and  prevalent  use.  We  have  been  compelled  to  condemn  certain  prac- 
tices which  have,  unfortunately,  been  associated  with  the  use  of  this 
valuable  material :  we  are,  for  this  reason,  the  more  willing  to  acknowl- 
edge its  utility  and  to  aid  in  its  development  by  a  full  statement  of 
what  we  regard  as  the  best  materials,  instruments,  and  manipulations ; 


VULCANITE.  715 

giving  such  rules,  explanations  and  speculative  views,  as  may  aid  in 
the  comprehension  of  present  methods,  or  lead  to  their  future  im- 
provement. 

"  Present  manipulations,  materials,  and  apparatus  in  this  compara- 
tively new  process  will  doubtless  be  modified,  and  some  of  the  objec- 
tions now  urged,  with  more  or  less  truth,  against  its  use  will  be  done 
away  with.  But  so  valuable  are  its  peculiar  properties  that  the  vul- 
canized India-rubber,  in  some  form  or  mode  of  application,  must, 
unquestionably,  become  inseparable  from  dental  practice.  Its  intro- 
duction forms  one  of  those  marked  eras  in  dental  prosthesis,  prominent 
among  which  may  be  mentioned  —  the  manufacture  of  porcelain  teeth, 
the  use  of  metallic  swaged  plates,  the  use  of  plaster  for  impressions, 
the  application  of  the  principle  of  atmospheric  pressure,  the  continu- 
ous-gum work,  lastly,  the  vulcanite.  Neither  the  material  itself,  the 
process  of  hardening,  nor  the  apparatus  used  are  yet  perfect ;  and  the 
various  applications  of  this  valuable  substance  to  dental  purposes  are 
only  partially  known.  The  ignorant  and  unskilful  will  do  it  discredit 
by  badly  working  and  by  misapplying  it.  Meanwhile  the  scientific 
and  philanthropic  practitioner  will  patiently  investigate  its  properties, 
in  the  hope  that,  perchance,  it  may  supply  some  want  of  sufiering 
humanity  which  dental  art  has,  as  yet,  been  unable  to  relieve." 

To  these  remarks,  written  eight  years  ago,  we  will  only  add,  in  con- 
clusion, that  the  Vulcanite  Process  will  pass  from  under  the  cloud 
which  now  shadows  it,  when  dentists  have  taught  their  patients  to 
recognize  the  truth  that  the  value  of  any  Art  work  springs  from  the 
Mind  which  plans  and  the  Hand  which  executes,  rather  than  from  any 
cost  of  the  Material  employed. 


716'  PORCELAIN    TEETH. 


CHAPTER  XVI. 

PORCELAIN     TEETH. 

AS  Pharmacy  was  once  a  part  of  Medical  practice  and  instrument 
making  a  part  of  Surgery,  so  the  manufacture  of  Porcehiin  teeth 
was,  at  one  time,  confined  to  the  dental  laboratory.  Until  within  the 
past  twenty  years,  a  practical  knowledge  of  the  Dento-ceramic  art  was 
considered  an  essential  part  of  dental  education.  Galen  compounded 
his  celebrated  Theriaca  for  two  Roman  Emperors:  Pare  and  Wiseman 
made  many  of  their  surgical  instruments ;  and  necessity  has  compelled 
physicians  and  surgeons  in  all  ages  to  imitate  these  examples.  But 
the  medical  and  surgical  world  have,  for  many  years,  committed  the 
manufacture  of  drugs  and  instruments  to  those  who,  by  making  it  a 
special  art,  can  produce  far  better  results. 

The  time  has  fully  come  when  Dentistry  should  do  the  same  with 
porcelain  work,  for  two  sufficient  reasons:  1.  Manufacturers  now  offer 
to  the  profession  porcelain  teeth,  in  such  variety  of  beautiful  forms, 
that  not  one  dentist  in  a  thousand  could  equal  them.  2.  Moderate 
proficiency  in  block-carving  requires  such  an  amount  of  preparatory 
training  and  of  continuous  experience,  that  the  dentist's  education  and 
practice  must  suffer,  in  the  line  of  important  duties,  which  cannot  thus 
be  delegated  to  others.  Hence  nearly,  if  not  quite,  all  of  the  most 
skilful  block-carvers,  engaged  in  the  general  practice  of  dentistry, 
have,  since  the  year  1850,  one  after  another,  given  up  this  art,  which 
it  cost  them  so  much  to  acquire.  For  these  reasons,  and  also  because 
the  management  of  a  porcelain  furnace  cannot  be  taught  in  books,  we 
shall  not  attempt  in  this  chapter  to  give  a  full  and  didactic  exposition 
of  the  manner  of  making  porcelain  block  or  single  teeth.  Those  who 
desire  such  knowledge,  with  a  view  to  making  it  a  specialty,  require 
that  which  it  no  longer  comes  within  the  scope  of  a  work  on  the 
"  Principles  and  Practice  of  Dentistry  "  to  teach. 

There  is,  however,  on  the  part  of  all  students,  and  probably  of  most 
practitioners,  a  desire  to  know  the  composition  of  dental  porcelain, 
and  to  have  some  idea  of  the  manner  in  which  a  few  earthy  materials 
and  metallic  oxides  are  made  to  assume  such  beautiful  forms.  Some 
knowledge  of  the  component  parts  of  porcelain  is  essential  to  a  correct 
understanding  of  the  necessity  for  their  admixture,  as  well  as  of  the 
eiFects  thus  produced. 


PORCELAIN    TEETH.  717 

PORCELAIN    MATERIALS. 

The  infusible  earths  Silica  and  Alumina,  and  the  fusible  alkalies 
Potassa  and  Soda,  form  the  bulk  of  all  porcelain.  Certain  Metallic 
oxides,  in  small  quantity,  give  color,  and  some  varieties  of  pottery  are 
modified  by  small  proportions  of  Lime  and  Magnesia.  Dental-porce- 
lain is  made  from  the  purest  compounds  of  silica,  alumina,  and  potassa, 
colored  by  metallic  Gold  and  Platina,  and  by  the  oxides  of  Gold, 
Titanium,  Manganese,  Cobalt,  and  Uranium, 

SILICA. 

Silica  (quartz,  siles,  silicie  acid)  is,  next  to  Oxygen,  the  most  univer- 
sally diffused  substance  in  nature,  constituting  fifty  per  cent,  of  all  rocks. 
Granite,  granitic  rocks,  sandstones  and  sand  contain  not  less  than  three- 
fourths  silica  :  mica-schist,  clay-slate  and  clay,  not  less  than  two-thirds: 
trap  rocks  and  lava,  one-half  Silica  is  to  the  mineral  kingdom  what 
carbon  is  to  the  vegetable —  the  element  of  stability.  In  its  purest 
forms  (rock-crystal,  Brazilian  pebbles,  or  crystals  of  quartz),  it  is  free 
from  discoloration  by  iron,  or  other  oxides,  it  is  absolutely  infusible  and 
is  insoluble  in  water :  this  is  the  kind  selected  for  dental-porcelain,  but 
for  other  varieties  of  porcelain,  flint  is  commonly  used.  It  forms  sili- 
cates with  alumina,  magnesia,  lime,  potassa  and  soda:  the  most  im- 
portant of  which,  in  this  connection,  are  the  silicates  of  alumina  and 
potassa.  Silica,  as  found  in  feldspar  and  kaolin,  is  partly  pure  silica, 
partly  the  silicate  of  alumina.  Now  the  "behavior,"  in  the  furnace, 
of  silica  and  the  silicate  of  alumina  is  different:  hence,  chemical  analy- 
sis can  estimate  only  the  relative  purity  of  these  substances ;  experiment 
alone  can  determine  the  proportions  of  each  necessary  for  the  develop- 
ment of  any  required  property  in  porcelain. 

FELDSPAR. 

Next  to  silica,  alumina  (oxide  of  aluminum)  is  the  most  universally 
diffused  of  all  minerals ;  but,  unlike  silica,  it  is  rarely  found  uncom- 
bined.  The  gem  Sapphire  is  pure  crystallized  alumina,  and  is  the  next 
hardest  mineral  to  the  diamond  :  a  less  pure  form  is  well  known  in 
dentistry,  as  emery  or  corundum  ;  some  specimens  of  which  seem,  under 
the  lens,  to  be  a  collection  of  minute  crystals  of  dark-colored  sapphire. 
For  porcelain  manufacture,  alumina  is  never  used  in  its  pure  state, 
but  in  its  natural  combinations  with  silica,  lime,  potassa,  and  soda. 
For  dental-porcelain  only  two  of  these  are  used  —  Feldspar  (known  to 
the  Chinese  as  Pe-tun-tse)  and  Kaolin.  Feldspar  is  a  silicate  of  alumina 
and  potassa,  containing  a  little  lime  and  a  trace  of  iron.  A  less  com- 
mon variety  of  spar  contains  soda  in  place  of  potassa  :  it  makes  a  soft 


718  PORCELAIN    TEETH. 

porcelain,  fusible  at  lower  heat  than  the  potasli-spar.  '  Lime-feldspar  is 
used  in  some  kinds  of  pottery,  but  for  dental  purposes  potash-feldspar 
is  the  only  variety.  It  is  an  abundant  mineral,  and  is  often  found  in 
large  masses ;  the  purest  varieties  alone  are  used  for  dental-porcelain : 
Delaware  and  Pennsylvania  spars  are  most  esteemed  by  American  man- 
ufacturers. Its  most  extensive  dissemination,  however,  is  as  one  of  the 
components  of  granite  and  granitic  rocks,  by  disintegration  of  the  feld- 
spathic  constituents  of  which,  large  beds  of  porcelain  clay  are  formed, 
as  found  in  China  and  Japan,  England,  Germany  and  France,  and 
also  in  the  United  States. 

Kaolin.  Ka-o-lin  (the  Chinese  word  for  clay)  is  the  purest 
of  these  mixtures  of  silica  and  silicate  of  alumina,  prepared  in 
Nature's  laboratory,  for  the  mauufiicture  of  porcelain.  Pipe-clay, 
potter's-clay,  blue-clay,  fire-clay,  and  Cornish-stone  are  similar  in  com- 
position, but  only  the  purest  kaolin  is  used  for  dental-porcelain.  It 
contains  nine  parts  of  silica  and  eight  parts  alumina ;  whereas  spar 
has  nine  parts  silica  and  only  two  parts  alumina  ;  also  spar  is  made 
fusible  by  its  silicate  of  potassa  —  kaolin  has  none.  Kaolin  is  there- 
fore feldspar,  deprived  of  its  soluble  silicate  of  potassa  (or  soda)  which 
has  been  washed  out  during  the  disintegration  of  the  feldspathic  rocks. 
It  is  soft  and  unctuous,  and  is  highly  plastic ;  pulverized  spar,  on  the 
contrary,  is  granular  or  powdery,  and  is  moulded  with  difficulty. 
Kaolin,  like  silex,  is  infusible ;  under  intense  and  continued  heat  it 
shrinks  greatly,  and  becomes  extremely  hard,  but  it  is  always  porous 
and  absorbent.  Silex  lessens  the  contraction  of  kaolin,  spar  gives  it 
fusibility ;  both  diminish  its  absorbent  quality,  so  objectionable  in 
any  material  that  is  to  be  worn  in  the  mouth. 

Stone-ware,  China-ware,  Wedgewood-ware,  Parian-porcelain,  and 
Dental-porcelain  vary  in  their  properties  because  of  the  different  pro- 
portions in  which  kaolin  and  feldspar  are  combined,  also  in  the  kind 
of  flux  used.  For  instance,  the  Parian  statuettes  have  kaolin  and  spar 
in  equal  proportions,  with  about  half  as  much  of  a  flux,  made  of  spar, 
quartz  and  potash.  Dental -porcelain,  demanding  less  heat,  less  shrink- 
age and  a  more  translucent  appearance,  has  a  very  much  greater  pro- 
portion of  spar.  It  has  required  a  very  extended  series  of  experiments 
to  combine  silica,  alumina  and  potassa  in  correct  proportions,  and  to 
know  just  which  of  Nature's  compounds  it  is  best  to  use,  in  order  to 
harmonize  the  requisites  of  strength  and  beauty,  so  essential  to  the 
character  of  a  porcelain  tooth. 

COLORING  MATERIALS. 

The  foregoing  materials  give  a  pure  white  porcelain  of  greater  or 
less  translucency.     It  is  now  required  to  find  substances  which  will,  in 


PORCELAIN    TEETH.  719 

the  strong  heat  of  the  furnace,  yield  indestructible  colors ;  by  skilful 
combination  of  which  the  porcelain  may  imitate  the  almost  endless 
varieties  of  tint  in  the  natural  teeth  and  gum.  Of  these  there  are 
three  principal  colors  and  three  subordinate  ones. 

Titanium.  —  The  purest  varieties  of  the  oxide  of  titanium  are  se- 
lected :  it  is  found  as  a  mineral  in  various  localities  throughout  the 
United  States.  The  crystals  are  reddish-brown,  and  have  a  bright 
metallic  lustre ;  they  give,  when  ground,  a  beautiful  yellow,  or  yellow- 
ish-brown color.  It  is  used  in  the  coloring  of  all  body,  and  is  the 
basis  of  color  for  the  class  of  yellowish  enamels. 

Platinum.  —  This  metal,  precipitated  from  its  solution  in  aqua- 
regia,  then  washed  and  dried,  is  known  as  Platina  sponge.  It  gives  a 
gray-blue  color,  and  is  the  basis  of  color  for  the  class  of  grayish-blue 
enamels. 

Gold.  —  Gold  precipitate  is  used  to  give  life  and  animation  to  the 
tooth,  producing  often  a  very  remarkable  effect.  The  oxide  of  gold, 
known  as  Purple  of  Cassius,  and  generally  considered  to  be  a  mixed 
oxide  of  gold  and  tin,  is  used  to  impart  the  well-known  red  color  of 
the  artificial  gum;  no  less  costly  substitute  has  ever  been  found  for 
this  purpose. 

Oxide  of  Manganese  gives  a  purplish  color,  and  is  used  occasionally 
for  some  shades  of  tooth,  but  not  of  gum.  Oxide  of  Cobalt  gives  a  bright 
blue  color.  If  wrapped  in  best  blue  paper,  and  burned  in  a  covered 
crucible,  it  is  called  the  Ashes  of  Cobalt,  and  is  thought  to  give  a  more 
desirable  tint  to  the  enamel  than  the  simple  oxide.  Oxide  of  Uranitim 
is  used  in  its  mineral  form,  and  gives  a  greenish-yellow  color ;  whilst 
a  lemon-yellow  color  may  be  given  by  the  oxide  of  silver:  but  this  is  a 
fugitive  color  at  high  temperatures. 

These  colors  singly,  and  in  combination  with  each  other,  produce  a 
great  variety  of  colors  or  shades.  Thus,  say  forty  shades  of  body-color 
are  made  by  using  these  materials  in  different  quantities  and  in  differ- 
ent combinations  ;  also  a  like  number  of  enamel-colors.  Then,  starting 
with  the  lightest  shade  of  body,  forty  different  grades  may  be  produced, 
by  using  a  different  point-enamel ;  so  of  each  of  the  forty  shades  of 
body,  making,  if  required,  sixteen  hundred  variations  of  shade. 

The  following  formulas  will  suffice  to  give  a  correct  idea  of  the  pro- 
portions in  which  the  preceding  materials  ai'e  combined,  to  give  the 
Body  and  Enamel  of  porcelain  teeth,  single  or  in  sections. 

BODY.  ENAMEL. 

Feldspar 12  oz.  Feldspar 3  oz. 

Quartz, 2  oz.  Sponge  Platina 1  to  4  grs. 

Kaolin 15  dwts.  Flux 3  dwts. 

Titanium 24  to  48  grs. 


720  PORCELAIN    TEETH. 

The  Flux  here  mentioned  is  made  by  fusing  four  ounces  of  finely 
ground  quartz  with  Glass  of  Borax  and  Sal  Tartar,  each  one  ounce  ; 
it  forms  a  transparent  glass.  The  following  formulas  show  the  prepara- 
tion of  Gum  Enamel. 

GUM    FRIT.  GUM    ENAMEL. 

Oxide  of  Gold 10  grs.  Gum  Frit 1  oz. 

Feldspar 1  oz.  Feldspar 3  oz. 

Flux 8  dwts. 

The  titanium,  platina  and  oxide  of  gold  must,  in  these  recipes,  of 
course,  be  modified  by  mixture  with  other  colors  to  produce  the  requi- 
site varieties  of  shade.  We  shall  now  briefly  describe  the  processes 
by  which  the  porcelain  teeth  and  sections,  sold  to  the  profession,  are 
manufactured. 

PROCESS   OF    MANUFACTURE, 

The  silex  and  feldspar,  in  their  crude  state,  are  first  submitted  to  a 
red  heat,  then  suddenly  thrown  into  cold  Avater.  This  is  called  "Cal- 
cining," and  the  effect  is  to  render  them  more  easily  broken  and  pul- 
verized. All  impurities  having  been  carefully  removed,  they  are 
crushed  between  flint  stones ;  when  fine  enough,  they  are  put  into  a 
mill,  formed  of  burr-millstone,  with  chasers  of  the  same  material. 
They  are  ground  in  Avater,  then  floated  off,  and  allowed  to  settle.  The 
water  is  then  drawn  off  or  evaporated  ;  the  silex  and  spar,  dried  and 
sifted,  are  then  ready  for  use.  The  kaolin,  having  been  already  pul- 
verized in  Nature's  laboratory,  is  prepared  by  washing  until  perfectly 
free  from  impurities,  and  when  dry  is  ready  for  use.  The  Flux  and 
Frit  are  coarsely  ground,  but  the  Coloring  materials  are  reduced  to  an 
impalpable  powder.  All  these  porcelain  materials  are  combined  in 
proper  proportions  to  form  the  body  and  the  enamel,  then  mixed  with 
water  and  worked  into  masses  resembling  putty.  When,  however,  the 
method  of  biscuiting  is  adopted,  the  enamels  are  mixed  in  a  much 
thinner  state  than  the  body. 

The  unbaked  porcelain  masses  are  now  ready  for  the  Moulding  room. 
The  moulds  in  which  single  teeth  or  sections  are  formed  are  made  of 
brass,  and  are  in  two  pieces  —  one-half  of  the  tootli  being  represented 
on  either  side.  The  precise  shapes  desired  are  carved  out  with  great 
care;  holes  are  drilled  to  receive  the  platina  pins  in  each  tooth  :  when 
the  two  halves  are  fitted  accurately  together,  with  guiding  pins  for 
exact  closure,  the  mould  is  ready  for  use.  The  brass  matrix  must  be 
made  about  one-fifth  larger  than  the  size  desired,  to  allow  for  shrinkage 
of  the  porcelain  paste.  After  greasing  the  moulds,  the  first  operation 
is,  by  means  of  small  tweezers,  to  place  the  platina  pins  in  the  holes 


PORCELAIN    TEETH.  721 

made  for  them  ;  (there  are  many  sizes  of  these  pins,  differing  in  length 
and  thickness,  to  suit  the  different  sizes  of  the  teeth).  As  no  piece  of 
mechanism  can  be  stronger  than  its  weakest  part,  there  should  alwa)'s 
be  such  a  relation  between  the  tooth  substance  and  the  pins,  as  to  shape, 
size,  and  angle  of  insertion,  that  one  will  be  as  strong  as  the  other,  and 
both  sufficient  for  all  legitimate  uses.  This  strength  of  pin,  without 
loss  of  strength  in  the  tooth,  characterizes  a  recent  and  valuable 
improvement  made  by  Dr.  S.  S.  White,  and  known  as  the  "  foot-shaped 
pin,"  illustrated  in  Fig.  356.     The  thickest  part  of  this  pin  is  at  the 

Fig.  356. 


^ 


angle,  or  heel;  the  point,  or  toe,  runs  upward  into  the  thick  par^ 
of  the  tooth,  giving  additional  security  against  its  being  drawn  out* 
The  insertion  of  the  pin  at  an  upward  angle  beds  it  in  the  strongest 
portion  of  the  tooth  material ;  thus  any  weakening  of  the  thin  portion 
of  the  tooth  is  avoided,  as  when  the  headed  pin  is  inserted  in  a  straight 
line;  also,  the  greatest  amount  of  material  is  found  where  the  greatest 
strain  is  brought  to  bear  upon  it.  The  force  of  mastication  is  exerted 
outward  and  toward  the  necks  of  the  teeth ;  thus  the  shape  and  direc- 
tion of  this  pin  are  best  calculated  directly  to  oppose  it.  It  will  also 
be  noticed  that  its  direction  and  unusual  length  of  insertion  permit  a 
close  grinding  of  the  tooth,  which  would  cause  the  usual  short  and 
horizontal  pin  very  soon  to  break  away  from  the  porcelain.  The  dou- 
ble-headed pin,  a  previous  patented  invention  of  Dr.  White,  was  a  very 
great  improvement  in  the  shape  of  tooth-pins ;  but  we  think  it  is  des- 
tined to  be  superseded  by  this  new  "  foot-shaped  pin." 

The  pins  being  properly  adjusted,  the  enamels  for  the  tooth  and  the 
gum  are  placed  in  the  moulds,  by  means  of  a  small  steel  spatula,  care- 
fully placing  them  in  the  exact  position  and  quantity  required ;  the 
body  is  placed  in  them  in  lumps  corresponding  to  the  size  of  the  teeth; 
the  top  of  the  mould  is  then  put  on,  and  the  matrix  placed  under  a 
press,  which  compacts  each  separate  mass.  They  are  then  dried  by  a 
slow  heat.  When  perfectly  dry,  the  top  is  removed,  and  the  teeth  will 
now  drop  out.  In  this  state  they  are  extremely  tender,  owing  to  the 
large  percentage  of  feldspar,  and  require  very  careful  handling. 

They  are  now  sent  to  the  trimmers'  room,  where  each  tooth  is  care- 
fully inspected,  and  all  imperfections  removed  or  filled  up ;  the  spare 
46 


722  PORCELAIN    TEETH. 

edges  left  by  the  union  of  the  two  sides  of  the  mould  are  smoothly 
filed,  and  the  arch  of  the  gum  over  each  tooth  made  rounding  and 
true  with  a  small  pointed  instrument.  They  are  then  placed  on  beds 
of  coarse  quartz  sand,  on  trays  or  slides  made  of  fire-clay,  and  are 
ready  for  the  furnace.  Formerly,  there  was  another  process,  called 
crucing,  or  biscuiting,  which  was  universally  practised,  and  is  still 
used  in  some  factories ;  it  is  also  used  in  the  making  of  blocks  carved 
to  order.  It  consists  in  submitting  the  teeth,  after  moulding,  to  a  heat 
sufficient  to  harden  them  so  they  can  be  cut  or  filed  like  chalk,  and 
what  is  called  an  outside  enamel  is  then  applied  with  a  camel's-hair 
brush  ;  but  it  has  been  found  th^t  the  composition  of  the  tooth  is 
injuriously  affected  by  this  partial  burning,  subsequent  cooling,  enam- 
elling, and  reburning.  This  process  is  unavoidable  when  the  blocks 
are  carved  by  hand  for  special  cases ;  but  whenever  they  can  be  made 
in  a  matrix,  the  tooth  is  better  and  stronger  when  it  is  enamelled  in 
the  mould,  and  finished  in  a  single  firing. 

The  furnace  is  built  substantially  on  the  principle  of  the  den- 
tists' furnace  (Fig.  375),  differing  chiefly  in  size.  The  trays  holding 
the  teeth  are  placed  in  the  muffle,  and  are  thus  protected  against 
injury  from  the  gases  of  the  fuel.  There  is  no  rule  which  can  be  given 
to  determine  the  exact  amount  of  time  the  teeth  must  remain  in  the 
furnace;'  the  practised  eye  of 'the  burner  must  determine,  from  the  ap- 
pearance of  the  teeth,  when  the  firing  is  completed.  If  taken  out 
before  they  are  done,  the  enamel  will  craze,  or  crack,  in  cooling ;  if  a 
little  too  much  done,  the  surface  will  be  too  glassy,  and  the  body  will 
not  be  strong.  When  cool,  the  teeth  are  removed  from  the  slides, 
placed  upon  wax  cards,  and  are  then  ready  for  the  dentist. 

The  vast  variety  in  shape,  size,  color,  etc.,  of  the  teeth  thus  made, 
gives  opportunity  for  the  selection  of  forms  suitable  to  nearly  every 
case  which  presents  itself  to  the  practitioner.  The  assortment  must  of 
necessity  be  very  large  and  varied,  to  meet  the  wants  of  the  operator ; 
in  fact,  the  manufacturer  has  shown  a  better  appreciation  of  the 
aesthetic  requirements  of  the  dental  art  than  the  practitioner.  Whilst 
the  work  of  the  latter  too  often  exhibits  an  unmeaning  monotony,  the 
former  has  made  provision  for  even  the  extreme  cases  which  are  some- 
times met  with ;  he  has  also  given  a  beautiful  series  of  those  various 
deviations  from  a  uniform  regularity  which  are  so  common  in  natural 
dentures.  In  some  mouths  these  seem  to  be  imperatively  demanded, 
to  restore  the  familiar  expression  ;  whilst  in  any  mouth,  the  use  of 
some  one  or  other  of  them  would  go  far  to  disarm  that  suspicion  of 
artificiality,  detection  of  which  is  mortifying  to  most  patients. 

Porcelain  is  a  material  in  which  the  beauty  of  the  result  well  repays 
the  highest  exercise  of  Art.     It  has  been  for  centuries  a  favorite  ma- 


PORCELAIN    TEETH.  723 

terial  for  expressing  the  Poetry  of  Form.  The  famous  Etruscan  vases 
of  antiquity,  the  exquisite  gems  of  the  Majolica  of  the  sixteenth  cent- 
ury, the  marvellous  works  of  Bernard  Palissy,  the  prince  of  potters, 
the  beautiful  productions  of  the  Sevres  and  Dresden  manufactories, 
the  well-known  charming  designs  of  the  Wedgewood-ware,  and  the 
still  more  recent  Parian  statuettes,  may  be  named  in  proof  of  the  fit- 
ness of  Porcelain  to  embody  the  conceptions  of  Genius.  Dental-porce- 
lain is  worthy  of  such  associations :  not  only  like  them  does  it  delight 
the  eye,  and  give  evidence  of  high  sesthetic  cultivation,  but  it  adds  to 
beauty  the  charm  of  usefulness.  It  is  customary  to  attribute  the  rapid 
growth  of  Dental  Art,  since  1840,  to  its  Associations,  Colleges,  Jour- 
nals, and  its  didactic  Literature,  —  and  with  much  truth.  But  to 
Porcelain  it  owes  its  very  existence,  as  an  sesthetic  art,  and  the  larger 
part  of  its  extent  and  utility  as  a  prosthetic  art.  It  was  altogether 
impossible  for  perishable  human  teeth,  or  their  wretched  imitations  in 
ivory,  to  offer  such  tempting  fac-similes  of  nature  as  we  meet  in  porce- 
lain. By  thus  creating  that  enormously  increased  demand  for  dental 
service,  which  has  been  the  chief  cause  of  the  rapid  development  of  its 
resources,  it  has  made  the  dental  profession  its  debtor  to  a  greater  ex- 
tent than  any  other  single  influence.  The  depot  not  only  renders  ser- 
vice by  the  superior  excellence  of  the  surgical  instruments  and  pros- 
thetic materials  which  it  supplies,  but  it  directly  benefits  the  science  and 
art  of  dentistry,  by  releasing  the  practitioner  from  manufacturing  toil, 
and  giving  time  for  the  acquirement  of  increased  knowledge  and  skill. 
Thus,  if  the  time  heretofore  given  to  block-making  were  devoted  to 
the  study  of  dental  aesthetics,  patients  would  have  the  benefit  of  an 
artistic  selection  from  a  far  larger  variety  of  porcelain  dentures  than 
could  otherwise  be  possibly  made.  The  illustrations  of  this  chapter 
can  but  imperfectly  convey  an  idea  of  the  beauty  and  expression  of 
the  originals:  they  will,  however,  assist  the  student  in  his  study  of 
those  principles  which  guide  in  the  selection  and  arrangement  of  teeth ; 
they  may  serve  also  to  awaken  practitioners  to  the  extent  of  the  pres- 
ent resources  of  Ceramic  dentistry,  and  to  the  importance  of  sesthetic 
culture  in  order  properly  to  make  full  use  of  the  same. 

The  improvements  in  the  Dento-Ceramic  Art  have  sprung  from  a 
careful  inquiry  into  the  essential  characteristics  which  artistically 
formed  porcelain  teeth  should  possess.  Among  these  are  (1)  Natural- 
ness: under  which  terra  are  included  shape,  color,  and  a  vital  appear- 
ance; the  last  depending  upon  the  precise  amount  of  translucency,  the 
texture  of  the  surface,  and  the  nice  blending  of  the  colors  of  the  body 
and  enamel, —  an  appearance  which  should  be  maintained  as  well 
under  artificial  as  under  solar  light.  Many  teeth,  which  will  bear  in- 
spection reasonably  well  in  daylight,  have  a  very  unnatural  and  arti- 


724 


PORCELAIN    TEETH. 


ficial  appearance  when  exposed  in  the  mouth,  to  a  light  under  which 
the  wearer  may  be  most  anxious  to  excite  admiration.  (2.)  Shape: 
which  includes  a  preservation  of  the  distinctive  characteristics  of  each 
tooth,  securing  the  instant  recognition  of  its  position  in  the  dental  arch. 
There  must  be  some  defect  or  inaccuracy  of  form  if,  out  of  the  twenty- 
eight  teet«h  of  a  set,  in  unassorted  confusion,  an  experienced  eye  can- 
not tell  the  place  of  each ;  for  every  tooth  has  its  distinctive  contour. 
Not  only  should  each  tooth  possess  the  individuality  which  belongs  to 

Fig.  3.57. 


Fig.  358, 


it,  but  it  should  also  indicate  the  character  of  its  relation  to  its  com- 
panions on  either  side,  and  to  its  antagonist.     The  eye  trained  to 


PORCELAIN    TEETH.  725 

observe  nature  should  not  be  offended  by  the  recognition  of  any  inhar- 
mony:  should  not  find  a  second  bicuspid  or  molar  in  place  of  a  first, 
or  incisors  undistinguishable  from  each  other,  or  an  upper  tooth  in 
place  of  its  corresponding  lower  one ;  nor  should  it  detect  in  the  midst 
of  one  style  of  denture  some  incisor  or  canine  characteristic  of  another. 
Figs.  357  and  358  exhibit  very  strikingly  the  marked  peculiarities  of 
each  one  of  the  twenty-eight  teeth  of  an  artistically  designed  artificial 
set :  whilst  these  and  subsequent  illustrations  demonstrate  how  possible 
it  is  for  modern  dentistry  to  adapt  its  work  to  the  great  varieties  of 
facial  expression.  Probably  every  reader  has  more  than  once  turned 
at  the  sound  of  a  familiar  voice,  to  see  a  face  strangely  resembling  the 
looked-for  friend.  This  correspondence  between  voice  and  face,  often 
so  startling,  is  only  another  one  of  those  links  between  external  and 
internal  conformation,  which  makes  the  study  of  aesthetic  anatomy 
essential  to  the  success  of  the  dental  mechanician. 

The  great  law  of  correspondence,  which  enabled  Cuvier  to  build  up  the 
entire  skeleton  from  a  single  bone,  makes  us  associate  the  idea  of  intel- 
lect with  certain  forms  of  forehead,  and  of  character  with  certain  forms 
of  mouth,  nose,  and  chin  :  it  is  the  same  law  which  permits  us  to  infer 
from  what  remains,  the  expression  of  what  is  lost.  Age,  sex,  tempera- 
ment, and  complexion ;  also  many  physical,  mental,  and  even  moral 
peculiarities,  are  suggested  to  the  acute  observer  by  certain  character- 
istics of  the  dental  organs.  The  artist  who  seeks  to  restore  harmony  in 
the  facial  expression  should  be  skilled  in  the  observance  of  these  varied 
manifestations :  such  skill  is  demanded  alike  in  the  manufacture  and 
io  the  application  of  artificial  dentures. 

In  addition  to  these  sesthetic  qualities,  porcelain  teeth  should  possess 

(3)  Strength  adequate  to  the  legitimate  use  for  which  they  are  in- 
tended ;  this  strength  should  come  from  the  quality  of  their  composi- 
tion, the  skilful  distribution  of  bulk  to  parts  most  requiring  it,  and 
from  the  due  form,  position,  and  proportion  of  the  pins,  rather  than' 
from  any  increase  in  bulk  and  weight  beyond  that  of  the  natural 
organs.     They  should  possess  also,  by  reason  of  their  conformation, 

(4)  Adaptability  to  the  various  irregularities,  caused  by  unequal  absorp- 
tion of  the  alveolar  ridge,  so  that  when  judiciously  selected  they  shall 
require  little  labor  to  adapt  and  antagonize  them.  Special  provision 
should  be  made  for  the  results  of  extreme  or  very  irregular  absorption, 
or  for  the  loss,  by  disease  or  otherwise,  of  parts  of  the  maxillary  ridge; 
so  that  in  such  cases  the  teeth  can  readily  be  made  to  articulate  and 
aflTord  comfort  to  the  wearer,  assisting  in  speech  and  mastication,  and 
yet  not  presenting  any  incongruous  appearance. 

There  are,  moreover,  special  modifications  demanded  by  many  other 
conditions :  as,  for  instance,  in  cases  having  a  very  short  articulation, 


726 


PORCELAIN    TEETH. 


requiring  the  pins  to  be  set  in  a  recess,  near  the  crowns  of  the  teeth,  thus 
bringing  the  greatest  resistance  where  there  is  the  greatest  strain  in 


Fio.  359. 


Fig.  3G0. 


mastication  :  as  is  well  shown  in  Fig.  360.  In  both  these  blocks  the 
full  external  size  of  tooth  is  given,  and  its  characteristic  form  and  the 
expression  of  interdental  gum  preserved:  this  could  not  be  done  with 
the  usual  form  of  blocks,  ground  down  to  suit  such  cases.    In  Fig.  359 


Fig.  361. 


we  have  front  blocks  for  mouths,  where  a  shoulder  is  required  to 
antagonize  with  the  lower  front  teeth,  when  there  are  no  back  teeth 


PORCELAIN    TEETH. 


727 


remaining.  Where  early  contraction  and  protrusion  of  the  upper  max- 
illary arch  has  caused  it  to  have  a  sharply  curved  projection,  bringing 
the  closure  of  the  lower  teeth  much  behind  the  upper  ridge  at  the  cen- 
tral incisors,  or  where  absorption  above  has  left  a  ridge  prominent  at 
its  lower  edge,  or  margin  of  the  gum,  it  becomes  necessary  to  give  a 
peculiar  twisted  form  to  the  front  blocks.  In  Fig.  361,  the  first  two 
blocks  are  for  a  pointed  arch,  accompanied  in  the  second  by  a  crowded 
denture,  so  often  seen  in  such  cases.  It  is  impossible  to  adapt  blocks 
of  ordinary  form  to  such  cases  without  destroying  their  true  expres- 
sion at  one  or  other  of  the  joints;  in  fact,  much  of  both  gum  aud  tooth 
is  often  sacrificed  to  get  correct  articulation.  The  third  blocks  are 
shaded,  with  a  view  to  show  the  fulness  of  gum  at  the  centrals,  and  its 
falling  back  over  the  canines:  this  is  also  shown  in  the  sectional  views 
of  the  first  and  third  blocks. 

For  cases  in  which  the  lower  jaw  closes  more  or  less  in  advance  of 
the  upper  maxillary  ridge,  a  large  gum  is  often  necessary,  as  in  Fig. 
363 :  but  such  mouths  require  a  peculiar  form  of  block,  if  the  lower 
jaw  has  much  projection.  Where  such  a  prominence  of  the  gum 
exists,  from  want  of  exterior  absorption  or  the  previous  wearing  of  a 
plate,  as  to  require  the  teeth  to  be  set  directly  upon  the  ridge,  there 
should  be  no  artificial  gum  between  it  and  the  lip.  When  the  molar 
block  of  lower  sets  extends  to  where  the  ramus  of  the  jaw  begins  to 
rise,  a  peculiar  ploughshare  curve  of  the  base  is  required :  such  that, 
whilst  the  gum  of  the  second  bicuspid  lies  on  the  outside  of  the  ridge, 
the  gum  of  the  second  molar  may  lie  partly  upon  the  ridge,  so  as  to 
give  more  perfect  antagonism  with  the  upper  molars.     The  molar  and 

Fig.  862. 


bicuspid  teeth,  from  which  Fig.  362  was  drawn,  are  also  marked  by 
a  characteristic  curve  of  the  buccal  surfaces,  giving  not  only  a  very 
natural  appearance,  but  acting  as  a  guard  to  the  cheek,  and  prevent- 
ing its  being  caught  between  the  teeth. 

Fig.  363  illustrates  the  difference  of  shape  required  for  a  mouth 


728 


PORCELAIN    TEETH. 


where  front  absorption  permits  the  artificial  gum  to  overlap  the  alveo- 
lus, and  one  where  fulness  of  the  natural  gum  requires  the  block  to 


Fia.  363. 


set  directly  upon  it.  In  the  latter  case,  if  the  color  of  gum  is  judi- 
ciously chosen  and  the  blocks  well  adapted,  the  triangles  of  artificial 
gum  will  be  scarcely,  if  at  all,  distinguishable  from  the  natural :  we 
regard  this  as  an  extremely  useful  form  of  block.  Sectional  view  of 
the  molar,  in  the  upper  cut,  shows  the  curve  necessary  to  bring  its 
grinding  surface  directly  under  the  ridge.  The  views  of  grinding  and 
cutting  surfaces,  together  with  front  views,  show  how  each  tooth  has  a 
distinctive  character;  as,  for  instance,  in  the  bicuspids,  so  often  chosen 
without  regard  to  the  diflTerence  in  form  between  the  first  and  second. 
Again,  the  curve  of  the  front  block  shows  two  of  several  variations 
required  in  the  curvature  of  the  arch :  in  the  upper,  the  sharp  turn  at 
the  canine  gives  a  squareness  across  the  incisors ;  in  the  lower,  this 
turn  is  at  the  central,  and  is  adapted  to  a  pointed  arch.  Variations 
in  curvature  of  the  arch  are  shown  also  in  Figs.  358,  371.  Notice  also 
the  marked  diflTerence  in  the  character  of  the  bicuspids  and  molars  in 
upper  and  lower  cuts,  and  the  totally  different  expression  of  the  front 
teeth. 

Fig.  364  shows  how  the  same  intermaxillary  space  may  be  filled 
with  teeth  of  mdely  different  size  as  well  as  character.  In  the  first,  a 
very  long  tooth  and  short  gum ;  in  the  second,  a  very  long  gum  and 
short  tooth.  But  length  of  teeth  is  by  no  means  the  only  difference 
here ;  relative  size  of  central  and  lateral,  direction  of  the  axis  of  lat- 
eral and  canine,  and  outline  of  cutting  edge  of  the  block,  are  three 
features  which  equally  mark  the  distinctness  of  these  two  styles :  these 
also  are  points  which  demand  that  both  long  and  short  teeth  shall  dif- 


PORCELAIN    TEETH. 


729 


fer  among  themselves  as  widely  as  these  samples  differ  from  each  other. 
The  lateral  view  of  these  teeth  shows  another  marked  difference  in 

form. 

Fig.  364. 


Fig.  365  gives  the  characteristic  equality  of  lower  incisors,  or  slightly 
greater  size  of  the  lateral;  it  also  gives  some  of  the  diversities  in  length, 
width,  shape  of  cutting  edge,  and  form  at  arch  of  the  gum.  Although 
there  is  much  less  difference  in  the  shape  of  the  six  lower  front  teeth 


Fig.  365. 


than  of  the  six  upper,  it  is  a  great  mistake  to  suj)pose  that  a  given 
lower  block  will  answer  for  any  lower  case,  if  only  long  enough.  Side 
views  show  also  a  difference  in  the  slant  of  the  teeth,  inward  or  out- 
ward, which  has  an  important  effect  in  modifying  the  expression  of 
the  lower  arch.  There  are  also  differences  in  curvature  of  the  lower 
arch  as  well  as  of  the  upper.  Fig.  358  shows  the  usual  upper  and 
lower  curves,  and  Figs.  363,  371  show  variations  of  upper  curvature 
requiring  some  modifications  of  the  lower,  dependent  on  the  character 
of  the  articulation.  In  Fig.  366  are  four  other  forms  of  lower  front 
blocks,  the  value  of  which  will  be  at  once  recognized.  The  two  right 
hand  sets  differ  from  those  of  Fig.  365  mainly  in  the  length  and  width 
of  teeth.  The  left  lower  set  is  well  suited  to  patients  whose  natural 
teeth,  for  many  years  before  their  loss,  were  marked  by  exposure  of 
the  neck:  this  appearance  may  also  be  increased  (sometimes  it  may 
be  made)  by  judicious  use  of  the  corundum-wheel,  but  the  block  here 
given  is  invaluable  for  such  cases.  The  left  upper  block  is  an  admi- 
rable imitation  of  a  very  usual  arrangement  of  inci.-ors,  resulting  from 
crowded  dentition:  the  drawing  gives  a  very  imperfect  idea  of  the 
great  beauty  of  the  original  porcelain  block.    When  the  facial  expres- 


730 


PORCELAIN    TEETH. 


sion  Indicates  its  use,  it  will  have  great  effect  in  disarming  suspicion 
of  artificiality,  —  a  very  desirable  quality  in  artificial  dentures. 

Fig.  3G6. 


In  Fig.  367  we  have  very  convenient  modifications  to  suit  front 
spaces  of  two  or  four  teeth  ;  the  set  of  four  being  in  two  blocks.  The 
peculiaritv  of  these  blocks  is  the  lateral  finish  of  the  gum  :  instead  of 
a  square  joint,  for  fitting  to  an  adjoining  block,  they  have  a  rounded 
edge  of  gum  color  that  can  be  adapted  to  the  curves  of  the  absorbed 
natural  gum.  There  should  also  be  blocks  of  two,  a  lateral  and  cen- 
tral, with  gum  shaped  like  the  double  central,  as  such  spaces  are  of 

Fig.  367. 


frequent  occurrence.  Besides  the  four  forms  of  teeth  here  given  there 
are  many  other  varieties,  in  size  and  shape,  of  this  very  useful  kind 
of  block. 

Fig.  368. 


Figs.  368,  369,  and  870  represent  a  few  of  the  great  variety  of  forms 
of  upper  incisors  and  canines,  designed  to  meet  the  demands  of  an 


POECELAIN    TEETH. 


731 


sesthetic  discrimination.  In  Fig.  368  we  have,  first,  a  long,  delicate 
lateral,  with  sloping  but  not  rounded  edge,  showing  a  decided  space 
between  it  and  the  cuspid  and  central :  then  we  find  it  wider,  with 
corners  and  edge  rounded  and  filling  the  space.  Lastly,  for  want  of 
space,  the  laterals,  although  long  and  narrow,  overlap  the  centrals : 
this  style  is  generally  accompanied  with  a  pointed  arch.  The  fourth 
block,  although  with  an  overlapping  incisor,  has  an  entirely  different 
character :  it  is  often  found  in  a  rather  flattened  arch,  and  does  not 
indicate  a  crowded  denture.  In  these  blocks  the  inclination  and  shape 
of  the  canine,-  as  well  as  the  shape  of  the  incisor,  help  to  give  to  each 
block  a  distinctness  of  character  which  will  not  permit  the  use  of  one 
in  a  case  demanding  either  of  the  others. 

The  celare  artem  effect  of  overlapping  or  twisted  laterals,  like  that 
of  irregular  lower  incisors,  is  such  as  to  tempt  one  to  use  them  when- 
ever admissible.  In  Fig.  369  we  have  some  additional  varieties  of 
this  kind  of  block.  In  all  these  six  cases  we  find  differences  in  the 
size  and  character  of  the  lateral,  in  the  extent  of  its  lapping,  and  in 
the  degree  of  twist  given  to  it.     A  careful  study  of  natural  teeth  will 

•  Fig.  369. 


teach  the  dentist  what  character  of  face  is  best  suited  to  each  of  these 
dififerent  forms,  and  thus  he  will  much  increase  the  extent  to  which  he 
may  properly  use  this  kind  of  irregularity. 

In  Fig.  370  the  blocks  vary  little  in  size,  yet  they  each  have  a  dis- 
tinctive character.  In  the  first,  we  have  lateral  rounded  on  both  cor- 
ners, and  its  axis  vertical ;  canine,  with  pointed  cusp  and  edges  quite 
rounded.  In  the  second,  we  have  lateral  inclined,  "with  median  corner 
pointed,  lateral  corner  quite  round  ;  canine  with  blunt  cusp,  also  axis 
inclined.  In  the  third,  surface  of  the  canine  is  decidedly  furrowed, 
which,  with  the  indented  edge,  gives  it  a  marked  character :  the  lat- 
eral and  central,  unlike  the  previous  blocks,  have  square-cut  edges, 
with  corners  but  slightly  rounded.  In  the  fourth,  the  lateral  is  more 
nearly  equal  to  the  central,  and  none  of  the  teeth  have  any  marked 


732 


PORCELAIN    TEETH. 


peculiarities :  this  style  of  block,  in  its  different  sizes,  suits  well  in 
many  cases,  and  is  perliajis  one  of  the  best  for  general  use  by  those 
practitioners  who  pay  no  regard,  in  their  selection  of  teeth,  to  the  indi- 
cations given  by  the  physical  characteristics  of  the  face  and  head. 
The  fifth  block  is  one  of  that  class  often  met  with  in  old  age,  Avhere, 
by  the  action  of  the  lower  teeth  or  other  causes,  the  arch  has  spread, 
widening  the  interdental  spaces.  The  interdental  gum  is  also  much 
shorter  than  in  youth,  as  is  finely  shown  in  the  original  from  which 

this  cut  is  taken. 

Fig.  370. 


In  the  selection  of  porcelain  blocks,  not  only  must  the  color,  size, 
and  form  of  the  teeth  be  carefully  considered,  but  reference  must  also 
be  had  to  the  curvature  of  the  arch.  For  although  moderate  varia- 
tions in  curvature  can  be  fitted  by  the  same  set  of  blocks,  the  true 
expression  of  a  porcelain  denture  is  often  lost  by  the  attempt  to  adapt 
it  to  a  curve  for  which  it  was  not  designed.  In  Figs.  358,  363,  and 
371  we  have  various  curves  of  the  alveolar  arch,  with  corresponding 
variations  in  shape  of  the  blocks.  Sometimes  the  canines  are  made 
separate  with  a  view  to  increase  the  range  of  application  of  a  given 
set:  but  a  joint  on  either  side  is  very  apt  to  injure  the  effect  of  this 
important  tooth.  In  the  lower  jaw  it  is  of  less  consequence  because 
the  gum  is  less  often  exposed,  and  it  is  frequently  desirable  to  make 
the  four  incisors  in  one  block.  But  in  the  upper  jaw,  it  is  much 
better  to  have  a  median  joint,  and  another  behind  the  canines. 

In  Fig.  371  the  reader  will  notice  that  the  centrals  of  the  first  set 
overlap  the  laterals,  an  arrangement  of  frequent  occurrence  in  promi- 
nent and  sharply  curved  arches.  It  vvill  be  observed  that  in  Fig.  361 
the  blocks  are  so  shaped  that  the  right  or  left  central  overlaps  its  fel- 
low.   Thus  we  have  three  varieties  of  overlapping  upper  teeth ;  laterals 


PORCELAIN    TEETH. 


733 


ever  centrals,  centrals  over  laterals,  central  over  central ;  each  of  which 
may  be  used  with  great  effect,  if  applied  with  discrimination.  In  the 
third  set  of  Fig.  371,  and  in  a  few  of  the  preceding  cuts,  the  gum  over 
the  cuspids  is  very  strongly  marked.  This  is  a  very  characteristic 
feature  of  some  mouths,  and  when  correctly  used  gives  a  fine  effect: 

Fig.  371. 


but  it  would  sadly  belie  the  expression  in  a  timid  and  gentle  lady's 
face.  Yet  such  incongruity  is  only  one  of  hundreds,  constantly  occur- 
ring, where  every  sense  of  aesthetic  beauty  and  harmony  is  violated: — 
teeth  of  a  Russian  in  the  mouth  of  a  Frenchman;  those  of  a  New 
Englander  given  to  a  South  Carolinian,  or  those  of  a  Canadian  to  a 
Cuban  —  the  lips  of  age  disclosing  the  teeth  of  youth,  and  no  distinc- 


734  PORCELAIN    TEETH. 

tion  made  between  a  male  and  a  female  denture.  These  esthetic 
blunders  are  not  confined  to  the  inexperienced  tyro,  but  are  perpe- 
trated by  many  Avho  presume  to  call  themselves  skilful  mechanicians. 
When  we  consider  the  extensive  assortment  of  porcelain  teeth  which 
ceramic  art  has  placed  at  the  disposal  of  the  practitioner,  such  mal- 
practice is  without  excuse. 

These  are  only  a  few  out  of  the  great  number  of  varieties,  in  size, 
form,  and  arrangement,  of  porcelain  teeth  ;  they  give  to  the  dentist  a 
much  wider  range  of  selection  than  some  have  the  ability  or  inclina- 
tion to  avail  themselves  of  When  to  variety  of  shape  we  add  shades 
of  color,  the  number  of  sets  that  admit  of  being  made,  distinguishable 
at  a  glance  from  each  other,  seems  almost  infinite.  A  visit  to  a  first- 
class  porcelain-tooth  manufacturer's  rooms  will  convince  any  one  that 
incongruity  or  want  of  expression  in  a  set  of  teeth  is  the  fault  of  him 
who  selects  and  applies  rather  than  of  him  who  designs  and  makes 
dental  porcelain. 

It  will  be  perceived  that  the  foregoing  illustrations*  of  the  aesthetic 
principles  of  the  dento-ceramic  art  are  taken  from  one  class  of  teeth, 
those  for  vulcanite  or  metallo-plastic  work.  We  have  done  so  because 
the  art  has  here  had  its  fullest  recent  development,  in  consequence  of 
the  great  demand  for  this  form  of  block.  But  dental  sesthetics  is  quite 
independent  of  the  material  of  the  plate,  so  long  as  that  which  is  vis- 
ible in  the  mouth  is  porcelain ;  and  dentures  which  show  any  substitute 
for  the  gum  other  than  this,  however  useful  they  may  be,  cannot  rank 
as  specimens  of  highest  art,  until  some  material  for  the  plate  shall  be 
discovered,  possessing  higher  claims  to  beauty  than  any  yet  known. 

The  foregoing  rules  will  apply  to  the  form  and  size  of  plain  teeth 
when  these  are  set  directly  upon  the  natural  gum ;  but,  except  in 
case  of  true  pivot  or  plate-pivot  teeth,  it  is  impossible  to  reproduce  the 
precise  natural  arching  of  the  gum  above  the  tooth  without  some  gura- 
colored  porcelain.  We  must  often  be  content,  in  such  cases,  with  the 
nearest  possible  approach  to  nature.  But  when  the  plate  is  seen  on 
the  outside  of  the  arch,  the  artist's  reputation  is  dependent  upon  the 
concealment  of  the  greater  part  of  his  work :  even  here,  however,  the 
cutting  edge  and  two-thirds  of  the  tooth  permit  the  display  of  great 

*  We  are  indebted  to  the  kindness  of  Dr.  Samuel  S.  "White,  of  Philadelphia, 
for  the  admirable  illustrations  by  the  aid  of  which  we  have  been  enabled  to 
express  our  views  upon  the  important  subject  of  dental  ^Esthetics.  No  illustra- 
tions, however,  can  convey  a  true  idea  of  the  high  artistic  excellence  of  those 
forms  the  production  of  which  has  placed  Dr.  White  among  the  greatest  benefac- 
tors of  Dental  Art.  We  take  this  occasion  to  acknowledge,  also,  the  liberality 
and  courtesy  with  which  our  inquiries,  for  information  on  the  manufacture  of 
daatal  porcelain,  were  responded  to  by  this  gentleman. 


PORCELAIN    TEETH. 


735 


varieties  of  expression.  Of  plain  teeth  -without  gum  there  are  four 
kinds.  1.  Pivot  teeth:  shaped  somewhat  like  the  crowns  of  the  upper 
incLsors  and  canines,  with  a  hole  in  the  base,  for  insertion  of  a  wooden 
pivot.  2.  Plate  teeth :  the  oldest  known  form  of  porcelain  teeth  hav- 
ing pins  for  attachment  of  a  back,  by  which  to  secure  it  to  the  plate. 
3.  Continuous  gum  teeth :  resembling  natural  teeth  in  having  a  root, 
which  is  more  or  less  serrated,  for  better  retention  in  the  investing 
porcelain  base :  they  are  sometimes  made  without  platina  pins ;  but 
they  are  better  with  pins,  so  that  they  may  be  securely  fastened  to  the 
platina  plate.  4.  Plain  vulcanite  (Fig.  376)  :  having  a  small  neck, 
by  which  they  are  held  in  the  vulcanite  or  other  material  in  which 
they  are  set.  These  teeth  may  Lj  set  directly  on  the  gum  by  grinding 
off  the  neck:  they  may  also  be  used  adjacent  to  natural  teeth  with 
exposed  neck,  by  slight  alteration  of  this  neck,  so  as  to  give  to  the 
artificial  tooth  the  same  appearance  as  the  natural  one. 

There  are  also  other  forms  of  gum  teeth  besides  those  above  repre- 
sented. Formerly,  single  gum  teeth  were  extensively  used  on  gold 
plate,  and  may  still  be  occasionally  required  when  the  supremacy  of 
that  old-fashioned  material  becomes  once  more  recognized  in  the  labo- 
ratory. The  great  facility  of  adapting  blocks  or  sections  in  vulcanite 
work,  or  in  vulcanite  attachment  to  swaged  plates,  has  led  to  the  almost 
entire  exclusion  of  this  form  of  tooth,  except  for  repairing.  A  serious 
objection  to  single  gum  teeth  is  the  number  of  joints :  these  greatly 
mar  the  artistic  effect  which 
it  is  the  design  of  the  artifi- 
cial gum  to  produce,  espe- 
cially when  not  kept  per- 
fectly clean,  or  when  the 
material  of  plastic  plates  is 
allowed  to  enter  the  joints. 
Figs.  357  and  372  .are  de- 
signed to  show  the  import- 
ance of  correct  and  accurate 
grinding  in  order  to  display 
the  true  character  of  a  set 
of  teeth.  When  properly 
done,  the  joint  does  not  in- 
terrupt the  continuous  sur- 
face of  the  gum  more  than 
the  lines  in  the  two  lower 
sets  of  Fig.  372;  nor  should 
it  in  any  case  be  more  visible  than  the  heavier  lines  of  the  first  set. 
Neither  should  the  set  be  so  inaptly  chosen  as  to  require  such  grind- 


FiG.  372. 


736  PORCELAIN    TEETH. 

ing  of  joints  and  base  as  to  injure  its  original  expression.  Figs.  357 
and  372  sliould  also  be  carefully  studied  by  the  student,  on  account 
of  the  varieties  of  form  and  relation  of  teeth  presented:  each  of  the 
four  upper  sets  here  displayed  having  a  very  distinctly  marked 
character. 

Porcelain  blocks  which  are  to  be  attached  to  a  gold  plate  by  solder- 
ing do  not  differ  in  external  appearance  from  the  forms  already  illus- 
trated ;  but  the  shape  of  inner  surface 
^^"  and  the  form  of  the  pins  are  different. 

Fig.  373  represents  such  a  set  of  upper 
blocks  in  three  sections.  If,  made  in 
four  sections,  the  set  should  be  divided 
between  the  centrals  and  between  the 
bicuspids:  it  may  also  be  in  five  sec- 
tions, the  four  joints  being  in  front  of 
the  cuspids  and  behind  the  bicuspids;  or 
it  may  be  divided  into  six  sections,  as  in 
Fig.  357.  The  line  above  the  pins  in  Fig.  373  marks  the  division  be- 
tween the  inner  slope  of  gum  next  the  teeth  and  the  plain  surface 
holding  the  pins  :  this  surface  should  be  as  smooth  as  possible,  for  the 
perfect  adaptation  of  the  gold  backing.  Blocks  may  also  be  made  in 
sets  of  three  or  five  sections,  with  the  inner  surface  finished  in  gum- 
enamel  to  the  j^late :  in  this  case  the  block  is  held  to  the  plate  by  pins 
passing  into  holes  made  in  its  base,  one  opposite  each  tooth.  The  best 
material  for  retaining  the  pins  is  undoubtedly  vulcanite,  as  described 
in  the  previous  chapter:  the  holes  should  be  rough,  for  its  better 
adhesion. 

The  dental  depots  cannot  keep  on  hand  an  assortment  of  such  blocks, 
since  the  demand  is  too  limited  to  justify  the  expense  of  the  brass 
moulds.  But  in  all  our  principal  cities  there  will  be  found  one  or 
more  Dental-block  Carvers,  whose  experience  and  constant  j^ractice 
enable  them  to  make  any  style  of  blocks  that  may  be  desired  for  spe- 
cial cases.  We  have  elsewhere  given  our  reasons  for  thinking  this  a 
better  plan  than  for  the  dentist  himself  to  attempt  occasional  ceramic 
experiments.  Let  him  prepare  an  accurate  articulating  model,  and 
adapt  a  tin-foil  plate  (to  avoid  the  risk  of  sending  the  gold  one)  :  then 
select  one  or  more  teeth,  to  guide  the  carver  in  the  required  color  and 
character  of  the  set.  If  any  peculiar  form  or  deviation  from  the  nor- 
mal arrangement  is  desired,  this  should  be  represented  in  wax :  then 
pack  carefully,  and  send  by  mail  or  express.  From  1858  to  1865,  be- 
fore dental  porcelain  had  reached  its  present  development,  we  prepared 
all  our  work  in  this  manner,  sending  the  articulator  to  Dr.  Wm.  Cal- 
Yert  and  Dr.  "Wm.  R.  Hall,  of  Philadelphia.     The  results  were  in  the 


POECELAIN    TEETH.  737 

highest  degree  satisfactory ;  and  this  plan  is  recommended  to  those  who 
may  desire,  for  some  special  case,  a  form  of  blocks  not  to  be  had  at 
the  depots.  Necessarily  such  blocks  are  much  more  expensive  than 
those  made  by  the  quantity  in  brass  moulds ;  but  if  the  dentist  values 
his  time,  the  blocks  would  cost  still  more  if  made  by  himself. 

The  true  question  is,  however,  not  one  of  cost :  if  the  depot  can 
furnish  the  form  of  blocks  which  the  case  requires,  it  is  best  to  get 
them  there :  otherwise,  they  must  be  had  elsewhere  and  at  any  cost. 
Dental  tradesmen,  who  sell  their  wares  at  a  moderate  advance  on  the 
cost  of  production,  may  not  deem  it  prudent  to  deal  in  such  high-priced 
materials ;  but  the  professional  dentist,  who  charges  for  "  services  reu- 
dered,"  will  never  find  it  necessary  to  hesitate  incurring  any  expense 
requisite  for  the  perfection  of  his  work.  The  actual  cost  of  material 
in  single  dentures  has  often  exceeded  thirty  dollars ;  yet  the  mechani- 
cian who  exercises  a  skill  commensurate  with  this  cost  never  has  found, 
and  never  will  find,  difficulty  in  adding  a  just  compensation  for  his  time 
and  skill.  As  a  rule,  patients  will  pay  best  for  art  when  exercised  on 
expensive  material;  except  where,  as.  in  painting,  the  effect  produced 
is  wholly  irrespective  of  the  cost  of  the  means  employed.  The  true 
basis  of  professional  fees  lies  in  that  which  makes  one  man's  work 
superior  to  another's ;  namely,  artistic  skill  exercised  upon  materials, 
the  quality  of  which  shall  not  detract  from  its  just  appreciation. 

As  we  have  briefly  described  the  processes  of  manufacture  of  por- 
celain dentures  on  a  large  scale,  —  a  work  which  of  course  no  practising 
dentist  proposes  to  engage  in,  —  it  is  proper  that  we  should  also  give  a 
brief  description  of  the  processes  by  which  Blocks  are  carved  for  spe- 
cial cases,  although  we  regard  this  as  equally  out  of  the  line  of  the 
modern  dentist's  duties.  We  occasionally  find  a  genius,  whose  gift 
shows  that  ceramic  art,  not  dentistry,  is  his  true  profession;  but  men 
engaged  in  ordinary  dental  practice  must,  in  justice  to  their  patients, 
make  use  of  the  experience  of  professional  block-carvers,  or  they  must 
use  those  forms  offered  by  the  ceramic  manufacturer,  which  are  the 
results  of  the  highest  artistic  skill  which  money  can  command. 

SPECIAL   BLOCK   CARVING. 

To  make  a  porcelain  dental  arch  in  three  sections  for  a  full  upper 
case  antagonizing  with  natural  teeth  below,  make  a  plaster  articula- 
tor as  described  in  the  tenth  chapter,  but  having  greater  thickness,  to 
permit  guiding  holes  or  grooves,  as  in  Fig.  374.  Open  the  articula- 
tor, increasing  the  space  one-fifth  (unless  this  one-fifth  enlargement  is 
to  be  made  by  addition  of  point-enamel) ;  place  on  the  plate  a  wax 
rim,  and  trim  it  to  antagonize  with  the  lower  teeth,  giving  the  precise 
external  fulness  required  in  the  blocks.  Mark  on  -wax  and  front  edg(» 
47 


738 


PORCELAIN    TEETH. 


FiQ,  374. 


of  articulator  the  medial  line  and  the  lines  of  proposed  division  of 
blocks;  that  is,  between  bicuspids  for  a  four-block  piece,  and  behind 

cuspids  for  a  piece  of  three  blocks :  in 
either  case  the  work  is  carved  in  three 
pieces.  It  is  also  well  to  mark,  in  fainter 
lines,  the  width  of  each  tooth  as  deter- 
mined by  the  size  of  the  lower  teeth  : 
this  will  be  some  guide  in  the  subsequent 
enlargement,  required  on  account  of 
shrinkage  of  the  porcelain  paste.  Next 
make  a  plaster  rim  about  a  half-inch 
thick  (Fig.  265,  on  page  597,  shows  the 
height  and  thickness),  covering  the  exte- 
rior surface  of  model  and  wax ;  making 
first  the  front  section,  extending  a  half 
tooth-space  behind  the  lines  marked  for 
the  block  joints  :  then  remove  this,  and 
make  the  two  side  sections,  extending 
each  a  half  tooth-space  in  front  of  these 
lines.  The  use  of  a  leaden  band  and 
some  paper-pulp  will  expedite  the  making  of  these  plaster  sections : 
they  should  be  trimmed  to  the  exact  length  required  for  the  crude 
blocks.  Of  course,  neither  in  plaster  nor  porcelain  can  the  front  and 
side  sections  be  applied  to  the  model  or  plate  at  the  same  time,  in  con- 
sequence of  the  one-fifth  allowance  for  thickness. 

On  removing  the  wax,  each  plaster  section  is  a  matrix  to  determine 
the  extei-nal  fulness  of  the  corresponding  block,  on  which  is  to  be 
carved  the  shape  of  teeth  and  gum.  The  plate  gives  exact  form  to 
the  base  of  the  block  ;  but  when  finished,  it  will  require  grinding,  be- 
cause of  the  derangement  of  fit  caused  by  shrinkage.  The  thickness 
and  interior  form  of  the  sections  is  determined  by  the  eye,  and  will 
vary  with  the  style  of  finish  or  mode  of  attachment,  being  careful,  in 
this  direction  also,  to  make  the  one-fifth  allowance  for  shrinkage.  The 
front  block  is  first  made  and  removed,  then  each  side  block  separately; 
in  a  double  set,  both  front  blocks  are  made,  then  both  right  sections 
together  and  left  sections  together,  so  as  to  obtain  their  proper  antag- 
onism :  also,  in  double  sets,  the  separation  of  the  articulation  must  be 
sufl3cient  to  allow  the  one-fifth  enlargement  in  each  set. 

The  porcelain  body  is  prepared  as  already  explained  :  it  can  be 
compounded  by  the  dentist,  or  purchased  from  the  manufacturer.  In 
mixing  the  small  quantities  required  for  single  cases,  two  points  demand 
special  care,  —  purity  of  the  water  and  absolute  exclusion  of  air  from 
the  mass.     It  must  also  be  remembered  that  irregular  contraction,  or 


PORCELAIN    TEETH.  739 

warping  of  blocks  in  firing,  is  often  caused  by  unequal  compression  in 
packing  the  body  into  the  moulds,  and  by  unequal  absorption  of  its 
moisture,  by  the  porous  plaster  rim  or  other  means  used  to  dry  it. 
Again,  it  should  be  remembered,  in  removing  the  rim,  in  carving  and 
in  all  other  operations  on  the  crude  paste,  that  the  excess  of  feldspar 
gives  it  a  tenderness  very  different  from  the  tough  plasticity  of  a  kaolin 
mass.  The  putty-like  body  is  to  be  carefully  worked  into  the  well- 
oiled  mould,  compressed  with  the  fingers,  trimmed  into  outline  shape, 
and  then  removed,  first  marking  upon  it  the  lines  of  the  articulator,  to 
guide  in  the  carving.  The  block  may  be  partly  or  entirely  carved 
while  en  the  articulator;  but  the  delicate  movements  of  the  very  deli- 
cately-shaped carving-tools  are,  in  the  opinion  of  some,  best  exercised 
upon  the  free  block. 

For  Carving,  no  directions  can  be  given  beyond  what  has  heretofore 
been  said  on  the  necessity  of  a  close  observance  and  exact  copying  of 
nature.  The  artist  requires  no  written  directions,  and  paper  instruc- 
tions never  yet  made  an  artist  out  of  a  bungler  :  in  fact,  the  heaven- 
born  genius  of  art  cannot  be  created  by  teaching,  however  it  may  be 
trained  and  directed.  Many  have  w^asted  years  in  porcelain  block 
carving,  only  to  produce  results  surpassed  by  the  least  artistic  forms 
ofiered  in  the  depots ;  whilst,  on  the  other  hand,  some  dental  Palissy 
will  work  out  a  marvel  of  beauty  that  no  purchased  block  can  equal. 
But  before  one  imagines  himself  a  Bernard  Palissy,  let  him  read  the 
history  of  that  wonderful  struggle  of  genius ;  then  ask,  how  far  the 
routine  duties  of  a  dental  office  will  permit  an  exclusiveness  of  devo- 
tion, which  ceramic  art  rigorously  exacts  as  a  condition  of  success. 

When  carved,  the  blocks  are  thoroughly  dried,  then  placed  on  coarse 
silex  upon  a  fire-clay  slab,  and  set  into  the  muffle  of  the  furnace,  (Fig. 
375.)  Here  they  are  biscuited  (or  cruced),  that  is,  raised  to  a  red  heat 
sufficient  to  give  some  hardness,  but  not  to  vitrify  or  even  to  cause 
incipient  fusion.  They  are  then  slowly  cooled,  and  holes  drilled  for  the 
pins,  or  else  holes  drilled  into  the  base  of  the  blocks,  as  may  be  pre- 
ferred :  the  pins  are  fastened  in  place  by  a  little  "body-slip,"  carefully 
worked  in  with  the  knife-point.  Slight  defects  of  carving  may  now  be 
corrected :  the  enamels  are  then  applied  with  a  camel's-hair  brush. 
They  must  be  reduced  to  the  consistence  of  cream,  and  require  much 
skill  and  judgment  in  their  application,  so  that  the  point-enamel  shall 
blend  properly  with  the  body-enamel ;  also  the  gum-enamel  must  pre- 
serve its  distinctness  of  outline,  and,  by  its  varying  thickness,  give  those 
alternations  of  shade  observable  in  the  natural  gum.  It  should  here 
be  remarked,  that  some  carvers  make  no  allowance  in  the  body  for 
shrinkage  in  length  of  the  tooth,  but  compensate  by  the  addition  of 
point-enamel.     The  crowns  of  bicuspids  and  molars  are  usually  enam- 


740 


PORCELAIN    TEETH. 


Fig.   375. 


elled  ;  also  part  of  the  inner  surface  of  the  blocks,  and  in  some  blocka 
the  gum-enamel  extends  to  the  base.  When  platina  pins  are  inserted, 
the  part  of  the  block  to  be  covered  by  the  backing  is  not  enamelled. 
It  is  scarcely  necessary  to  remark  that  a  large  assortment  of  body-, 
point-,  and  gum-enamels  is  required ;  also,  that  these  must,  with  great 
care,  be  kept  separate,  with  their  respective  test-pieces  attached ;  for, 
except  by  the  pinkish  color  of  gum-enamel,  they  cannot  be  distin- 
guished when  in  form  of  powder,  paste,  or  cream. 

The  blocks  are  now  well  dried,  and  are  ready  for  the  furnace.  Fig. 
375.  Success  thus  far  is  dependent  upon  :  1.  Thorough  mixing  of  the 
body  and  its  careful  packing ;  2.  Skilful  carving,  so  as  not  only  to 
give  the  required  expression,  but  also  to  know  what  allowances  to 
make  at  each  point  for  shrinkage  and  for  the  subsequent  application 

of  the  enamels ;  3.  Selection  of 
enamels  and  their  skilful  blend- 
ing and  shaping ;  4.  The  giving 
of  such  form,  in  adjustment  of 
the  relative  length  and  thickness 
of  each  block  and  apportionment 
of  material,  as  shall  prevent 
warping  in  the  furnace.  These 
points,  however,  may  have  been 
perfectly  attended  to ;  yet  all  will 
have  been  done  in  vain,  unless 
the  operator  has  a  thorough  prac- 
tical knowledge  of  the  manage- 
ment of  the  furnace.  It  is  this 
which  makes  the  ceramic  experi- 
ments of  the  practising  dentist  so 
often  a  failure ;  for  fail  he  cer- 
tainly will,  unless  he  knows  the 
exact  heat  at  which  the  differing 
fusibilities  of  his  body  and  vari- 
ous enamels  will,  by  their  com- 
bined effect,  develop  the  propei'ties  aimed  at  in  their  composition. 
Some  are  governed  in  this  by  test  pieces :  the  experienced  workman, 
guided  by  constant  practice  in  a  way  that  he  cannot  explain,  prefers 
the  indications  offered  by  looking  at  the  piece  itself.  If  not  sufficiently 
baked,  the  body  will  be  porous;  also  neither  this  nor  the  enamels  will 
have  their  true  life-like  character.  If  overdone,  there  is  an  offensive, 
glassy,  and  transparent  condition,  equally  fatal  to  the  natural  appear- 
ance; also,  there  is  too  much  shrinkage  and  greater  danger  of  warping. 
Both  errors  impair  the  full  strength  of  the  porcelain,  in  which  the 


PORCELAIN    TEETH.  741 

ingredients  are  so  combined  as  to  develoj)  greatest  strength  at  a  certain 
temperature. 

Furnace  temperature  is  measured  by  instruments  called  Pyrometers. 
Tlie  limit  of  mercurial  registration  of  temperature  is  600°  Fahrenheit. 
Daniell's  pyrometer  registers  by  the  expansion  of  a  platina  rod  in  a 
plumbago  case,  and  is  the  most  accurate.  Wedgewood's  pyrometer 
registers  by  the  rate  of  permanent  contraction  of  kaolin  under  intense 
heat.  A  clay  wedge,  fitting  the  upper  part  of  a  tapering  groove,  will, 
after  exposure  to  furnace  heat,  slip  farther  into  the  groove :  supposing 
the  rate  of  contraction  uniform,  this  distance  will  be  a  measure  of  the 
heat,  after  establishing  its  exact  relation  to  the  600°  point  of  Fahren- 
heit. But  the  contraction  of  any  two  pieces  is  not  the  same,  unless 
their  composition  is  identical ;  also,  the  relation  to  the  mercurial  scale 
is  not  easy  to  determine.  Wedgewood's  zero  was  1076°  Fahrenheit, 
and  he  estimated  one  degree  of  his  pyrometer  equal  to  130°  :  on  which 
basis  of  calculation  the  highest  heat  of  the  porcelain  furnace  (130°  to 
160°  Wedgewood)  would  range  from  19,000°  to  22,000°  Fahrenheit. 
Others  estimate  his  degree  at  62.5°  Fahrenheit,  reducing  the  registra- 
tion from  9,500°  to  11,000°  Fahrenheit.  Taking  the  fusion-point  of  gold 
at  2,000°,  and  of  pure  iron  at  3,000°,  we  thus  have  some  idea  of  the 
infusibility  of  platinum,  and  the  extreme  heat  of  ceramic  furnaces. 
But  it  is  evident  that  the  correct  regulation  of  this  heat  must  be  the 
result  of  experience  rather  than  of  written  direction;  also,  that  the 
furnace  practice  of  different  persons  cannot  be  accurately  compared. 

The  mufile  protects  against  the  gases  of  the  fire.  Charcoal,  coke,  or 
anthracite  are  used  as  fuels,  according  to  the  location  of  the  operator : 
the  last  is  preferable  when  it  can  be  procured,  because  it  gives  the 
steadiest  heat ;  charcoal  requires  practice  to  maintain  a  uniform  heat ; 
coke  is  used  in  all  the  bituminous  coal  regions.  With  either  of  these,  after 
sufiicient  experience,  a  furnace  may  be  kept  regularly  at  the  required 
heat  for  a  length  of  time  sufl[icient  to  fire  the  porcelain  blocks.  They 
must  be  thoroughly  dried  on  the  furnace-shelf  before  going  into  the 
muffle:  the  mouth  of  the  mufile  should  be  well  luted,  and  the  stopper 
withdrawn  only  to  examine  the  work.  The  more  slowly  blocks  are 
cooled,  the  more  perfectly  are  they  annealed,  and  hence  less  liable  to 
crack  from  sudden  changes  of  temperature,  as  in  soldering. 

Not  to  interrupt  the  order  of  operations,  we  have  deferred  the  de- 
scription of  a  very  ingenious  method  of  carving  devised  by  Dr.  Wm. 
Calvert.  Instead  of  the  wax  rim  before  mentioned.  Dr.  Calvert  pro- 
vided an  assortment  of  teeth  having  all  the  varieties  of  form  and  size 
required  in  practice,  but  one-fifth  larger  than  the  given  case.  These 
are  arranged  in  a  wax  gum,  and  the  plaster  mould  then  taken.  Thus, 
in  Fig.  376,  teeth  of  the  first  size,  set  in  wax,  will  give,  when  dimin- 


742  PORCELAIN    TEETH. 

ished  by  the  furnace,  teeth  of  the  second  size :  so  in  Fig.  332,  each  of 
the  two  lower  sizes  in  wax  will  give,  in  the  finished  block,  the  size 
above  it.  Dr.  Calvert's  method  has  three  recommendations :  1.  Like 
continuous-gum  work,  it  limits  the  necessity  of  sesthetic  skill  (which 

Fig.  376. 


SO  few  possess  in  high  degree)  to  the  shaping  of  the  gum,  the  judicious 
selection  of  teeth,  and  their  proper  arrangement;  leaving  the  details 
of  form  to  the  genius  of  the  manufacturer's  artist.  2.  It  pei'mits  the 
application  of  enamels,  or  rather  the  addition  of  body  to  enamels,  with- 
out the  necessity  of  crucing,  which  some  regard  as  injurious  to  the 
tooth.  3.  By  selecting  a  variety  of  styles  of  model  teeth,  and  by 
varying  the  relative  adjustment  of  them  in  the  wax,  that  tendency  to 
uniformity  of  style  is  obviated,  which  characterizes  almost  every  block- 
carver's  work. 

Dr.  Calvert's  process  differs  mainly  from  the  foregoing  in  the  follow- 
ing details :  For  a  four-block  piece  the  teeth  are  set  in  wax  shaped  in 
exact  imitation  of  the  natural  gum,  omitting  the  second  bicuspid,  in 
place  of  which  a  half  tooth-space  is  left  between  first  bicuspid  and 
molar,  the  wax  gum  being  carried  around  continuously.  The  plaster 
mould  of  the  eight  front  teeth  is  then  taken,  a  thin  septum  of  foil  being 
placed  opposite  the  mesial  line,  so  that  it  may  be  easily  broken  there 
in  the  act  of  removal,  the  plaster  coming  slightly  over  the  inside,  so 
as  to  give  with  certainty  the  shape  of  the  cutting  edges.  Upon  remov- 
ing the  front  mould,  and  before  making  the  lateral  moulds,  where  as 
yet  the  wax  holds  only  two  molars,  it  is  necessary  to  detach  the  bicus- 
pid of  the  front  block  and  put  it  adjacent  to  the  molar :  this  gives  the 
arch  its  full  complement  of  bicuspids.  This  must  be  done  very  neatly^ 
so  as  not  to  disturb  the  continuity  of  the  wax  gum ;  otherwise,  the 
effect  of  the  porcelain  blocks  at  their  joints  will  be  injured.  Dr.  Cal- 
vert prefers  using  cuspids  for  insertion  in  the  wax  instead  of  bicuspids, 
since  their  external  expression  is  similar  and  their  form  more  conven- 
ient, especially  in  the  change  just  described.  By  similarity  of  form 
we  do  not  mean  that,  in  any  mouth,  the  canines  and  bicuspids  are 
alike  externally  ;  but,  out  of  a  collection  of  canines,  after  choosing 
the  cuspids  themselves,  others  may  be  selected,  harmonizing  with  them 


PORCELAIN    TEETH.  743 

as  first  and  as  second  bicuspids.  Besides  overlapping  the  blocks  at  the 
bicuspids  to  compensate  shrinkage,  a  slight  extension  of  each  block 
beyond  the  last  tooth  should  be  made,  to  allow  for  accurate  grinding. 
If  holes  are  made  in  the  base,  instead  of  platina  pins  in  the  back,  it 
will  be  best  to  make  a  continuous  front  block  of  six  teeth,  in  which 
case  the  half  tooth-space  above  named  comes  behind  the  cuspid. 

Since  the  carved  wax  and  the  contained  teeth  make  carving  of  the 
porcelain  paste  unnecessary,  the  plaster  moulds  are  varnished,  oiled, 
and  treated  as  are  the  brass  moulds  in  wholesale  manufacture.  The 
stifi"  paste  of  point-enamel  is  placed,  with  a  delicate  spatula,  into  each 
tooth-matrix,  thickest  at  the  point,  and  disappearing  at  the  neck.  The 
tooth-enamel  paste  is  then  applied,  with  thickness  reversed :  gum- 
enamel  might  also  be  added  in  the  same  Avay,  but  it  is  usually  applied 
afterward  with  the  brush,  as  this  permits  delicacy  and  uniformity  -of 
coating  or  easier  modification  of  its  thickness.  A  layer  of  soft  body- 
paste  is  now  laid  over  the  enamels,  the  mould  is  placed  on  the  articu- 
lator, and  the  thickness  of  the  block  is  built  out  and  shaped  in  the 
usual  way,  compressing  it  firmly,  and  removing  surplus  moisture  with 
bibulous  paper  or  the  blow-pipe  flame.  The  block  is  next  carefully 
removed,  and,  whilst  resting  in  its  matrix,  the  platina  pins  are  inserted 
or  holes  drilled  in  the  base,  or  dovetails  cut,  as  may  be  preferred,  and 
the  whole  inner  surface  examined  and  trimmed.  If  the  inside  of  the 
block  is  to  be  finished  in  gum,  the  enamel  should  now  be  applied;  then 
remove  the  block  from  the  matrix  and  apply  the  outside  gum-enamel, 
and  trim  between  the  teeth,  where  the  thin  edges  of  the  plaster  matrix 
are  apt  to  be  defective :  the  block  is  then  ready  to  be  dried  and  placed 
in  the  furnace,  where  it  is  fired  at  a  single  heat  without  previous  bis- 
cuiting.     The  side  blocks  are  made  in  precisely  the  same  manner. 

PORCELAIN   PLATES. 

In  addition  to  what  has  already  been  said  upon  this  subject,  it  is 
only  necessary  here  to  consider  some  of  the  preceding  properties  and 
manipulations  of  the  porcelain  material,  in  its  use  as  a  plate.  Neither 
in  itself,  nor  by  known  combination  with  any  substances,  can  a  thin 
porcelain  plate  be  otherwise  than  frail.  The  fusible  porcelain  of  the 
"continuous-gum  work"  is  supported  by  the  platina  plate  and  the  con- 
tinuously soldered  platina  backings.  Such  porcelain,  without  metallic 
support,  would  be  very  frail.  In  endeavoring  to  give  strength,  by  de- 
creasing the  flux  and  increasing  the  refractory  ingredients,  we  are  at 
once  met  by  the  difficulty  of  shrinkage.  Thus  we  encounter  two  horns 
of  a  dilemma, —  a  very  fusible  porcelain  with  less  contraction,  but  great 
tenderness;  a  more  refractory  porcelain  with  greater  strength,  but  the 


744  PORCELAIN    TEETH. 

ubual  one-fifth  contraction,  which  necessarily  destroys  the  fit  of  the 
phite,  if  made  over  the  unchanged  modeh 

Dr.  Allen  frankly  acknowledges  the  weakness  of  his  very  beautiful 
porcelain  by  giving  it  a  metallic  support.  The  dentist  knows  just 
what  he  is  using  here  (see  the  fourteenth  chapter),  and  can  exercise 
his  judgment  upon  the  suitability  of  the  work  to  any  case  in  hand. 
The  few  dentists  who  make  porcelain  plates  are  nioi'e  reserved  in  com- 
municating their  knowledge.  Such  unprofessional  reserve  is  damaging 
to  dentistry  as  a  science :  it  would  injure  it  also  as  an  art,  if  entire  por- 
celain dentures  had  a  strength  equal  to  their  beauty.  It  is  claimed  by 
some  makers  of  these  plates,  that  their  formulas  give  a  porcelain  which 
is  very  strong,  yet  has  a  very  slight  shrinkage.  But  until  such  form- 
ulas are  made  known  to  the  profession,  and  an  opportunity  given  to 
test  them,  the  general  prejudice  against  the  porcelain  base  must  con- 
tinue to  be  well  founded.  To  those  desirous  of  experimenting  in  this 
direction,  we  might  suggest  the  use  of  silicate  of  magnesia  and  lime 
(asbestos)  and  coarsely  pulverized  porcelain  fragments,  as  perhaps  les- 
sening the  shrinkage  of  the  mass. 

By  some  the  ordinary  dental  porcelain  paste  is  used,  making  provi- 
sion for  shrinkage  by  enlargement  of  the  model.  One  method  of  en- 
largement is  as  follows :  With  a  fine  saw  divide  the  plaster  model  by 
a  cut  through  the  median  line  and  another  on  each  side;  separate  these 
four  sections  one-eighth  inch  and  fill  the  joints  with  plaster,  first  satu- 
rating them  with  water :  then  cut  the  model  twice  at  right  angles  to 
the  first  lines,  and  fill  with  plaster  as  before.  If  the  back  of  model  is 
perfectly  level,  and  the  work  is  very  carefully  done,  we  shall  have  a 
tolerably  accurate  enlargement  of  about  one-fifth.  INIake  a  plaster 
matrix  over  this  in  the  manner  described  under  Dr.  Bean's  cast  alu- 
minum process,  and  into  this  pour  a  furnace-model,  composed  of  three  or 
four  parts  asbestos  or  sand  to  one  of  plaster.  On  this,  mould  and 
carve  and  bake  the  plate  and  teeth  ;  else  transfer  the  plate  to  a  pile 
of  coarse  silex,  so  arranged  as  to  give  it  as  much  support  as  possible 
during  the  firing. 

Teeth  and  plate  are  sometimes  carved  out  of  the  same  mass  on  the 
enlarged  model ;  or  blocks  may  be  made  as  already  described,  then 
transferred  and  united  to  a  porcelain  plate  on  this  model.  Sometimes 
the  teeth  from  the  depots  are  arranged  in  the  porcelain  paste,  and  gum- 
enamel  applied  around  the  teeth  and  over  the  plate.  Unlike  continu- 
ous-gum work,  the  teeth  are  not  attached  to  any  unyielding  plate; 
hence  they  are  liable  to  change  position  by  the  contraction  of  the  plate 
durino;  firino;. 

"We  cannot  more  appropriately  close  this  chapter  on  dental  porce- 


DEFECTS    OF    THE    PALATINE    ORGANS.  745 

lain  than  by  quoting  some  remarks  of  the  great  English  ceramic  man- 
ufacturer, Josiah  Wedgewood,  applicable  to  the  art  which  he  did  so 
much  to  elevate.  They  have  a  significance  beyond  ceramic  art;  and 
convey,  in  this  lesson  of  the  past,  a  warning  to  those  who  may,  perhaps 
unconsciously,  be  dishonoring  the  profession  of  their  choice. 

"All  works  of  taste  must  bear  a  price  in  proportion  to  the  skill, 
taste,  time,  expense,  and  risk  attending  their  invention  and  manufac- 
ture. Those  things  called  dear  are,  when  justly  estimated,  the  cheap- 
est: they  are  attended  with  much  less  profit  to  the  artist  than  those 
which  everybody  calls  cheap.  Beautiful  forms  and  compositions  are 
not  made  by  chance,  nor  can  they  ever,  in  any  material,  be  made  at 
small  expense.  A  competition  for  cheapness,  and  not  for  excellence 
of  workmanship,  is  the  most  frequent  and  certain  cause  of  the  rapid 
decay  and  entire  destruction  of  arts  and  manufactures." 


CHAPTER    XVII. 

DEFECTS   OF   THE   PALATINE   ORGANS. 

ONE  of  the  most  distressing  deformities  to  which  the  human  frame 
is  liable,  is  found  in  that  defective  condition  of  the  palatine  organs 
which  is  known  to  surgeons  by  the  name  of  Cleft  Palate.  The  unfor- 
tunate sufferer  is  compelled,  in  a  great  measure,  to  be  an  alien  among 
his  fellow-creatures ;  an  object  of  compassion  to  the  considerate,  he  is 
often  made  painfully  conscious  of  notice  by  the  heartless  crowd ;  and 
were  he  gifted  with  the  power  and  eloquence  of  a  Demosthenes,  or  with 
the  garrulousness  of  a  CI  eon,  he  could  make  little  more  use  of  his  en- 
dowments than  a  mute.  Fortunately,  this  painful  defect  is  no  longer 
to  be  reckoned  as  one  of  the  Opprobia  Medieorum;  for  both  surgical 
and  mechanical  means  are  now  at  hand  by  which  the  imperfection  may 
at  least  be  remedied,  and  often  cured. 

Defects  of  the  palatine  organs  may  be  divided  into  two  classes,  viz. : 
Accidental  and  Congenital.  The  first  includes  all  loss  of  substance  in 
either  hard  or  soft  palates,  whether  occasioned  by  disease  or  otherwise. 
Such  defects  are  not  uniform  in  locality,  nor  in  extent ;  consisting 
sometimes  of  simple  perforations,  and  at  others  involving  the  destruc- 
tion of  the  velum,  a  considerable  portion  of  the  os  palati,  the  vomer 
and  turbinated  bones,  and  the  loss  of  a  greater  or  less  number  of  the 
teeth.  The  second  class  includes  all  malformations,  from  the  simple  bi- 
furcation of  the  uvula  to  an  opening  through  the  velum,  palatine  and 


746  DEFECTS    OF    THE    PALATINE    ORGANS. 

maxillary  bones,  and  a  fissure  of  the  upper  lip;  thus  uniting  the  nasal 
passages  with  the  oral  cavity  throughout  their  entire  extent. 

These  malformations  are  quite  similar  in  character,  but  not  uniform 
in  extent.  They  may  be  said  to  begin  with  the  uvula,  and  in  the  uvula 
and  velum  always  occupy  the  median  line;  but  as  the  defect  progresses 
anteriorly,  it  may  deflect  to  one  side  or  the  other  of  the  vomer  and,  fol- 
lowing the  nasal  passage,  divide  the  lip,  leaving  the  vomer  articulated 
with  the  i^alatine  bone  upon  one  side ;  while  in  other  cases,  the  deform- 
ity seems  to  follow  the  median  line,  and  thus  involves  both  nasal  pas- 
sages, terminating  in  a  double  fissure  of  the  lip. 

Congenital  defects  of  the  palate  are  usually  accompanied  by  more  or 
less  deformity  of  the  sides  of  the  alveolar  arch,  and  of  the  teeth.  Some- 
times the  sides  of  the  alveolar  ridge  are  forced  too  far  apart,  and  at 
other  times  they  are  too  near  each  other ;  while  the  teeth  are  either 
too  large  or  too  small,  and  are  generally  of  a  soft  texture,  with  imper- 
fectly developed  roots. 

Want  of  coaptation,  resulting  from  defective  formation  in  the  pal- 
atine plates  of  the  maxillary  and  palate  bones,  is  the  cause  of  con- 
genital deficiencies  of  the  parts  in  question.  In  the  human  embryo  of 
about  the  third  week,  the  development  of  the  face  is  clearly  in  prog- 
ress. Five  tubercles  bud  out  from  the  front  of  the  cephalic  mass,  of 
which  the  middle  one  —  which  is  double  —  is  directed  vertically  down- 
w^ard,  and  bears  the  appellation  incisive  tubercle ;  because  the  inter- 
maxillary bones,  destined  to  hold  the  superior  incisor  teeth  exclusively, 
are  developed  in  it.  On  either  side  is  the  tubercle,  or  rudiment  of  an 
upper  maxillary  bone,  which  is  separated  from  its  fellow  by  a  wide 
interval,  and  from  the  neighboring  incisive  process  by  a  fissure.  The 
fourth  and  fifth  tubercles,  also  separated  in  front,  form,  by  their  sub- 
sequent union  in  the  median  line,  the  inferior  maxillaiy  bone.  At  the 
same  period,  the  palate  begins  to  be- formed  by  the  approach  toward 
the  median  line  of  two  horizontal  plates,  or  processes,  springing  from 
the  maxillary  process  on  either  side. 

If  now  development  proceed  regularly  and  normally,  the  palate 
processes  of  the  superior  maxilla  meet  in  the 
Fig.  3/r,  median    line,  and   unite   with   the  blended 

intermaxillary  tubercles  ;  while  the  vomer 
grows  downward  to  meet  the  palate  processes 
in  their  line  of  union.  The  upper  jaw,  after 
the  accomplishment  of  these  changes,  is  com- 
plete, and  the  formation  of  the  lip  and  pri- 
mary dental  groove  follows  in  due  course. 
But  it  sometimes  happens  that  the  superior 
maxillary  and  intermaxillary  processes  fail  to 
unite  wdth  each  other ;  whence  we  have  the 


DETECTS    OF    THE    PALATINE    OEGAIS^S.  747 

malformation  known  as  harelip,  or  the  palate  plates  are  arrested  in 
their  growth,  and  permanent  fissure  of  the  palate  is  the  result.  Conse- 
quently, the  fissure  of  single  harelip  is  never  exactly  in  the  median 
line,  but  on  the  edge  of  the  intermaxillary  bone  ;  whereas,  in  double 
harelip,  a  fissure  exists  on  each  side  of  this  bone,  in  which  the  four 
incisor  teeth  are  planted. 

Fissure  of  the  hard  palate  is  usually  a  little  lateral,  and  not  median, 
as  it  results  from  a  deficiency  of  one  or  other  of  the  palate  plates  of  the 
upper  maxillary  bone;  and  it  is  frequently  associated  with  harelip 
and  fissure  of  the  upper  jaw. 

The  tubercles,  or  formative  processes  of  the  lower  jaw,  advance  and 
meet  in  the  median  line,  while  the  upper  maxillary  processes  are  still 
separate.  In  man  they  are  consolidated  into  a  single  piece ;  but  they 
remain  permanently  divided  in  many  of  the  lower  animals  by  a  median 
suture. 

The  principal  effects  resulting  from  an  absence  of  a  portion  of  the 
palatine  organs  are,  an  impairment  of  the  functions  of  mastication, 
deglutition,  and  speech.  Distinct  utterance  is  sometimes  wholly  de- 
stroyed, and  mastication  and  deglutition  are  often  so  much  embarrassed 
as  to  be  performed  only  with  great  difficulty. 

These  eflTects  are  always  in  proportion  to  the  extent  of  the  separation 
or  deficiency  of  the  parts.  The  simple  act  of  triturating  the  food  may 
not  be  materially  impaired  by  the  absence  of  a  portion  —  however  ex- 
tensive—  of  the  palatine  organs,  unless  the  natural  relations  of  the 
teeth  of  the  upper  and  lower  jaws  are  changed  ;  still,  the  process  is 
more  or  less  interfered  with,  as  substances  taken  into  the  mouth  cannot 
be  so  readily  managed  as  when  the  parts  are  in  their  natural  state. 
They  are  liable  to  escape  from  the  control  of  the  tongue,  and  pass  into 
the  cavity  of  the  nose. 

In  cases  of  congenital  defects  of  the  palate  and  velum,  it  is  difficult 
to  conceive  how  infants  manage  to  obtain  from  the  breast  of  the  mother 
or  nurse  the  food  necessary  for  their  subsistence ;  yet,  even  when  the 
anterior  part  of  the  alveolar  border  and  a  part  of  the  upper  lip  are 
wanting,  the  suggestions  of  natural  instinct  enable  them,  by  a  peculiar 
management  of  tongue  and  lips,  to  do  it.  The  expedient  resorted  to 
for  eflTecting  this  process  is  curious.  The  nipple,  instead  of  l)eing 
seized  between  the  tongue,  upper  lip,  and  gum,  is  taken  between  its 
lower  surface  and  the  under  lip  and  gum  ;  and  in  this  way  it  manages 
to  extract  the  nourishment  necessary  for  subsistence  and  growth.  The 
tongue  is  thus  made  to  close  the  opening  in  the  palate,  and  perform 
the  office  of  an  obturator.  By  contracting  the  lip  and  depressing  the 
tongue,  the  milk  is  drawn  from  the  breast  of  the  mother  or  nurse.  At 
this  young  and  tender  age,  the  child  is  not  conscious  of  the  imperfec- 


748  DEFECTS    OF    THE    PALATINE    ORGANS. 

tion  of  its  palate ;  and  it  is  not  until  the  period  arrives  when  it  should 
begin  to  make  its  wants  known  by  words,  tliat  it  feels  the  importance 
of  the  function  of  speech,  and  begins  to  realize  the  misfortune  with 
which  it  is  afflicted. 

As  the  child  arrives  at  this  period,  the  mechanism  of  sucking  is  per- 
fected, and  is  ultimately  applied  to  the  mastication  of  solid  aliments. 
The  food,  when  chewed,  is  conveyed  between  the  tongue  and  movable 
floor  (which  serves  for  a  point  d'appui),  and  it  is  brought  back  between 
the  teeth.  Thus  it  is  that  the  complicated  operation  of  mastication 
and  deglutition  is  performed  without  the  alimentary  morsel  getting 
into  the  nose ;  or,  if  this  does  sometimes  happen,  it  is  the  result  of 
accident.  But  in  cases  of  accidental  lesion  of  the  palate,  the  individual 
has  not  the  advantage  of  this  training  of  the  parts  during  early  in- 
fancy. Those  who  are  afilicted  with  accidental  lesions,  no  matter  what 
may  be  their  position  and  extent,  having  acquired  the  habit  of  eating 
by  placing  the  aliment  upon,  and  not  under,  the  tongue,  can  take  no 
nourishment  without  a  part  of  it  getting  into  the  nose.  When  to  this 
inconvenience  is  added  a  change  in  the  natural  relation  of  the  teeth  of 
the  two  jaws,  mastication  is  rendered  still  more  difiioult  and  embar- 
rassing. When  this  is  the  case,  the  tubercles  of  the  teeth  of  one  jaw, 
instead  of  being  received  into  the  depressions  of  those  of  the  other, 
strike  upon  their  protuberances,  and  cannot  be  made  to  triturate  the 
food  in  as  thorough  and  perfect  a  manner  as  is  required  for  healthy  and 
easy  digestion.  Thus,  not  only  is  the  process  of  mastication  rendered 
imperfect,  but  it  is  also  more  tedious. 

The  process  of  deglutition  itself,  so  long  as  the  velum  and  uvula  are 
perfect,  is  not  materially  affected  by  a  simple  perforation  of  the  vault 
of  the  palate,  although  much  difficulty  maybe  experienced  in  convey- 
ing alimentary  and  fluid  substances  to  the  fauces  and  pharynx.  But 
when  this  curtain  is  cleft,  or  is  partially  or  wholly  Avanting,  degluti- 
tion is  rendered  very  difficult ;  for,  by  the  contraction  of  the  muscles 
of  the  pharynx,  part  of  the  food  is  forced  up  into  the  nose.  The 
reason  of  this  will  appear  obvious,  when  we  take  into  consideration  the 
form  and  function  of  this  movable  appendage.  When  its  muscles  are 
relaxed,  it  forms  a  slightly  concave  curtain ;  but  in  the  act  of  degluti- 
tion, the  muscles  contract,  raise  the  velum,  and  close  the  opening  from 
the  pharynx  into  the  posterior  nares.  By  this  valvular  arrangement 
alimentary  substances  and  fluids  are  prevented  from  escaping  into  the 
nose.  It  matters  not,  therefore,  whether  the  imperfection  of  the  velum 
palati  be  the  result  of  accident  or  disease;  its  effects  upon  deglutition 
are  the  same.  In  proportion  as  the  lesion  or  deficiency  is  great,  will 
this  operation  be  rendered  difficult  and  embarrassing.  There  are  cases 
where,  in  consequence  of  an  imperfection  of  the  palate,  the  patient  can 


DEFECTS    OF    THE    PALATINE    OEGANS.  749 

swallow  no  fluids  without  a  part  being  returned  by  the  nose.  To  obvi- 
ate this  inconvenience,  the  head  is  thrown  sufficiently  far  back  to  pre- 
cipitate them  into  the  oesophagus.  This  is  an  expedient  to  which  many 
thus  affected  have  been  compelled  to  resort. 

Imperfection  of  speech  always  results  from  an  opening  in  the  palate; 
it  gives  the  voice  a  nasal  twang,  and  renders  the  formation  of  some 
sounds  impossible.  The  loss  of  the  teeth,  to  a  less  extent,  is  pro- 
ductive of  the  same  effect.  To  comprehend  fully  the  manner  in  which 
a  lesion  of  the  palate  may  affect  the  utterance  of  speech,  it  will  be 
necessaiy  to  understand  the  agency  which  the  several  parts  of  the 
mouth  have  in  the  formation  of  articulate  sounds.  Speech  consists  in 
the  sounds  produced  by  the  organs  of  the  glottis  modified  by  the  organs 
of  the  mouth.  The  modulation  of  the  voice,  that  is,  the  raising  or 
lowering  of  its  pitch,  is  accomplished  by  the  vocal  cords  of  the  glottis ; 
but  the  articulation  of  the  consonants  requires  the  co-operation  of  all 
the  movable  and  fixed  parts  of  the  mouth  and  pharynx,  palate, 
tongue,  lips,  teeth,  and  palatine  arch.  Hence,  if  any  of  these  be  defective 
or  wanting,  the  power  of  forming  some  of  these  sounds  is  wholly  lost, 
of  others  very  much  impaired ;  hence,  also,  the  ability  to  sing  is  much 
less  interfered  with  than  the  power  of  distinct  speech.  The  tongue 
has  a  remarkable  power  of  adapting  itself  to  the  loss  of  teeth  and  of 
some  other  parts,  so  as  measurably  to  correct  the  effect  on  speech ;  but 
the  effect  of  the  loss  of  the  hard  or  soft  palate  upon  the  voice  cannot 
be  remedied  in  any  such  way. 

In  both  cases  (accidental  and  congenital)  the  faculty  of  distinct 
articulate  speech  is  seriously  impaired  by  defects  of  any  extent.  In 
ordinary  cases  of  congenital  deformity  in  an  adult,  deglutition  is  not 
materially  interfered  with.  The  patient,  having  never  known  any 
other  method  of  swallowing,  is  not  conscious  of  any  difficulty.  Acci- 
dental lesions,  however,  coming  generally  in  adult  life,  produce,  in  this 
respect,  very  great  inconvenience.  The  remedy  for  these  evils  must 
be  the  closing  of  the  abnormal  passage  by  some  means  which  will 
restore  to  the  deformed  organs  their  functions.  In  perforations  of  the 
hard  palate,  unless  of  extraordinary  extent,  the  method  is  very  simple. 
In  the  loss  of  the  soft  palate  by  disease  the  remedy  is  more  difficult, 
and  in  extensive  congenital  deformity  still  more  complicated  means 
must  be  resorted  to. 

STAPHYLORAPHY. 

The  operation  which  is  resorted  to  in  the  treatment  of  fissured  palate 
is  known  by  the  name  of  Staj^hyloraphy,  a  word  of  Greek  derivation, 
signifying  suture  of  the  uvula.  It  is  an  operation  which  has  been 
perfectly  successful  in  many  instances,  although  there  are  numerous 


750  DEFECTS    OF    THE    PALATINE    ORGANS. 

cases  whicli  will  derive  far  more  benefit  fi'om  mechanical  assistance 
than  from  the  surgeon's  aid. 

In  considering  the  operation,  a  brief  sketch  will  be  given  of  the 
anatomy  of  the  parts  concerned  in  its  ])erformance ;  this  will  be  fol- 
lowed by  a  description  of  the  various  kinds  of  clefts;  we  shall  then 
describe  the  means  adopted  by  different  surgeons  for  their  relief  or  cure. 
To  obtain  success  in  staphyloraphy,  the  first  care  must  be  to  gain  a 
practical  acquaintance  with  the  position  and  relation  of  the  muscles 
connected  with  the  palate  and  fauces;  and  this  can  be  accomplished 
best  by  laying  open  the  pharynx  fi-om  behind,  for  thus  the  posterior 
surface  of  the  soft  palate  is  at  once  exposed  to  view.  We  shall  find 
that  this  structure  is  wholly  composed  of  muscular  tissue,  covered  with 
a  layer  of  mucous  membrane  continuous  with  that  lining  the  hard 
palate. 

The  muscles  with  which  we  have  chiefly  to  do  are :  the  palato-glossi 
and  the  palato-phuryngei,  forming  the  anterior  and  the  posterior  pillars 
of  the  soft  palate  respectively;  the  levatores  palati,  the  tensores  palati, 
and  the  azygos  uvulre. 

The  levator  palati  is  a  long,  rounded  muscle  lying  obliquely  on  the 
outer  side  of  the  posterior  opening  of  the  nares.  It  takes  its  origin 
from  the  petrous  portion  of  the  temporal  bone  and  from  the  cartilage 
of  the  Eustachian  tube,  and  then  descends  obliquely  downward  and 
inward,  its  fibres  spreading  out  over  the  posterior  surfiice  of  the  soft 
palate  until  they  meet  with  those  of  the  corresponding  muscle  on  the 
opposite  side. 

The  palato-glossus  is  a  very  small  muscle  arising  from  the  anterior 
surface  of  the  soft  palate  on  each  side  of  the  uvula,  whence  it  passes 
forward  and  outward  to  be  inserted  into  the  dorsum  of  the  tongue, 
thus  forming  the  anterior  pillar  of  the  fauces. 

The  palato-pharyngeus  is  separated  from  the  preceding  muscle  by  a 
space  in  which  the  tonsil  lies.  It  arises,  by  two  origins,  from  the  soft 
palate  and,  descending  outward  and  downward,  is  inseited  into  the 
posterior  border  of  the  thyroid  cartilage. 

The  tensor  palati  arises  from  three  points,  viz. :  first,  from  the  sca- 
phoid fossa,  at  the  base  of  the  internal  pterygoid  plate;  secondly,  from 
the  cartilaginous  portion  of  the  Eustachian  tube;  and  thirdly,  from 
the  spinous  process  of  the  sphenoid  bone :  it  then  tei'minates  in  a  ten- 
don which  winds  around  the  hamular  process,  which  may  be  plainly 
discovered  with  the  finger  about  half  an  inch  behind  the  tuberosity  of 
the  sujierior  maxilla;  and  it  then  passes  horizontally  aryi  expands  into 
a  broad  aponeurosis  on  the  anterior  surface  of  the  soft  palate. 

The  azygos  uvulae  arises  from  the  posterior  nasal  spine  of  the  palate 


DEFECTS    OF    THE    PALATINE    ORGANS.  751 

bone  and  from  the  aponeurosis  of  the  soft  palate,  and  descends  to  be 
inserted  into  the  uvula. 

Having  learned  the  attachment  of  these  muscles,  it  will  be  well  to 
consider  their  respective  actions  upon  the  palate,  in  order  more  clearly 
to  comprehend  their  relations  to  the  separated  portions  of  a  cleft  pal- 
ate. The  levatores  palati  slightly  raise  the  soft  palate  while  it  is  made 
tense  by  the  action  of  the  tensor  palati.  The  palato-pharyngei  con- 
tract, and  bring  the  two  sides  of  the  palate,  from  whence  their  fibres 
arise,  in  close  contact,  together. 

The  action  of  these  muscles  show  what  an  important  part  they  must 
bear  in  regard  to  the  operation  of  staphyloraphy ;  and  when  this  is 
considered  in  detail,  it  will  be  seen  why  but  little  success  was  met  with, 
until  means  were  found  to  render  muscular  action  of  the  parts  im- 
possible. 

The  deficiency  of  the  palate  varies  considerably,  from  a  mere  divi- 
sion of  the  uvula  to  a  gap  which  constitutes  a  hopeless  deformity.  When 
this  abnormal  state  is  limited  to  the  soft  palate,  the  cleft  is  always 
of  a  triangular  shape,  the  apex  being  above  and  the  base  below ;  but 
when  the  soft  and  hard  structures  are  involved,  it  is  of  a  more  or  less 
quadrilateral  shape. 

We  shall  here  only  consider  those  cases  which  are  congenital  in  their 
origin,  merely  alluding  to  the  distinction  between  this  class  of  deform- 
ity and  that  kind  which  may  be  said  to  be  acquired,  or  is  accidental. 
In  congenital  cleft,  the  fissure  is  generally  confined  to  the  median 
line  of  the  palate,  because  the  two  halves  have  not  united  at  that  part 
at  the  usual  period.  In  acquired  or  accidental  deformity,  lesions  are 
met  with  in  all  parts  of  the  palate,  to  the  right  or  left  of  the  median 
line,  and  are  usually  the  result  of  syphilitic  ulceration,  or  have  some 
traumatic  origin. 

Congenital  clefts  may  be  thus  classed  :  Firstly,  a  small,  triangular- 
shaped  fissure  extending  through  the  uvula  and  the  posterior  portion 
of  the  velum  palati,  the  other  portion  of  the  palate  being  quite  intact 
and  sound.  Secondly,  the  whole  of  the  soft  palate  is  involved.  Thirdly, 
the  soft  palate  and  a  portion  of  the  palate  bone  is  deficient.  Fourthly, 
the  cleft  may  be  associated  with  abnormality  in  the  alveolar  process  of 
the  palate  bone,  and  even  with  harelip.  Fifthly,  openings  occur  in 
the  hard  palate,  the  soft  palate  being  unaffected.  These  separations 
may  be  veiy  narrow,  not  exceeding  a  few  lines  in  width,  or  the  gap 
inay  be  such  that  mouth  and  nostril  seem  but  one. 

The  fissure  posteriorly  is  alivays  on  the  median  line ;  anteriorly,  it 
generally  deflects  to  one  side  or  the  other  of  the  nasal  septum,  passing 
also  to  one  side  of  the  inter-maxillary  bone.  In  some  rare  cases  both 
nasal  passages  are  involved,  and  a  double  harelip  is  the  consequence. 


752  DEFECTS    OF    THE    PALATINE    ORGANS. 

The  eflects  of  tliis  condition,  already  stated,  may  thus  be  briefly 
summed  up.  During  iniuucy  the  tunctions  of  suction  and  deglutition  are 
witii  difficulty  performed,  and  at  a  later  age  mastication  and  articula- 
tion are  much  impeded.  There  is  also  imperfect  control  over  the  mus- 
cles of  the  palate,  both  fluids  and  solids  are  liable  to  pass  into  the 
Avindpipe,  and  not  unfrequently  there  is  regurgitation  through  the  nose. 
The  speech  is  guttural  and  nasal,  often  so  indistinct  as  to  render  it  almost 
entirely  unintelligible,  and  the  patient  is  only  too  anxious  to  grasp  at 
any  chance  which  may  be  held  out,  as  being  likely  to  gri^t  some  amel- 
ioration of  his  condition. 

Various  methods  have  been  suggested  for  the  cure  of  this  deformity. 
Some  have  proposed  to  close  the  cleft  in  early  infancy,  by  means  of 
pressure  on  the  yielding  bones :  others  maintain  that  artificial  substi- 
tutes are  best  adapted  to  relieve  the  patient's  suffering  ;  whilst  others 
as  strenuously  proclaim  the  knife  to  be  the  only  means,  whereby  success 
may  be  attained. 

The  first  surgeon  who  directed  serious  attention  to  the  operation  was 
M.  Roux,  a  notable  French  surgeon,  who  performed  it  upon  a  young 
American  physician  in  the  year  1825.  Velpeau  informs  us  that  M. 
Colombe,  another  Frenchman,  performed  the  operation  on  the  cadaver, 
in  1813,  being  probably  actuated  to  attempt  its  performance  by  read- 
ing the  successful  efforts  of  a  French  dentist  (Le  Monnier)  to  cure 
cleft  palate  by  surgical  procedui'e,  as  early  as  1764.  For  more  than 
fifty  years  after  this  date  the  operation  seems  to  have  been  forgotten, 
or  to  have  fallen  into  disuse,  until  it  was  revived  by  M.  Roux,  in  France, 
and  almost  simultaneously  by  Dr.  John  C.  Warren,  of  Boston,  each 
of  w^hom  seems  to  have  performed  the  operation  in  total  ignorance  of 
what  was  done  by  the  other. 

In  1827,  Dr.  Stevens,  of  New  York,  operated  with  success ;  in  the 
succeeding  year,  Dr.  Mettauer,  of  Virginia,  followed  in  the  footsteps  of 
his  confreres  in  the  profession,  and  embodied  his  experience  of  staphyl- 
oraphy  in  a  very  interesting  article  which  appeared  in  1837.  The  oper- 
ation also  attracted  attention  in  England,  where  we  believe  it  was 
performed  for  the  first  time  by  Mr.  Alcock,  in  1822.  Since  then  it 
has  become  one  of  the  most  frequent  operations  in  surgery,  and, 
through  the  suggestions  and  improvements  made  by  Hamilton  and 
Dieffenbach,  by  Fergusson,  Pollock,  and  Mason,  it  has  served  still 
further  to  enhance  the  benefits  which  it  is  the  privilege  of  the  sur- 
geon's art  to  extend  to  all  mankind. 

The  operations  of  M.  Roux  and  Dr.  Warren  were  very  similar  in 
character,  and  w'e  think  that  equal  credit  must  be  extended  to  the 
Frenchman  and  to  the  American  for  the  revival  of  staphyloraphy ; 
whilst  English  surgery  deserves  no  little  credit  for  the  suggestions  of 


DEFECTS  OF  THE  PALATINE  ORGANS, 


753 


men  like  Pollock  and  Fergusson,  which  have  contributed  so  much  to 
its  present  success. 

Fig.  378.  Fig.  379. 


All  the  earlier  operations  of  staph yloraphy  consisted  in  paring  away 
the  edges  of  the  cleft,  and  then  bringing  them  in  contact,  by  means  of 
sutures,  until  union  was  efiected.  The  various  stages  of  the  operation, 
as  then  performed,  are  sufficiently  illustrated  in  the  accompanying 
engravings,  the  successive  steps  being  taken  in  the  order  of  these  draw- 
Fio.  380.  Fig.  381. 


ings.   Many  modifications  of  this  plan  were  made  by  Warren,  Mettauer^ 
Stevens,  Graefe,  and  others ;  but  Fergusson  introduced  a  new  prin- 
ciple of  treatment  in  the  operation  which-  has  very  materially  added, 
to  its  successful  results. 
48 


764 


DEFECTS  OF  THE  PALATINE  ORGANS. 


Fig.  382.  We  have  alluded  to  the  use  of  the 

muscles  composing  the  velum  of  the 
palate  and  their  important  action  on 
it,  and  to  Fergusson  must  be  assigned 
the  credit  of  being  the  first  to  realize 
practically  the  fact  that  muscular 
action  was  the  most  frequent  cause 
of  failure  of  the  operation ;  and  he 
proved  the  truth  of  his  conjecture  by 
his  method  of  removing  the  difficulty ; 
namely,  the  division  of  the  muscles  of 
the  palate,  thus  entirely  paralyzing 
their  action. 

Prior  to  this  discovery,  Sir  Wm. 
Fergusson  had  adopted  an  operation 
somewhat  similar  to  Warren's  and 
founded  on  that  of  Roux,  which  was  performed  as  follows :  The 
patient  was  placed  in  a  chair  with  a  back  slightly  more  inclined 
than  usual;  his  head  being  then  well  supported,  and  his  mouth 
kept  open  by  means  of  a  gag,  the  edges  of  the  fissured  palate 
were  pared  from  above  downward  with  a  curved  bistoury.  Next 
a  curved  needle,  with  a  movable  eye,  armed  with  a  strong  silken 
ligature,  was  passed  through  the  palate,  at  the  upper  angle  of  the 
wound,  at  a  distance  of  about  a  line  from  the  fissure.  The  other 
edge  was  transfixed  in  a  similar  manner.  Two  other  ligatures  were 
then  inserted  in  the  same  way,  the  third  and  last  being  as  close  as  pos- 
sible to  the  extremity  of  the  wound.  The  threads  were  then  seized 
with  the  fingers  and  tied,  being  very  careful  to  avoid  pressure  of  the 
knot  upon  the  middle  of  the  wound.  This  earlier  operation  of  Mr. 
Fergusson,  which  was  the  type  of  many  others  that  have  been  proposed, 
and  which  is  substantially  the  same  as  that  illustrated  by  the  figures 
before  referred  to,  has  been  described  in  order  that  the  improvement  in 
the  modern  operation  may  be  the  more  fully  appreciated,  when  it  is 
subsequently  described  at  length. 

Preparation  of  the  Patient. — Mr.  Hamilton  Cartwright,  of  the  Royal 
College  of  Surgeons,  London,  makes  the  following  suggestions  for  the 
preparation  of  the  patient.  Before  undertaking  the  operation  of  sta- 
phyloraphy,  various  points  have  to  be  considered.  Firstly,  having 
decided  that  a  surgical  operation  will  be  of  more  benefit  to  the  patient 
than  mechanical  aid,  cognizance  must  be  taken  of  his  general  health  ; 
for  upon  its  good  condition  much  of  success  must  ultimately  depend. 
Should  the  patient  be  chlorotic  or  anaemic,  the  operation  must  be  post- 
poned until  after  a  proper  treatment.     A  healthy  regimen  must  be 


DEFECTS    OF    THE    PALATINE    ORGANS.  755 

prescribed ;  frequent  but  not  fatiguing  exercise  in  the  open  air  must 
be  insisted  upon,  and  tonics  must  be  given,  their  character  being  deter- 
mined by  the  patient's  diathesis.  Particular  care  must  be  shown  in 
cases  of  struma,  as  there  is  no  condition  in  which  the  parts  are  more 
unlikely  to  heal  favorably  than  in  this.  For  the  relief  of  this  condi- 
tion it  may  be  necessary  to  devote  great  attention  for  many  months. 
Sea  air  will  be  of  much  service,  whilst  its  effects  will  be  enhanced  by 
giving  a  course  of  iron.  Mr.  Cartwright  recommends  particularly 
two  chalybeate  preparations,  which  are  of  the  greatest  value  in  anae- 
mia, as  well  as  in  that  diathesis  now  under  consideration.  They  are 
the  syrup  of  the  iodide  of  iron  and  the  syrup  of  the  hypophosphate 
of  iron  and  manganese.  The  latter  acts  as  a  tonic  and  an  alterative ; 
at  the  same  time  it  keeps  up  an  easy  action  upon  the  bowels :  indeed, 
there  is  no  medicine  which  he  has  found  more  rapidly  successful  in 
improving  those  weak  and  enfeebled  states  of  the  system  which  are 
owing  to  scrofula  or  to  an  impoverished  condition  of  the  blood.  Noth- 
ing has  more  conduced  to  bring  staphyloraphy  into  disrepute  than 
a  disregard  of  the  physical  condition  of  the  patient ;  good  health  is  the 
sine  qua  non  of  rapid  and  successful  union  of  the  parts. 

Having  suited  the  treatment  to  the  indications  of  the  case,  it  is  of 
utmost  importance  that  the  patient  be  educated,  so  to  speak,  to  assist 
the  surgeon  in  the  operation  which  he  is  about  to  undertake :  for  the 
fauces  are  intensely  sensitive,  and  were  the  condition  of  the  parts  for- 
gotten, the  retchings  and  convulsive  movements  so  easily  induced  in 
them  would  probably  cause  a  failure  in  the  proposed  cure.  Various 
means  of  lessening  this  sensibility  have  been  suggested :  some  have 
recommended  rough  fingering  of  the  parts  daily ;  and  Dr.  Garretson 
proposes  to  occasionally  pass  a  tenaculum  through  the  parts  to  be 
operated  upon,  a  treatment  which  we  rather  think  would  make  the 
patient  more  fearful  than  ever  of  the  operation.  As  good  a  method 
as  any  proposed  is  to  enjoin  the  friends  of  the  patient,  or  the  patient 
himself,  if  old  enough,  to  irritate  the  fauces  with  the  feather  of  a  quill ; 
in  a  few  weeks  it  will  be  found  that  the  parts  will  become  tolerant  of 
almost  any  irritation.  The  same  results  may  be  obtained  by  wearing 
an  obturator  extending  far  back  over  the  palate ;  the  irritation  at  first 
produced  by  it  will  soon  disappear,  and  after  wearing  it  constantly  for 
a  few  wrecks,  all  the  usual  symptoms  produced  by  interference  with  the 
fauces  will  have  passed  away. 

Mr.  Cartwright  proposes  another  method  of  treatment,  which  is  some- 
what novel,  but  most  successful  in  its  results.  It  has  been  found  that 
the  exhibition  of  the  bromide  of  potassium  tends  to  deaden  the  sensi- 
bility of  the  fauces  in  a  very  remarkable  manner,  and  thus  it  may  be- 
come a  most  useful  agent  preparatory  to  the  operation.     If  exhibited 


756  DEFECTS    OF    THE    PALATINE    ORGANS. 

in  half-drachm  doses,  given  thrice  daily  for  two  or  three  weeks  prior 
to  the  period  decided  upon,  but  little  irritability  of  the  parts  will  be 
found  remaining ;  and  by  the  time  a  few  imaginary  operations  on  the 
parts  have  been  performed,  by  the  aid  of  such  harmless  instruments  as 
a  camel's-hair  brush  or  the  feather  of  a  quill,  the  patient  will  be  found 
in  a  fit  condition  to  be  operated  upon,  A  few  days  prior  to  the  time 
of  operating,  more  particular  attention  must  be  paid  to  the  condition 
of  the  patient.  Primarily,  he  must  be  well  nourished,  inasmuch  as  he 
Avill  be  forced  to  adopt  a  different  regimen  from  that  to  which  he  has 
been  accustomed  for  some  days.  His  diet  must  be  nutritious  without 
being  stimulating,  and  the  greatest  attention  must  be  given  to  the  reg- 
ular action  of  the  bowels,  and,  indeed,  in  all  cases  it  is  well  to  give  a 
mild  aj)erient  before  operating. 

The  patient  having  been  thus  prepared,  much  of  the  success  of  the 
operation  will  depend  upon  his  ability  to  remain  tranquil  during  its 
performance,  and  to  give  as  much  assistance  to  the  surgeon  as  may  lie 
in  his  power.  Thus  he  may  assist  the  operator  by  opening  his  mouth 
widely,  by  not  resisting  the  introduction  of  instruments,  and,  subse- 
quently, by  keeping  the  newly-connected  parts  as  quiet  as  possible  by 
restraining  the  movements  necessarily  induced  by  deglutition  or  by 
attempts  at  articulation.  It  will  thus  be  seen  why  the  operation  for 
cleft  palate  must  be  delayed  until  the  patient  is  old  enough  to  exercise 
control  over  his  movements.  The  best  period  is  from  nine  to  ten  years 
of  age,  although  Sir  Wm.  Fergusson  has  frequently  operated  much 
earlier,  with  complete  success. 

As  befoi'e  observed,  the  pioneers  who  cleared  the  way  for  the  success 
of  staphyloraphy  were  Roux  and  Warren,  and  many  modifications  of 
their  plans  have  been  made  from  time  to  time  by  others;  but  the  man 
who  introduced  a  new  era  in  the  history  of  the  operation  was  Sir  Wm. 
Fergusson,  of  Loudon,  who  has  rendered  it  most  perfect  in  all  its  de- 
tails. This  credit  being  generally  conceded  to  him,  we  shall  describe 
his  mode  of  operating  as  the  type  of  operations  generally  performed  in 
modern  days. 

Warren  divided  the  pillars  of  the  fauces  empirically,  with  a  view, 
as  he  states,  of  relieving  the  tension  of  the  parts ;  but  nowhere  do 
we  find  that  he  speaks  specifically  of  dividing  the  muscles  contained  in 
them :  it  remained  for  ]Mr.  Fergusson  to  point  out  that  muscular  action 
was  the  great  cause  of  failure  in  most  cases,  and  he  practically  proved 
the  truth  of  his  conjecture  by  resorting  to  the  operation  of  myotomy, 
dividing  the  muscles  of  the  palate,  and  thus  paralyzing  their  move- 
ments. He  found  that  the  tension  on  the  line  of  union  was  principally 
exercised  by  the  levator  palati  and  by  the  levator  pharyugeus,  and  he 
then  proposed  the  following  operation : 


DEFECTS    OF    THE    PALATINE    ORGANS.  757 

Sir  Wm.  Fergusson's  Operation.  —  Mr.  Cartwright  describes  Mr. 
Fergusson's  operation  as  follows :  He  first  divides  the  muscles  of  the 
palate  by  passing  a  curved  knife  around  between  the  velum  palati  and 
the  end  of  the  Eustachian  tube,  thus  at  once  dividing  the  levator  palati. 
In  the  second  stage  he  seizes  the  uvula,  thus  bringing  forward  the  pos- 
terior pillar  of  the  fauces,  which  is  snipped  across  with  round-pointed 
scissors,  so  as  to  divide  the  fibres  of  the  palato-pharyngeus  muscle ; 
should  it  be  deemed  necessary  to  do  so,  the  anterior  pillar  may  be  divided 
at  the  same  time,  so  as  to  sever  the  palato-glossus,  though  Sir  William 
lays  no  stress  upon  the  necessity  of  doing  so.  Next,  the  uvula  is  again 
seized,  with  a  view  of  extending  the  palate  so  that  the  edges  of  the 
fissure  may  be  pared  away ;  this  is  accomplished  with  a  narrow  bis- 
toury from  behind  forwards,  on  either  side  alternately,  the  angle  of 
union  being  left  for  subsequent  removal.  A  few  moments  then  are 
granted  to  the  patient  to  recover,  and  he  is  permitted  to  swallow  a  few 
small  pieces  of  ice,  with  the  double  view  of  refreshing  him  and  of 
staunching  the  bleeding.  When  this  has  sufficiently  ceased,  it  is  time 
to  introduce  the  sutures,  and  this  is  done  by  means  of  a  nsevus-needle, 
armed  with  a  silken  ligature,  the  needle  being  introduced  about  a 
quarter  of  an  inch  from  the  edge  of  the  fissure.  Next,  the  extremity 
of  the  thread  is  pulled  out  by  means  of  forceps,  and  another  ligature 
is  passed  in  like  manner,  until  the  desired  number  of  stitches  is  at- 
tained. The  extremities  must  then  be  tied  loosely,  so  as  just  to  keep 
the  parts  in  apposition,  and  no  more;  after  which  the  patient  is  put 
to  bed,  every  care  being  taken  to  avoid  all  motion  of  the  palate.  He 
should  take  nothing  but  nourishing  liquid  food  for  a  few  days,  and  must 
be  particularly  enjoined  to  abstain  from  all  movements  involving  action 
of  the  muscles  engaged  in  deglutition,  such  as  swallowing,  coughing, 
gneezing,  and  the  like,  which  would  much  endanger  the  success  of  the 
operation.  The  next  stage  consists  in  the  removal  of  the  stitches;  this 
need  not  be  done  too  soon,  provided  they  produce  no  irritation ;  indeed, 
they  may  remain  until  union  is  perfect.  The  general  time  for  their 
removal  is  about  the  seventh  or  eighth  day,  although  Fergusson  often 
removes  them  on  the  third  or  fourth. 

Mr.  G.  Pollock  has  introduced  the  following  modifications  in  the 
performance  of  this  operation  :  Instead  of  dividing  the  muscle  with  a 
curved  knife  from  behind,  according  to  the  method  we  have  just  de- 
scribed, Mr.  Pollock  passes  a  ligature  through  the  soft  palate,  so  as  to 
contract  and  draw  it  forward,  and  he  then  pushes  a  narrow-bladed 
knife  through  it,  a  little  to  the  inner  side  of  the  hamular  process  of  the 
pterygoid  plate  of  the  sphenoid  bone,  which  may  be  plainly  discovered 
by  passing  the  finger  along  the  roof  of  the  mouth  to  a  distance  a  little 
posterior  to  the  tuberosity  of  the  superior  maxilla.     By  raising  the 


758 


DEFECTS  OF  THE  PALATINE  ORGANS. 


hand,  and  so  depressing  the  point  of  the  scalpel,  he  most  effectively, 
and  in  a  very  simple  manner,  divides  the  muscle.  The  parts  having 
healed,  the  patient  must  be  impressed  with  the  necessity  of  practising 
himself  frequently  in  elocution,  telling  him  that  his  success  in  articu- 
lation will  depend  upon  himself  alone.  Constant,  patient,  persevering 
effort  will  be  necessary,  and  the  end  to  be  attained  must  be  sought  by 
distinctly  articulating  every  syllable  of  every  word  which  he  may  be 
called  upon  to  utter.  It  is  a  good  exercise  to  read  a  portion  of  some 
good  author  each  day  with  a  friend,  who  will  assume  the  role  of  school- 
master for  the  time  being,  permitting  no  word  to  be  indistinctly  uttered 
or  slurred  over,  and  requiring  each  syllable  to  be  correctly  and  sepa- 
rately pronounced. 

Fissure  of  the  hard  palate,  simple  or  connected  with  a  fissure  of 
the  soft  —  various  means  of  closure  have  been  proposed.  Dr.  Warren 
dissects  the  mucous  membrane  from  the  bone  on  either  side,  carrying 
his  knife  sufficiently  forward  toward  the  alveolar  border  to  form  a  flap 
broad  enough  to  meet  a  like  one  from  the  opposing  side,  along  the 
median  line.  When  the  fissure  is  so  wide  as  to  prevent  the  margins 
being  brought  together.  Dr.  Mettauer,  of  Virginia,  recommends  making 
several  lateral  incisions  through  the  mucous  membrane,  with  a  view 

of  permitting  the  edge  to  be  brought 
into  close  apposition.  Dr.  Mutter, 
of  Philadelphia,  who  was  very  suc- 
cessful in  the  operation,  also  had  re- 
course to  the  longitudinal  incision, 
(as  shown  by  Fig.  383)  which  was 
first  proposed  by  Dieffenbach,  with 
the  most  happy  results.  Dr.  Warren's 
operation  has  been  introduced  into 
England  by  Mr.  Pollock,  who,  with 
his  peculiarly  constructed  instru- 
ments, proceeds  as  follows :  He 
makes  an  incision  along  the  edge  of 
the  cleft  at  the  juncture  of  the  nasal 
and  palatal  mucous  membrane.  The 
soft  covering  of  the  hard  palate  is 
carefully  dissected  or  scraped  from 
the  bones  with  curved  knifes,  great  care  being  taken  that  the  mucous 
membrane  and  its  subjacent  fibro-cellular  tissue  are  not  perforated. 
When  this  has  been  well  loosened  on  either  side,  it  will  be  found  to 
hang  down  like  a  curtain  from  the  vault  of  the  mouth,  the  two  parts 
coming  into  apposition  along  the  median  line,  or  possibly  overlapping. 
The  edges,  being  then  smoothly  pared,  are  brought  together  by  means 


Fig.  883. 


DEFECTS  OF  THE  PALATINE  OEGANS. 


759 


Fig.  384. 


of  a  few  points  of  suture  introduced  in  the  ordinary  way,  and  without 
any  dragging.  Where  the  hole  is  not  very  large,  Dr.  Pancoast's  inge- 
nious operation  of  staphyloplasty  may  be  performed,  in  which  he  raises 
two  flaps  of  mucous  membrane  from  the  bone  on  either  side,  and  then 
reflecting  them  across  the  chasm,  their  edges  are  brought  together  by 
suture  in  the  usual  manner,  a  plan  which  is  so  perfectly  exhibited  in 
Fig.  384,  that  we  do  not  deem  any 
further  description  necessary.  Re- 
cently, M.  Langenbeck  has  suggested 
another  operation,  in  which  he  pro- 
poses to  dissect  the  mucous  membrane, 
together  with  the  periosteum,  from 
the  surface  of  the  bone  prior  to  bring- 
ing the  opposed  surfaces  of  the  cleft 
in  apposition ;  and  the  advantage 
claimed  by  him  for  this,  which  he 
considers  to  be  a  novel  method  of 
procedure,  is  that  the  chasm  is  oblit- 
erated not  merely  by  soft  tissue,  but 
by  bone,  which  is  formed  from  the 
periosteum  thus  loosened  from  con- 
tact  with   the   surface   of  the   hard  

palate.     If  this  theory  be  correct,  we 

cannot  but  think  that  Dr.  Warren  and  ^r.  Pollock  must  have  met 
with  like  results ;  although  it  is  remarkable  that  they  seem  to  have 
been  unconscious  of  the  great  advances  they  had  thus  made  in  the 
treatment  of  cleft  palate,  by  the  operation  which  the  one  proposed  and 
the  other  carried  out.  We  deem  it  impossible  that  Warren  should 
have  merely  raised  the  mucous  membrane  without  the  periosteum  at- 
tached to  it,  —  a  dissection  so  difficult,  that  we  could  excuse  the  ablest 
surgeon  for  not  accomplishing  such  a  separation,  when  operating  on 
the  living  subject,  without  lesion  of  the  mucous  tissue ;  and  until  an 
autopsy  reveals  to  us  that  real  osseous  tissue  has  filled  up  the  breach  in 
the  continuity  of  the  palate  bone,  we  must  confess  that  we  shall  remain 
skeptical  as  to  the  results  now  claimed  by  Herr  Langenbeck  and  others 
for  their  revival  of  Dr.  Warren's  old  operation. 

There  is  one  other  treatment  which  we  have  mentioned,  and  to  which 
we  must  make  a  short  allusion,  and  that  is  the  method  of  closing  fis- 
sure of  the  hard  palate  by  means  of  pressure.  Velpeau  proposed  tO' 
take  advantage  of  the  yielding  character  of  young  bone,  by  adopting 
mechanical  means  Avhich  would  bring  the  parts  separated  into  closer 
or  even  perfect  coaptation ;  this  idea  of  his  has  recently  been  more 
fully  worked  out  by  more  modern  experimentalists,  who  speak  highly. 


7C0  DEFECTS    OF    THE    PALATINE    ORGANS. 

of  the  success  which  has  crowned  their  efforts.  The  method  of  cure 
may  be  thus  briefly  described :  A  chimp  or  compressor,  with  pads  ar- 
ranged according  to  the  exigencies  of  the  case,  is  applied  on  either  side 
of  the  alveohir  arch  ;  the  edges  of  the  fissure  and  of  the  bone  having 
been  pared  away,  the  action  of  a  screw  is  brought  to  bear  upon  the 
instrument,  until  the  soft  and  pliant  bones  are  brought  together. 
That  there  are  grave  disadvantages  attendant  on  this  mode  of  treat- 
ment cannot  fail  to  appear  to  every  dentist.  Firstly,  the  alveoli  of 
the  superior  maxilla  are  thrown  within  those  of  the  alveolar  border  of 
the  inferior  maxillary  bone,  thus  laying  the  foundation  of  serious  de- 
formity in  after-life.  Secondly,  the  germs  of  the  teeth  might  be  so 
affected  as  to  induce  subsequent  irregularity  and  malposition.  Thirdly, 
there  is  danger  of  inflammation  being  excited,  Avhilst  the  delicate 
physique  of  the  young  child  runs  great  risk  of  being  affected  inju- 
riously by  the  irritation  resulting  from  constant  wearing  of  such  an 
instrument  as  that  described.  Lastly,  we  must  consider  the  chance  of 
fracture  by  exercising  too  much  compressive  power  upon  the  bones. 
This  hazard  is  acknowledged  by  those  who  advocate  the  proposed  oper- 
ation of  Velpeau  ;  but  they  excuse  themselves  by  urging,  that  even 
should  fracture  occur,  it  would  be  of  little  consequence,  inasmuch  as 
the  injured  parts  are  kept  in  splints,  and  that,  therefore,  the  treatment 
■which  would  be  correct  in  the  one  case  is  already  provided  for  the 
other.  It  is  to  be  feared  that  this  admission  will  rather  deter  others 
from  attempting  an  operation  in  which  much  evil  may  be  done  for  an 
uncertain  possible  future  good.  The  fact  is  more  and  more  acknowl- 
edged in  the  humane  surgery  of  the  present  day,  that  the  gentler  the 
means,  if  equal  to  the  end  proposed,  the  more  entitled  is  any  treatment 
to  recognition  and  to  praise. 

In  the  usual  operation  of  staphyloraphy  certain  muscles,  most  im- 
portant to  speech,  have  to  be  divided;  and  it  is  upon  this  very  division 
of  them  that  its  success,  in  an  operative  point  of  view,  so  much  de- 
pends: whilst  it  is  an  important  question,  whether  the  muscles  are  not 
thus,  in  spite  of  their  reunion,  to  a  certain  extent  deprived  of  power ; 
and  this  we  believe  to  be  the  reason  why  articulation  is  often  so  little 
improved  after  the  successful  performance  of  the  operation  in  question. 
Hence  we  propose  that  surgical  and  mechanical  skill  should  com- 
bine to  i^roduce  more  perfect  results  in  the  treatment  of  fissured  palate. 
We  have  been  led  to  make  this  proposition  by  the  success  which  has 
attended  our  efforts,  in  cases  where  surgery  has  been  but  partially  suc- 
cessful in  her  attempts  to  secure  perfect  union  and  coaptation  of  the 
opposing  edges  of  the  cleft,  thus  leaving  a  gap  in  the  anterior  portion 
of  the  original  fissure,  whilst  the  posterior  parts  are  well  united.  The 
operation  which  we  suggest  is  to  pare  the  edges  of  the  halves  of  the 


DEFECTS    OF    THE    PALATINE    ORGANS.  761 

bifurcated  uvula  and  the  posterior  portion  of  the  soft  palate  nearest  to 
them,  and  to  bring  about  the  union  of  these  parts  in  the  usual  man- 
ner by  means  of  suture.  Union  having  been  effected,  the  deficiency 
in  the  anterior  portion  of  the  palate  is  to  be  filled  by  means  of  an 
artificial  velum :  the  artificial  velum  at  the  same  time  extending  back- 
ward and  nearly  filling  the  pharynx.  The  advantages  of  this  com- 
bined operation  are  very  manifest;  for  the  muscles,  being  uninjured, 
their  action-  is  nearly  normal,  and  the  great  objection  of  bringing  about 
a  too  tense  condition  of  the  newly-united  palate  is  avoided ;  this  being 
another  of  the  causes  which  prevent  great  improvement  of  articulation 
as  a  result  of  staphyloraphy.  Now  in  the  partial  operation  just  de- 
scribed, these  disadvantages  are  at  once  removed,  and  the  gap,  which 
still  remains  after  the  reunion  of  the  uvula,  being  filled  up  by  the  arti- 
ficial palate  attached  to  an  obturator,  the  muscles  still  have  their  nor- 
mal play,  and  the  palatine  deficiency  is  better  supplied  than  by  the 
natural  union  of  the  separated  edges  of  the  cleft.  The  best  results 
have  been  obtained  by  this  most  simple  means  of  action.  Figs.  398 
and  400,  being  illustrations  of  cases  occurring  in  the  writer's  practice, 
show  very  forcibly  the  manner  of  the  proposed  treatment ;  Fig.  400 
being  an  especially  interesting  case,  because  the  operation  of  staphy- 
loraphy, surgically  considered,  had  been  most  successfully  performed  ; 
but  articulation  seemed  but  little  improved.  The  patient  was  willing 
to  be  the  subject  of  an  experiment,  and  the  anterior  portion  of  the 
reunited  cleft  was  opened  up  again,  and  a  velum,  with  an  obturator, 
introduced  in  the  space  thus  created.  The  results  were  eminently  sat- 
isfactory;  the  tension  of  the  soft  parts  was  at  once  relieved  by  this 
division,  and  after  a  little  practice  the  patient  spoke  as  she  had  never 
spoken  theretofore. 

There  are  many  cases  of  abnormality  in  the  os  palati  which  can  only 
be  relieved  by  mechanical  appliances,  and  this  relief  can  be  afibrded 
in  a  most  satisfactory  manner ;  no  more  inconvenience  being  felt  by  the 
patient  than  he  would  experience  in  wearing  an  artificial  denture,  with 
which  the  false  palate  could  be  connected,  were  it  necessary  to  do  so. 
Artificial  aid  has  been  several  times  alluded  to  in  reference  to  the 
operation  of  staphyloraphy,  and,  indeed,  it  is  still  an  open  question 
whether,  in  a  large  number  of  cases,  the  greatest  relief  is  not  afforded 
by  mechanical  appliances.  The  surgeon's  only  desire  should  be  to 
recommend  that  plan  of  treatment  which  he  considers  will  ultimately 
render  the  greatest  service  to  his  patient.  Undoubtedly,  the  operations 
which  have  been  described  are  often,  as  far  as  mere  union  is  concerned, 
most  satisfactory  in  their  results ;  but  there  are  other  considerations 
besides  these.  Naturally,  the  chief  desire  of  the  patient  is  to  take  a 
footing  in  society  on  equal  terms  with  other  men;  and  there  are  no 


762  DEFECTS    OF    THE    PALATINE    ORGANS. 

means  which  will  enable  him  to  do  so,  unless  they  can  restore  to  him  his 
lost  or  impaired  power  of  speech,  —  that  divine  gift  which  places  man 
so  immeasurably  above  the  brute  creation.  This  has  been  almost  lost 
in  many  cases  of  cleft  palate  ;  and  it  is  the  great  object  of  treatment 
to  put  the  sufferer  in  a  way  of  uttering  his  thoughts  in  plainly-spoken 
words  like  those  around  him  ;  whatever  means  are  best  calculated  to 
bestow  this  inestimable  benefit  are  those  which  the  conscientious  surgeon 
ought  to  select. 

There  are  certain  cases  where  the  opening  is  not  large  and,  as  there 
is  little  tension  of  the  parts,  the  opposite  sides  come  together  in  close 
proximity :  staphyloraphy  may  here  be  performed  with  good  results, 
for  it  must  be  recollected  that  it  is  always  a  desideratum  to  avoid  the 
presence  of  foreign  substance  as  a  substitute  for  natural  tissues,  if  these 
are  equally  effective.  Allusion  has  been  made  to  the  liability  to  injury 
of  the  parts  by  a  division  of  the  muscles.  Where  an  artificial  palate  is 
used,  the  muscles  are  unimpaired ;  and  we  have  heard  persons,  who 
when  without  the  instrument  could  not  be  understood,  speak  fluently 
and  distinctly  the  moment  they  introduced  it  into  their  mouths.  So  far 
as  the  discomforts  of  wearing  such  an  apparatus  are  concerned,  after  a 
short  time  the  wearers  become  entirely  unconscious  that  they  are 
wearing  anything  artificial. 

OBTURATORS   AND   ARTIFICIAL   PALATES. 

We  have  classified  palatine  defects  as  accidental  and  congenital :  we 
shall  also  classify  the  appliances  used  for  their  remedy.  The  term 
obturator  will  be  used  for  all  instruments  intended  to  stop  or  close 
all  those  openings  in  the  hard  or  soft  palate  which  have  a  complete 
boundary.  Appliances  made  to  supply  the  loss  of  the  posterior  soft 
palate,  whether  accidental  or  congenital,  will  be  called  artificial  vela 
or  artificial  palates. 

Any  unnatural  opening  between  the  oral  and  nasal  cavities  which 
will  permit  the  free  passage  of  the  breath  will  impair  articulation. 
Any  appliance  which  will  close  such  passage,  and  can  be  worn  without 
inconvenience,  will  restore  articulation.*  Obturators  were  formerly 
made  of  metallic  plate,  gold  or  silver  being  most  commonly  employed, 
and  many  very  ingenious  pieces  of  mechanism  were  the  result  of  such 
efforts ;  but  latterly,  vulcanized  rubber  has  almost  entirely  superseded 
the  use  of  metals.     Vulcanite  has  been  found  preferable  to  metals, 

*  The  student  will  bear  in  mind  that  no  cognizance  is  here  taken  of  openings 
similar  to  those  described  in  cases  of  congenital  fissure  where  the  surgeon  has 
united  the  soft  palate,  and  left  an  opening  through  the  hard  palate  to  be  covered 
by  an  obturator. 


DEFECTS    OF    THE    PALATINE    OEGANS.  763 

being  mucli  lighter  and  much  more  easily  formed  and  adapted,  partic- 
ularly when  of  peculiar  shape. 

According  to  Guillemeau,  obturators  were  employed  by  the  Greek 
physicians;  but  it  is  to  that  celebrated  French  surgeon,  Ambrose  Pare, 
that  we  are  indebted  for  the  first  description  of  an  appliance  of  this 
sort.  This  author  has  furnished  an  engraving  of  an  obturator  which 
he  had  constructed  in  1585,  consisting  of  a  metallic  plate,  probably  of 
silver  or  gold,  fitted  into  an  opening  in  the  vault  of  the  palate.  It 
was  held  up  by  means  of  a  piece  of  sponge,  fastened  to  a  screw  in  an 
upright  attached  to  the  upper  surface  of  the  plate.  The  employment 
of  sponge,  however,  was  found  to  be  objectionable,  as  the  secretions  of 
the  nasal  cavities,  which  it  absorbed,  soon  became  insufierably  ofien- 
sive ;  notwithstanding  which  it  continued  to  be  used  for  a  long  time. 
Ultimately,  however,  it  was  superseded  by  an  obturator  invented  by 
Fauchard.  This  was  held  up  by  means  of  wings,  which  turned  on  a 
pivot.  Both  of  these  obturators,  however,  exerted  a  hurtful  influence 
upon  the  surrounding  parts,  as  the  pressure  produced  by  the  sponge 
and  wings  caused  them  to  be  gradually  destroyed,  and  thus  augmented 
the  evil  they  were  designed  to  remedy ;  consequently,  their  use  has 
been  wholly  abandoned.  We  do  not,  therefore,  deem  it  necessary  to 
give  a  description  of  either.  We  will,  however,  quote  a  passage  from 
Bourdet  upon  the  subject.  In  alluding  to  the  impropriety  of  having 
recourse  to  any  appliance  which  has  a  tendency  to  counteract  the  cura- 
tive efforts  of  nature,  he  says:  "Before  considering  the  cicatrized  per- 
forations of  the  palate  as  being  of  a  nature  incapable  of  diminishing 
in  diameter,  practitioners  should  satisfy  themselves,  thoroughly  and 
beyond  doubt,  that  such  is  the  case.  We  do  not  think  that  this  con- 
dition of  permanency  can  exist,  for  positive  facts  attest  the  contrary ; 
and  as  holes  made  in  the  cranium  with  the  trepan  close  almost  entirely, 
in  like  manner  those  of  the  palate  constantly  diminish."  Numerous 
examples  might  be  adduced,  if  it  were  necessary  to  prove  the  impro- 
priety of  sustaining  an  obturator  by  any  fixtures  which  act  upon  the 
lateral  parts,  as  they  necessarily  tend  to  increase  the  dimensions  of  the 
opening  in  the  palate. 

Where  atmospheric  pressure  cannot  be  obtained,  and  there  are  no 
teeth  for  clasping,  the  use  of  spiral  springs,  attached  to  a  partial  lower 
piece  or  to  caps  placed  over  the  lower  molars,  would  be  preferable  to 
this  very  objectionable  prominence  on  the  upper  surface  of  obturators. 
It  is  of  the  greatest  importance  that  an  artificial  palate  or  obturator 
should  be  executed  in  the  most  perfect  manner,  and  be  made  to  fit 
accurately  to  all  the  parts  with  which  it  is  to  be  in  contact,  so  that  it 
may  not  produce  the  slightest  irritation  or  exert  undue  pressure  upon 
any  of  the  surrounding  parts.     As  in  the  case  of  the  application  of  a 


764 


DEFECTS  OF  THE  PALATINE  ORGANS. 


dental  substitute,  the  piece  should  not  be  applied  while  any  of  the 
teeth,  especially  those  of  the  upper  jaw,  are  in  an  unhealthy  condition. 
The  gums  and  sockets  of  the  teeth  should  also  be  free  from  disease. 

With  a  view  of  obviating  the  objections  which  have  been  mentioned 
as  existing  to  the  obturators  of  Pare  and  Fauchard,  Bourdet  proposed 
to  employ  simply  a  metallic  plate,  fitted  to  the  vault  of  the  palate  and 
large  enough  to  cover  the  opening,  with  two  lateral  prolongations,  one 
on  each  side,  extending  to  the  teeth,  to  which  they  are  fastened  by 
means  of  ligatures.  This  was  also  found  to  be  objectionable,  as  the 
ligatures  were  productive  of  constant  irritation  to  the  gums;  moreover, 
they  did  not  hold  the  plate  in  place  with  sufficient  stability,  and  its 
use  was  soon  abandoned.  But  these  objections  were  both  obviated  by 
an  improvement  made  by  M.  Delabarre,  which  consisted  in  the  em- 
ployment of  clasps,  instead  of  ligatures,  attached  to  lateral  branches  of 
the  plate.  To  prevent  these  from  slipping  too  high  up  on  the  teeth, 
he  attached  to  each  a  kind  of  spur,  which  was  so  bent  as  to  come  down 
over  the  grinding  surface  of  the  tooth  to  which  it  was  applied.  The 
last-named  author  also  made  another  modification,  which  consisted  in 

the  application  of  a  drum  to  the 
^^°-  ^^^-  upper  surface  of  the  plate.    (Fig. 

385.)  The  object  of  this  was  to 
prevent  the  accumulation  of  mu- 
cous fluids  from  the  nose  in  the 
cul-de-sac,  formed  by  simply  closing 
the  opening  below;  also  to  prevent 
fluids  in  swallowing  from  passing 
up  between  the  obturator  and  the 
soft  parts,  through  the  opening  into 
the  nose.  The  drum  evidently  offers 
the  same  impediment  to  nature's  efforts  in  closing  the  opening  as  the 
obturator  before  mentioned :  on  this  score,  therefore,  it  is  equally  ob- 
jectionable. 

When  the  opening  in  the  palate  is 
small,  and  has  no  connection  u'ith  the 
velum,  it  is  unnecessary  to  raise  the 
upper  surface  of  the  plate  by  attach- 
ing a  drum  or  air-chamber  to  it.  If 
it  be  accurately  fitted  to  the  vault  of 
the  palate,  it  will  effectually  prevent 
fluids  in  deglutition  from  passing  up 
into  the  nasal  cavities,  or  the  escape 
of  any  portion  of  the  voice  through 
the  opening;  also  by  frequently  re- 


^=-=^ 


C^l 


Fig.  386. 


DEFECTS  OF  THE  PALATINE  OEGANS, 


765 


moving  the  plate,  the  accumulation  of  the  secretions  in  the  cul-de-sac 
will  be  prevented.  A  simple  plate,  like  the  one  represented  in  Fig.  386 
will  be  all  that  is  required  to  remedy  the  defect;  and  this,  in  fact,  will 
probably  be  found  the  best  form  in  all  cases,  whether  the  openings  be 
large  or  small. 

Fig.  387  represents  an  obturator  without  teeth  and  without  clasps, 
for  a  perforation  of  the  hard  palate,  being  sustained  in  situ  by  imping- 
ing upon  the  natural  teeth  with  which  it  comes  in  contact.  Accuracy 
of  adaptation  and  delicacy  in  form  are  all  that  is  essential  in  such 
cases,  and  the  restoration  of  the  speech  will  follow  immediately. 

A  clumsy  contrivance  will  interfere  with  articulation  almost  as 
much  as  it  is  improved  by  stopping  the  opening;  therefore,  if  the  obtu- 
rator could  be  confined  entirely  to  the  opening,  like  a  cork  in  a  bottle, 
it  would  be  more  desirable.  As  this  cannot  be,  resort  must  be  had 
to  clasping  the  contiguous  teeth,  if  there  are  any;  if  there  are  none,  the 
obturator  must  extend  over  the  whole  jaw,  and  receive  its  support  in 
the  same  manner  as  would  a  set  of  artificial  teeth.  In  fact,  this  is 
precisely  what  it  becomes  in  such  a  case  —  an  upper  set  of  teeth  bridg- 
ing over  and  filling  up  an  opening  in  the  palate,  thus  combining  an 
obturator  with  a  denture.     Fig.  388  represents  a  more  complicated 


Fig.  387. 


Fig.  388. 


obturator,  adapted  to  an  opening  in  the  soft  palate.  The  necessity  for 
a  variation  in  the  plan  will  be  found  in  the  anatomical  fact  of  the  con- 
stant muscular  action  of  the  soft  palate,  which  would  not  permit, 
without  irritation,  the  presence  of  an  immovable  fixture.  This  is  con- 
trived, therefore,  with  a  joint,  which  will  permit  the  part  attached  to 
the  teeth  to  remain  stationary,  while  the  obturator  proper  is  carried  up 
or  down  as  moved  by  the  muscles.  The  joint.  A,  should  occupy  the 
position  of  the  junction  of  the  hard  and  soft  palates.  The  joint  and 
principal  part  of  the  appliance  is  made  of  gold,  the  obturator,  of  vul- 
canite. The  projection,  B,  lies  like  a  flange  upon  the  superior  surface 
of  the  palate,  and  sustains  it;  otherwise  the  mobility  of  the  joint  would 
allow  it  to  drop  out  of  the  opening.     This  flange  is  better  seen  in  the 


766  DEFECTS    OF    THE    PALATINE    ORGANS. 

side  view  marked  C.     It  is  readily  placed  iu  position  by  entering  the 
obturator  tirst,  and  carrying  the  clasps  to  the  teeth  subsequently. 

Figs.  387  and  388  will  illustrate  the  essential  principles  involved  in 
all  obturators.  The  ingenuity  of  the  dentist  will  often  be  taxed  in 
their  application,  as  the  cases  requiring  such  appliances  all  vary  in 
form  and  magnitude.  The  steps  to  be  taken  in  the  formation  of  an 
obturator  are^not  unlike  those  used  in  making  a  base  for  artificial 
teeth.  It  is  essential  that  an  accurate  model  be  obtained  of  the  open- 
ing, the  adjacent  palatal  surface,  and  the  teeth,  if  any  remain  in  the 
jaw.  For  this  purpose,  an  impression  taken  in  plaster  is  the  only  kind 
to  be  relied  upon.  Care  must  be  used  that  a  surplus  of  plaster  is 
not  forced  through  the  opening,  thus  preventing  the  withdrawal  of 
the  impression  by  an  accumulated  and  hardened  mass,  larger  than  the 
opening  through  which  it  passed.  To  avoid  this,  beginners  or  timid 
operators  had  better  take  an  impression  iu  the  usual  manner  with  wax. 
If  this  is  forced  through,  it  can  be  easily  removed  without  injury  to 
the  patient.  From  this  wax  impression  make  a  plaster  model,  and 
upon  this  plaster  model  form  an  impression  cup  of  sheet  gutta-percha, 
using  a  stick,  piece  of  wire,  strip  of  metal,  or  any  other  convenient 
thing,  for  a  handle.  This  extemporized  impression  cup  must  not  im- 
pinge upon  the  borders  of  the  opening,  neither  should  it  enter  to  any 
extent.  With  a  uniform  film  of  soft  plaster,  of  from  one-sixteenth  to 
one-eighth  of  an  inch  in  thickness,  laid  over  this  cup,  a  correct  impres- 
sion can  be  taken  without  any  surplus  to  give  anxiety.  Upon  a  correct 
plaster  model,  taken  from  such  an  impression,  the  obturator  should  be 
moulded  out  of  gutta-percha,  or  any  other  plastic  substance ;  the  sub- 
sequent steps  being  in  principle  the  same  as  in  making  any  other  piece 
of  vulcanite.  It  is  desirable  that  it  should  enter  the  perforation,  and 
restore,  as  far  as  possible,  the  lost  portion  of  the  palate;  but  it  must 
not  protrude  into,  or  in  any  way  obstruct,  the  nasal  passage.  The 
entire  freedom  of  the  nasal  passage  is  essential  to  the  'purity  of  articulation. 
That  portion  of  the  obturator  which  occupies  the  oral  cavity  should  be 
made  as  delicate  as  possible,  consistent  with  its  strength  and  durability. 

ARTIFICIAL    PALATES. 

Before  proceeding  to  a  description  of  artificial  palates,  a  brief  refer- 
ence to  the  anatomical  relations  and  functions  of  the  velum  palati  will 
be  necessary.  The  palate  exercises  quite  as  important  an  ofiice  in  the 
articulation  of  the  voice  as  does  the  tongue  or  lips.  Being  a  muscular 
and  movable  partition  to  separate  the  nasal  and  oral  cavities,  one  edge 
is  attached  to  the  border  of  the  hard  palate,  while  the  other  vibrates 
between  the  pharynx  and  the  tongue.  The  voice,  therefore,  as  it  issues 
from  the  larynx,  is  directed  by  the  palate  entirely  into  the  mouth,  or 
through  the  nose,  or  permitted  to  pass  both  ways. 


DEFECTS    OF    THE    PALATINE    OEGAISTS. 


767 


Fig.  389. 


A  very  slight  deviation,  in  this  organ  from  its  natural  form  will  make 
the  voice  give  a  diiferent  sound :  so  the  presence  of  anything  that 
clogs  the  natural  passages,  either  oral  or  nasal,  modifies  the  vocal  vibra- 
tions. Place  any  obstruction  in  the  nasal  passages,  paralyze  the  soft 
palate,  or  let  it  be  deficient  in  size,  and  the  power  of  distinct  articulation 
is  wanting.  Evidence  of  this  statement  is  very  frequently  found,  after 
the  surgeon  has  successfully  performed  the  operation  of  staphyloraphy 
in  case  of  congenital  fissure.  In  such  instances  (with  rare  exceptions) 
the  newly-formed  palate  is  so  deficient  in  length,  and  so  tense,  as  to  be 
deprived  of  its  function.  It  cannot  be  raised  so  as  to  meet  the  pharynx 
and  shut  off  the  nasal  passage,  but  hangs  like  an  immovable  septum 
to  divide  the  column  of  sound. 

Fig.  389  represents  a  defective  palate  belonging  to  the  first  class,  the 
uvula  and  a  portion  of  the  contiguous  soft  palate  being  destroyed  by 
disease.  In  such  a  case  an  obturator  would  be  useless :  the  constant 
activity  of  the  surrounding  parts  would  not  tolerate  it.  The  material 
used  for  a  substitute  must  be  soft,  flexible,  and  elastic ;  and  the  elastic 
vulcanite  is  admirably  adapted  to 
this  purpose. 

By  observing  the  cut  (Fig.  389), 
it  will  be  seen  that  a  portion  of 
the  soft  palate  along  the  median 
line  remains,  and  consequently 
there  will  be  considerable  muscu- 
lar movera.ent  which  must  be  pro- 
vided for,  and  which  may  be  taken 
advantage  of.  It  is  desirable  to 
make  this  movement  available  in 
using  an  artificial  palate,  as  thereby 
more  delicate  sounds  are  produced 
than  otherwise. 

This  case  presented  some  extraor- 
dinary difficulties  in  the  fact  that 
all  the  teeth  of  the  upper  jaw  had 
been  extracted ;  and  it  was  necessary,  therefore,  to  adapt  a  plate  which 
should  not  only  sustain  the  teeth  for  mastication,  but  bear  the  addi- 
tional responsibility  of  supporting  the  artificial  palate.  In  the  choice 
of  material  best  adapted  as  a  base  for  the  teeth  in  such  instances,  it 
is  preferable  to  adopt  that  which  will  prove  the  most  durable.  There 
are  too  many  interests  involved  to  risk  the  adoption  of  anything  but 
the  best.  In  the  case  under  description  the  patient  desired  duplicates, 
and  two  sets  of  teeth  were  made,  one  on  gold,  and  the  other  on  platina, 
with  continuous  gum.     The  plates  were  made  like  other  sets  of  teeth, 


768  DEFECTS    OF    THE    PALATINE    ORGANS. 

with  the  exception  of  a  groove  located  on  the  median  line  at  the  pos- 
terior edge,  to  receive  the  attachment  for  the  palate  (marked  C  in 
Fig.  390). 

Fig.  390  will  indicate  the  set  of  teeth  with  palate  attached.  The 
wings,  marked  A  and  B,  are  made  of  soft  rubber ;  the  frame  to  sup- 
port them  is  made  of  gold,  with  a  joint  to  provide  for  the  perpen- 
dicular motion  of  the  natural  palate,  as  in. the  case  of  the  obturator 
represented  in  Fig.  388.  When  the  artificial  palate  is  in  use,  the  joint 
and  frame  immediately  contiguous  lie  close  to  the  roof  of  the  mouth; 
the  rubber  wing,  letter  A,  bridges  across  the  opening  on  the  inferior 
surface  or  side  next  the  tongue ;  the  wing,  letter  B,  bridges  across  the 
opening  on  the  superior  or  nasal  surface,  and  is  also  prolonged  back- 

FiG.  S90. 


ward  until  it  nearly  touches  the  muscles  of  the  pharynx,  when  they 
are  in  repose. 

Both  these  wings  reach  beyond  the  boundary  of  the  opening  and 
rest  on  the  surface  of  the  soft  palate  for  a  distance  of  from  one-eighth 
to  one-quarter  of  an  inch,  thus  embracing  the  entire  free  edge  of  the 
soft  palate.  This  last  provision  enables  the  natural  palate  to  carry  the 
artificial  palate  up  or  down,  as  articulation  may  require. 

When  the  organs  of  speech  are  in  repose  there  is  an  opening  behind 
the  palate  sufficient  for  respiration  through  the  nares.  When  these 
organs  are  in  action,  a  slight  elevation  of  the  palate,  or  a  contraction 
of  the  pharynx,  will  entirely  close  the  nasal  passage,  and  direct  all  the 
voice  through  the  mouth.  The  palate  thus  becomes  a  valve  to  open 
or  close  the  nares,  and  to  be  tolerated  must  be  made  with  thin,  delicate 
edges  which  will  yield  upon  pressure.  An  instrument  thus  made  will 
restore,  as  far  as  is  possible  by  mechanism,  the  function  of  the  natural 
organ. 

Fig.  391  represents  the  artificial  palate  separated  into  its  constituent 
parts.  The  frame  is  bent  at  the  joint  in  the  engraving  to  show  a  stop, 
marked   D,    which   prevents   the    appliance   from   dropping   out   of 


DEFECTS  OF  THE  PALATINE  ORGANS. 


769 


position.     Letter  C   shows  the  tongue,  which  enters  the   groove   in 

the  plate  of  teeth   and  connects  them. 

Letters  A  and  B  are  the  rubber  flaps, 

Avhich  are  secured  to  the  frame  by  the 

hooks,  as  seen  in  the  engraving.     The 

process   for   making   the    rubber   wings 

will  be  found  described  on  page  783. 

Fig.  392  shows  a  more  extensive  pala- 
tine defect  of  the  first  class.  In  this 
case  the  entire  soft  palate  is  gone, 
together  with  a  small  portion  of  the 
hard  palate  at  the  median  line.  Al- 
though this  defect  is  greater  in  extent,  the  means  for  its  remedy  are 
more  simple.  The  muscles  of  the  palate  are  entirely  gone,  and,  con- 
sequently, no  perpendicular  movement  need  be  provided   for.     The 


FcG.  392. 


Fro.  393. 


appliance  in  this  case  will  resemble  an  elastic  obturator  more  than  the 
valve-like  palate  of  the  preceding  one.  The  principle  here  adopted 
is  substantially  that  recommended  by  Mr.  Sercombe,  of  London,  some 
years  since,  and  consists  of  a  plate  with  a  set  of  teeth  in  the  usual 
form,  and  attached  to  its  posterior  edge,  an  apron  of  soft  rubber,  which 
shall  bridge  the  opening  on  its  inferior  surface,  extending  nearly  to 
the  pharynx.  Fig.  393  represents  the  set  of  teeth  with  the  palate  at- 
tached. In  Mr.  Sercombe's  appliance  this  apron  was  made  of  the 
common  sheet  rubber  in  the  market,  prepared  for  other  uses,  and  is- 
49 


770  DEFECTS    OF    THE    PALATINE    ORGANS. 

objectionable  for  two  reasons :  1st.  A  want  of  purity  in  the  materials 
of  which  it  is  compounded;  in  many  instances  substances  being  used  in 
its  manufacture  which  would  prove  deleterious  to  the  health  of  the 
patient ;  and,  2d,  its  uniformity  of  thickness.  It  is  far  preferable, 
therefore,  to  make  a  mould  from  which  to  form  a  palate  of  pure  and 
harmless  materials;  one  which  shall  be  of  sufficient  thickness  in  the 
central  part  and  at  its  anterior  edge,  to  give  it  stability,  and  yet 
shall  have  a  thin  and  delicate  boundary  wherever  it  comes  in  contact 
with  movable  tissue.  Such  a  palate  may  be  made  in  a  mould  by  sub- 
stantially the  same  process  as  hereafter  described.  (See  page  783.) 
It  may  be  secured  to  the  plate  by  a  variety  of  simple  means.  One, 
which  will  give  as  little  trouble  to  the  patient  as  any  other,  is  to  make 
a  series  of  small  holes  along  the  edge  of  the  plate,  and  stitch  it  on 
with  silk;  or  fine  platina,  gold,  or  silver  wire  may  be  used.  It  is  desir- 
able in  this  case  to  have  the  plate  and  palate  present  a  uniform  sur- 
face on  the  lingual  side.  In  fitting  the  plate,  therefore,  it  may  be 
raised  along  the  posterior  edge  from  the  sixteenth  to  the  tenth  of  an 
inch,  according  to  the  thickness  of  the  palate  desired.  The  rubber 
will  thus  be  placed  on  the  palatine  surface  of  the  plate,  and  present 
uniformity  on  the  lingual  surface. 

A  little  thought  will  show  that  in  this  case  the  patient  must  educate 
the  muscles  of  the  pharynx  alone  to  do  the  work  of  shutting  off*  the 
nares,  which,  in  the  former  case,  was  performed  by  them  in  conjunc- 
tion with  the  muscles  of  the  palate.  Perfection  of  articulation  will, 
therefore,  depend  upon  the  success  of  the  patient  in  this  new  use  of 
these  muscles. 

In  cases  of  accidental  lesions  of  the  palate,  such  as  are  under  con- 
sideration, this  education  of  the  muscles  to  a  new  work  will  not  be 
difficult.  The  patient  at  some  former  time  has  had  the  power  of  dis- 
tinct articulation ;  his  ear  has  recognized  in  his  own  voice  the  contrast 
between  his  jDresent  and  former  condition:  the  ear  will  therefore  direct 
and  criticize  the  practice  until  the  result  is  attained. 

In  the  case  illustrated  by  Figs.  392,  393,  the  defect  had  existed  for 
twenty-eight  years,  the  patient  at  the  time  of  the  introduction  of  the 
artificial  palate  being  nearly  fifty  years  of  age.  The  effect  upon  the 
speech  was  instantaneous.  Articulation  was  immediately  almost  as 
distinct  as  in  youth  ;  and  this  remarkable  distinctness  can  only  be  ac- 
counted for  upon  the  assumption  that  the  pharyngeal  muscles  had 
undergone  a  thorough  training  in  the  vain  effort  to  articulate  without 
any  palate.* 

These  two  cases,  chosen  to  illustrate  the  application  of  artificial  pal- 

*  An  account  of  this  case  appears  in  the  "  Argus,"  of  Bainbridge,  Georgia, 
-August  1st,  1868,  written  by  the  patient  himself,  who  is  the  editor  of  that  paper. 


DEFECTS    OF    THE    PALATINE    ORGANS.  771 

ates  in  accidental  lesion,  have  required,  as  will  have  been  perceived, 
entire  upper  sets  of  artificial  teeth  in  connection  with  the  palates.  This 
selection  was  purposely  made  because  the  difficulties  to  be  overcome 
are  much  greater.  In  cases  where  there  are  natural  teeth  remaining 
in  tfie  upper  jaw,  the  palate  and  its  connection  with  a  plate  would  be 
substantially  the  same,  and  the  plate  might  easily  be  secured  to  the 
teeth  by  clasps  in  the  same  manner  as  a  partial  denture. 

Artificial  Palates  for  Congenital  Fissure.  —  Congenital  fissure  of  the 
palate  presents  far  greater  difficulties  to  be  overcome  than  cases  of 
accidental  lesion.  The  opening  is  commonly  more  extensive,  the  ap- 
pliance more  complicated,  and  the  result  more  problematical.  Never- 
theless, appliances  have  been  made  in  a  large  number  of  cases  which 
have  enabled  the  wearers  to  articulate  with  entire  distinctness,  so  much 
so  as  not  in  the  least  to  betray  the  defect. 

The  first  efforts  made  in  this  direction  resembled  obturators.  They 
were  simply  plugs  to  close  the  posterior  nares,  and  the  results  were  far 
from  satisfactory.  It  was  not  until  it  was  recognized  that  the  two 
classes  of  cases,  accidental  and  congenital,  were  entirely  distinct,  that 
much  progress  was  made. 

Nearly  every  case  of  accidental  lesion  can  be  treated  by  an  obtura- 
tor with  considerable  success ;  but  very  rarely  will  an  obturator  be  of 
any  benefit  in  congenital  fissure,  even  if  the  congenital  and  accidental 
cases  present  substantially  the  same  form  of  opening.  For  this  reason 
much  embarrassment  has  been  thrown  around  these  appliances  within 
a  few  years  past.  The  character  of  the  different  classes  has  been  con- 
founded, and  an  instrument  admirably  adapted  to  one  class  has  had 
claimed  for  it  an  equal  apj^llcation  to  the  other  class.  Let  it  be  under- 
stood, therefore,  as  a  rule  to  which  there  will  be  but  few  exceptions, 
that  congenital  fissure  of  the  soft  palate  requires  for  its  successful  remedy 
a  soft,  elastic,  and  movable  appliance ;  and  that,  with  the  most  skilfully 
made  instrument,  vocal  articulation  must  be  learned  like  any  other 
accomplishment.  .  Various  inventions  have  been  made  for  this  purpose 
within  the  last  twenty-five  years,  from  the  most  ^complicated  one  of 
Mr.  Stearns,  described  in  a  former  edition  of  this  work,  to  the  extremely 
simple  one  of  bridging  the  gap  with  a  single  flap  of  rubber.  The 
Stearns  instrument,  with  all  its  complexity,  embodied  the  only  true 
principle,  viz.  :  the  rendering  available  the  muscles  of  the  natural  palate 
to  control  the  movements  of  the  artificial  palate. 

The  essential  requisites  of  an  artificial  palate  are  (1)  to  replace,  as 
far  as  possible,  the  natural  form  of  the  defective  organs  (2)  with  such 
material  as  shall  restore  their  functions.  Muscular  power  certainly 
cannot  be  given  to  a  piece  of  mechanism,  but  the  material  and  form 
may  be  such  that  it  will  yield  to,  and  be  under  the  control  of,  the  mus- 


772 


DEFECTS  OF  THE  PALATINE  ORGANS. 


cles  surrounding  it,  and  thus  measurably  bestow  upon  it  the  function 
of  the  orgau  which  it  represents. 

Fig.  394. 


<B 


r^ 


)"  _>-^: 


Fig.  394  represents  a  model  of  a  fissured  palate,  complicated  with 
harelip  on  the  left  of  the  median  line.  There  is  a  division  also  of  the 
maxilla  and  the  alveolar  process ;  the  sides,  being  covered  with  mucous 
membrane,  lie  in  contact  with  each  other,  but  they  are  not  united. 
If  it  is  desired,  a  very  simple  surgical  operation  can  be  performed 
which  will  unite  both  soft  and  hard  tissues  at  this  point  of  division. 
The  left  lateral  incisor  and  left  canine  tooth  are  not  developed.  Fig. 
395  represents  the  artificial  velum  as  viewed  upon  its  superior  surface, 
together  with  the  attachment  of  a  plate  containing  a  clasp  and  two  ar- 
tificial teeth  to  fill  the  vacancy.. 

Fig.  395. 


The  lettered  portion  of  this  appliance  is  made  of  elastic  vulcan- 
ized rubber ;  its  attachment  to  the  teeth,  of  hard  vulcanized  rubber, 
to  which  the  velum  is  connected  by  a  stout  gold  pin,  firmly  im- 
bedded at  one  end  in  the  hard  rubber  plate.  The  other  end  has  a 
head,  marked  C,  which  being  considerably  larger  than  the  pin  and 
than  the  corresponding  hole  in  the  velum,  it  is  forced  through  —  the 
elasticity  of  the  velum  permitting  —  and  the  two  are  securely  con- 


DEFECTS  OF  THE  PALATINE  OEGANS. 


773 


nected.  The  process  B  laps  over  the  superior  surface  of  the  maxilla 
(the  floor  of  the  nares),  and  effectually  prevents  all  inclination  to  droop. 
The  wings,  A,  A,  reach  across  the  pharynx,  at  the  base  of  the  chamber 
of  the  pharynx,  behind  the  remnant  of  the  natural  velum.  The  wings, 
D,  D,  rest  upon  the  opposite  or  anterior  surface  of  the  soft  palate. 

Fig.  396  represents  a  model  the  same  as  Fig.  394,  with  the  appliance. 
Fig.  395,  in  situ;  the  wing  D,  D,  in  Fig.  395,  and  the  posterior  end  of 
the  artificial  velum  A  alone  being  visible  in  this  figure. 

The  reader  will  bear  in  mind  that  the  essential  characteristics  of 
this  appliance  are  a  soft,  elastic  substance  filling  the  gap  in  the  soft 

Fig.  396. 


palate,  with  a  flap  behind  as  well  as  before,  which  enables  it  to  follow 
all  movements  of  the  muscles  with  which  it  comes  in  contact,  and 
thus  perform,  to  a  very  considerable  degree,  the  function  of  the  fully- 
ieveloped  natural  organ. 

It  is  this  characteristic  alone  which  made  the  Stearns  palate  a  suc- 
cess, and  to  produce  which  result,  Stearns  invented  the  complicated  and. 
for  most  cases,  impracticable  machinery  as  seen  in  Figs,  402  and  403. 
It  was  to  produce  the  same  effect  by  a  simple  appliance,  that  the  writer 
labored  unremittingly  for  more  than  ten  years :  the  appliance  of  to-day 
being  no  modification  in  any  sense  of  the  Stearns  instrument,  nor  of 
that  of  any  other  author,  but  an  individual  and  separate  invention,  so 
very  simple  that  we  can  conceive  of  no  different  way  by  which  perfec- 
tion of  result  can  be  so  nearly  attained.  A  hundred  instruments  of  like 
character  now  being  successfully  worn,  attest  the  writer's  confidence  in 
it.  Simplicity  has  gone  but  one  step  farther,  and  that  has  been  to  leave 
off*  entirely  the  posterior  flap  marked  A,  A  in  Fig.  395.  This  has  been 
done  in  England,  France,  and  Germany,  and  occasionally  in  our  own 
country,  and  a  parade  made  of  the  fact,  as  an  improvement  on  the 


774 


DEFECTS  OF  THE  PALATINE  ORGANS, 


inventions  of  the  writer ;  but  the  experience  of  the  past  shows  that 
in  all  these  cases  the  makers  have  failed  to  comprehend  the  require- 
ments of  the  case,  and  have,  in  attempting  to  improve  the  instrument, 
dispensed  with  one  of  its  essential  characteristics. 

A  later  invention,  and  one  which  the  author  believes  to  be  of  almost 
imiversal  application,  is  represented  in  Fig.  397.     To  appreciate  the 

Fig.  397. 


importance  of  this  invention,  it  must  be  boyne  in  mind  that  heretofore 
an  instrument  j^eculiar  in  form  has  been  required  for  every  separate 
case.  Each  appliance,  being  made  in  a  mould  of  special  adaptation, 
has  therefore  entailed  upon  the  operator  a  large  amount  of  labor. 

With  this  later  invention,  it  is  believed  that  with  a  few  moulds,  pro- 
ducing a  limited  variety  of  palates  adapted  to  the  leading  features 
in  such  cases,  nearly  every  case  of  congenital  cleft  can  be  provided  for, 
upon  the  same  princi])le  as  other  forms  of  surgical  appliance  are  made 
for  general  use.  It  was  only  after  years  of  experience,  and  the  observa- 
tion of  many  cases,  that  the  characteristics  which  were  common  to  all 
could  be  determined. 

Those  common  features  are :  (a)  The  fissure  through  the  soft  palate 
is  always  in  the  median  line;  (6)  the  variations,  if  any,  from  the  median 
line  are  anterior  to  the  soft  palate,  in  the  palatine  and  maxillary 
bones ;  (e)  thickness  of  the  border  of  the  fissure  in  the  remnant  of 
the  soft  palate  is  generally  uniform  ;  (d)  the  sides  correspond  very 
nearly  with  each  other  in  length,  breadth,  thickness,  and  contour; 
(e)  the  chief  variation  in  nearly  all  clefts  of  the  soft  palate  is  in  their 
size  or  breadth,  and  this  is  true  without  any  reference  as  to  whether 
the  fissure  extends  forward  into  the  hard  palate  or  not.  Figs.  394  and 
397  represent  two  cases  of  remarkably  general  likeness,  although  they 


DEFECTS  OF  THE  PALATINE  ORGANS. 


775 


differ  twenty  years,  in  age  and  more  than  five  years,  in  the  period  of 
time  at  which  they  were  treated. 

The  palate  placed  in  situ  in  Fig.  397  shows  an  instrument  which, 
with  variations  in  size,  is  of  almost  universal  application.  It  is  nearly 
identical  with  the  palate.  Figs.  395  and  396,  were  that  one  cut  across 
the  middle.  Like  the  other,  it  is  made  of  soft  rubber  and,  moreover,  it 
will  need  an  additional  fixture  to  fill  the  gap  in  the  hard  palate  and 
also  keep  the  artificial  velum  from  being  swallowed.  In  Fig.  395 
there  is  a  projection  marked  B,  which  is  made  of  soft  rubber,  and  is 
a  part  of  the  velum.  This  projection,  as  has  already  been  noticed,  is 
intended  to  assist  in  supporting  the  velum  in  position.  This  is  not 
always  necessary  or  desirable;  there  are  cases  where  the  velum  is  quite 
as  well  sustained  without  this  projection,  and  where,  if  it  were  applied, 
it  would  certainly  injure  the  tone  of  the  voice  by  clogging  the  nasal 
passage.  In  the  case  Fig.  397,  if  support  were  desired  by  lapping  on 
the  floor  of  the  nares,  toward  the  apex  of  the  fissure,  it  would  form  a 
portion  of  the  hard  palate  or  obturator,  instead  of  being  part  of  the 
velum  or  soft  palate,  as  heretofore. 

OBTURATORS  AND  PALATES  COMBINED. 

We  shall  proceed  now  to  consider  another  class  of  cases,  the  proper 
treatment  of  which  has  been  followed  by  the  most  encouraging  results. 

For  fifty  years  the  operation  of  staphyloraphy  has  been  a  favorite 
one  with  surgeons,  yet  tli#  number  of  cases  in  which  there  has  been 
only  a  partial  union  are  largely  in  the  majority.     In  many  instances 

Fig.   398. 


all  that  has  been  accomplished  is  simply  the  tying  together  of  a 
small  portion  of  the  soft  palate,  across  the  back  part  of  the  fissure, 
leaving  an  opening,  of  greater  or  less  size,  through  the  hard  palate, 


776 


DEFECTS  OF  THE  PALATINE  ORGANS. 


anterior  to  the  newly-formed  septum.     This  opening  has  generally  been 

plugged  with  an  obturator;  but  vocal  articulation  has  been  little,  if  at 

all,  improved.     To  meet  this  emergency  a  new  form  of  artificial  velum 

was  invented.     Fig.  398  will  illustrate  such  a  case,  with  the  obturator 

and  artificial  palate  in  situ. 

The  patient  was  a  man  fifty  years  of  age.     The  operation  of  staphy- 

loraphy  had  been  performed  twenty  years  previously  ;  an  obturator  of 

silver,  and  afterward  one  of  vulcanite,  has  been  worn  constantly  ever 

since.      Nevertheless   the  articulation  was  not  benefited,  the  reason 

being  the  same  as  in  every  other  case  of  staphylorajihic  operation ; 

the  new  fleshy  palate,  marked  A,  not  being  long  enough  to  close  by 

any  muscular  effort  the  passage  to  the  nares.     There  was,  however, 

some  remaining  muscular  action,  to  utilize  which  power,  was  the  desired 

object  to  be  attained.     Letter  B  shows  the  obturator,  and  letter  C  the 

velum.     In  this  instance  the  obturator  is  made  of  soft  rubber,  the 

same  as  the  velum,  and  when  in  use  the  velum  is  but  an  extension  of 

the  natural  palate,  as  seen  in  Fig.  398. 

_      „„„  Fig.  399  shows  the  appli- 

FiG.  399.  ®  .  ^J^ 

i   l^^^^^^i  ance  when  not  in  use.     The 

\  plate  D secures  the  obturator 

to  the  teeth,  as  in  other  cases 
of  artificial  palates.  In  or- 
der to  introduce  the  piece, 
tHe  broad  flap,  C,  should  be 
first  passed  through  the  open- 
,  ,   ^^-^  \    \\mmm  I      '^^S  '^^^  t^^^  roof,  and  pushed 

ir-^-  /=^  \i^P^      li^^ck ;  the  whole  fixture  will 

"         '  ■«  readily  fall  into  correct  po- 

sition. In  the  case  of  this 
patient,  the  improvement  in  vocal  articulation  was  immediate*  and  very 
decided. 

Fig.  400  illustrates  another  case  of  a  similar  character,  but  with 
incidental  circumstances  much  more  interesting.  The  patient  was  a 
lady  sixty-two  years  of  age,  for  whom  staphyloraphy  was  performed 
in  1845  by  a  distinguished  surgeon,  and  the  result  was  a  remarkable 
success,  so  far  as  the  union  of  the  parts  was  concerned.  The  union 
was  perfect  throughout  the  entire  length  of  the  fissure,  including  the 
uvula ;  but  although  the  patient  had  applied  herself  diligently  to  the 
improvement  of  her  speech,  she  was  unsatisfied  with  her  progress. 
The  fault  being  the  same  as  in  all  other  cases,  — too  short  a  palate,  — 
the  remedy  must  be  the  same.  But  here  arose  another  diflSculty.  There 
was  no  opening  through  the  roof  of  the  mouth,  as  in  case  of  Fig.  398, 
and  there  was  no  method  of  securing  the  desired  palate  extension  to 
the  inferior  surface  of  the  natural  palate.    To  convey  to  the  artificial 


DEFECTS  OF  THE  PALATINE  ORGANS, 


777 


velum  tlie  action  of  the  levatores  palati  was  essential  to  success.  After 
consultation  with  a  skilful  and  distinguished  surgeon  of  this  city  (Dr. 
Geo.  A.  Peters,  Kew  York),  it  was  decided  to  undo,  in  a  measure,  the 
operation  of  twenty-five  years  before;  and  an  opening  was  made  through 
the  soft  palate  on  the  median  line  immediately  behind  the  hard  palate, 

Fig.  400. 


as  shown  in  Fig.  400.  The  opening  was  a  simple  straight  incision,  which 
was  subsec|uently  enlarged  by  wearing  a  tent  for  a  short  time.  There 
was  no  pain ;  but  little  bleeding ;  and  in  a  few  days  it  was  entirely 
healed.  What  complicated  the  case  still  further  was  the  loss  of  all 
the  teeth  in  the  upper  jaw,  and  an  entire  upper  denture  had  been  worn 
for  years.  The  artificial  palate  was  attached  to  such  a  denture,  and 
instead  of  proving  detrimental  to  the  denture,  it  was  an  advantage  ; 
serving,  when  in  place,  to  keep  the  back  edge  of  the  plate  from  the 
possibility  of  dropping.  The  marked  improvement  in  articulation 
and  the  gratification  of  the  patient  were  a  sufiicient  justification  for 
the  partial  undoing  of  such  an  admirable  surgical  operation. 

The  later  experience  of  the  writer  favors  the  idea  of  a  partial  sta- 
phyloraphic  operation,  with  a  view  of  making  a  narrow  bridge  across 
the  posterior  part  of  the  fissure.  Even  the  tying  of  the  bifurcated  uvula 
together  would  be  of  far  more  service  to  the  patient  than  a  union 
throughout  the  length  of  the  cleft.  Such  a  slight  bridge  of  the  gap  is 
more  easily  and  certainly  obtained  than  when  greater  attempts  are 
made ;  as  the  surgical  operation  can  be  supplemented  by  an  artificial 
velum  of  a  very  simple  character,  the  patient  thus  derives  the  highest 
benefit  which  surgical  skill  can  at  this  day  give. 


778  DEFECTS    OF    THE    PALATINE    ORGANS. 

Method  of  Making  an  Artificial  Palate. — The  success  of  these  ap- 
pliances depends  very  much  upon  the  perfect  accuracy  of  the  model : 
since  it  is  upon  this  that  the  parts  are  moulded.  It  is  essential  that 
the  entire  border  of  the  fissure,  from  the  apex  to  the  uvula  should 
be  perfectly  represented  in  the  model,  as  these  parts  are  when  in 
repose.  It  is  also  necessary  that  the  model  show  definitely  the  form 
of  the  cavity  above,  and  on  either  side,  of  the  opening  through  the 
hard  palate;  since  that  part  of  the  cavity  is  hidden  from  the  eye. 
It  is  desirable,  although  it  is  not  essential,  that  the  posterior  surface 
of  the  remnant  of  the  soft  palate  be  shown ;  but  it  is  especially  im- 
portant that  the  anterior  or  under  surface  be  represented  with  relaxed 
muscles,  and  in  perfect  repose.  The  impression  for  such  a  model  must 
be  taken  in  plaster :  it  is  the  only  material  now  in  use  adapted  to  the 
purpose.  An  ordinary  Britannia  impression  cup  may  be  used,  selecting 
one  corresponding  in  size  and  form  to  the  general  contour  of  the  jaw. 
This  cup  will  be  found  too  short  at  the  posterior  edge  to  receive  the 
soft  palate,  but  it  may  be  extended  by  the  addition  of  a  piece  of  sheet 
gutta-percha,  which  must  be  moulded  into  such  form  as  not  to  impinge 
upon  the  soft  palate,  but  which  will  reach  under  and  beyond  the  uvula, 
and  thus  protect  the  throat  from  any  droppings  of  plaster.  Before 
using  the  plaster,  the  posterior  edge  of  the  gutta-percha  extension  may 
be  softened  by  heat,  and  introduced  into  the  mouth.  Contact  with  the 
soft  palate  will  cause  it  to  yield,  so  that  there  is  no  danger  of  its  forcing 
away  the  soft  tissues  when  the  plaster  is  used.  The  first  effort  will  be 
to  get  only  the  lingual  surface,  taking  precaution  not  to  use  too  much 
plaster.  After  trial,  if  the  impression  show  definitely  the  entire  bor- 
der of  the  fissure,  and  the  soft  palate  has  not  been  pushed  up  by  the 
spasmodic  action  of  the  levator  muscles,  it  is  all  that  is  thus  far  de- 
sired. If,  however,  the  soft  parts  have  been  disturbed  (which,  on  close 
comparison,  a  little  experience  will  decide),  it  is  better  to  take  a  model 
from  the  impression ;  and  upon  this  model,  extemporize  an  impression 
cup,  as  described  on  page  766.  This  temporary  cup  will  have  the 
advantage  of  the  former,  inasmuch  as  it  requires  but  a  thin  film  of 
plaster  to  accomplish  the  result,  thus  lessening  the  danger  of  disturb- 
ing the  soft  tissues.  After  the  removal,  if  it  is  seen  that  any  surplus 
has  projected  through  the  fissure  and  spread  out  over  the  floor  of  the 
nares,  it  should  be  trimmed  ofl'. 

In  most  cases  such  an  impression  will  be  all  that  is  required.  Such 
an  impression  can  be  taken,  with  a  little  experience,  quite  as  readily 
as  a  correct  impression  for  a  set  of  teeth.  The  all-important  point  is 
to  have  the  border  of  the  fissure  closely  defined,  with  the  soft  parts 
hanging  in  their  relaxed  condition.  It  is  not  essential  to  one  of  expe- 
rience that  the  pharynx  behind  the  uvula  should  be  taken  in  the  im- 
pression.    When  the  model  is  obtained  from  the  impression,  a  repre- 


DEFECTS    OF    THE    PALATINE    ORGANS.  779 

sentation  of  the  pharynx  can  be  made,  with  sufficient  accuracy  for 
practical  purposes,  by  carving.  It  is  only  when  the  floor  of  the  nares 
is  used  for  the  support  of  the  palate,  that  it  becomes  necessary  to  obtain 
a  more  complicated  impression,  one  which  shall  represent  not  only  a 
portion  of  the  buccal  cavity,  but  all  the  superjacent  nasal  cavity.  When 
this  is  required,  the  next  step  will  be  to  obtain,  in  conjunction  with 
this  impression  of  the  under  surface,  (which  we  call  the  palatal  impres- 
sion,) an  impression  of  the  upper  or  nasal  surface  of  the  hard  palate. 
This  can  be  done  by  filling  the  cavity  above  the  roof  of  the  mouth 
with  soft  plaster  down  to  the  border  of  the  fissure,  and,  while  yet  very 
soft,  immediately  carrying  the  palatal  impression  against  it,  and  retain- 
ing it  in  that  position  until  the  plaster  is  hard,  which  can  be  easily 
ascertained  by  the  remains  in  the  vessel  from  which  it  was  taken. 
Taking  the  precaution  to  paint  the  surface  of  the  palatal  impression 
with  a  solution  of  soap,  to  prevent  the  two  masses  from  adhering  when 
brought  in  contact,  there  will  be  no  difficulty  in  removing  it  from  the 
mouth,  leaving  the  mass  which  forms  the  nasal  portion  in  situ.  With 
a  suitable  pair  of  tweezers  this  mass  is  easily  carried  backward  and 
withdrawn  from  the  mouth ;  the  irregular  surface  of  contact  indi- 
cates its  relation  to  its  fellow  when 

I.  i,^  ^       .1,  Fig.  401. 

brought  together. 

Fig.  401  will  show  such  an  im- 
pression. The  portion  marked  A, 
B,  C  will  readily  be  distinguished 
as  that  which  entered  the  nasal  cav- 
ity. The  line  of  separation  from 
the  palatal  impression  is  plainly 
indicated  in  the  engraving.  The 
groove  marked  D  shows  clearly  the 
impression  made  by  the  delicate 
uvula  in  the  soft  plaster.  The  nasal  portion  is  relatively  large,  show- 
ing an  unusually  large  nasal  cavity.  The  vomer  lies  between  the  pro- 
jections marked  A,  A,  these  projections  entering  the  nasal  passages. 
The  surfaces  marked  B,  B  came  in  contact  with  the  middle  turbinated 
bones ;  the  surface  marked  C,  in  contact  with  the  inferior  turbinated 
bone.  In  many  instances  these  turbinated  bones  are  so  large  as  nearly 
to  fill  the  nasal  passages. 

The  method  of  obtaining  a  model  of  the  mouth  from  this  impression 
does  not  require  any  particular  description.  The  process  is  similar  to 
the  making  of  a  cast  into  any  other  mouth  impression.  The  model 
represented  in  Fig.  400  shows  a  convenient  form  for  such  a  case. 

When  the  nasal  portion  of  the  impression  does  not  indicate  the 
superior  surface  of  the  soft  palate,  the  part  may  be  represented  in  the 
model  by  "carving.     It  is  not  essential  to  the  success  of  the  artificial 


780 


DEFECTS  OF  THE  PALATINE  ORGANS. 


palate,  that  the  posterior  surface  of  the  soft  palate  should  be  repre- 
sented with  the  same  accuracy  that  is  required  on  the  inferior  surface 
or  on  both  surfaces  of  the  hard  palate.  By  the  aid  of  a  small  mirror 
and  a  blunt  probe,  the  thickness  of  the  velum  and  the  depth  behind 
the  fissure  can  be  ascertained :  approximate  accuracy  is  sufficient,  since 
the  portion  of  the  artificial  palate  coming  in  contact  with  it  is  so  elastic 
that  it  easily  adapts  itself  to  a  slight  inequality,  rendering  absolute  ac- 
curacy less  important. 

The  next  step  will  be  the  formation  of  a  model,  or  pattern,  of  the 
palate.     Sheet  gutta-percha  is  preferable  for  this  purpose,  although 
wax,  or  some  other  plastic  substance,  might  answer.     The  form  which 
Fig.  402.  Fig.  403. 


should  be  given  is  better  indicated  by  the  drawing,  Figs.  395  and  406, 
than  it  could  be  by  written  description.  The  Stearns  instrument,  of 
■which  a  cut  is  here  given  (Figs.  402,  403),  was  made  to  embrace  the 
edges  of  the  fissure,  and  was  slit  up  through  the  middle,  so  that  when 
the  edges  of  the  fissure  approached  each  other,  as  they  always  do  in 
swallowing,  the  two  halves  of  the  instrument  would  slide  by  each  other ; 
a  third  flap  or  tongue  was  made,  and  supported  by  a  gold  spring,  to 
cover  and  keep  closed  this  central  slit. 

This  complicated  provision  for  the  contraction  of  the  fissure  is  en- 
tirely superseded  in  Figs.  395  and  406,  by  making  the  instrument 
somewhat  in  the  form  of  two  leaves,  one  to  lie  on  the  inferior  and  the 
other  upon  the  superior  surface  of  the  palate,  and  joined  together 
along  the  median  line.  "When  the  fissure  contracts,  the  halves  of  the 
divided  uvula  slide  toward  each  other  between  these  two  leaves.  The 
posterior  portion,  marked  A  in  Fig.  395,  is  made  very  thin  and  deli- 


DEFECTS    OF    THE    PALATINE    OSGANS.  781 

■  cate  on  all  its  edges,  as  it  occupies  the  ebamber  of  tlie  pharynx,  and 
is  subject  to  constant  muscular  movement.  The  sides  are  rolled  slightly- 
upward,  while  the  posterior  end  is  curved  downward.  The  inferior 
portion,  marked  D,  D,  should  reach  only  to  the  base  of  the  uvula,  and 
bridge  directly  across  the  chasm  at  this  point  (Fig.  396) ;  and  no  effort 
to  imitate  the  uvula  should  be  made.  The  extreme  posterior  end  should 
not  reach  the  posterior  wall  of  the  pharynx  by  a  quarter  of  an  inch 
when  all  the  muscles  are  relaxed  (although  subsequent  use  must  deter- 
mine whether  to  increase  or  diminish  this  space),  thus  leaving  abundant 
room  for  respiration  and  for  the  passage  of  nasal  sounds.  In  cases 
where  it  is  desirable  to  make  the  instrument,  as  far  as  possible,  inde- 
pendent of  the  teeth  for  its  support,  the  anterior  part  which  occupies 
the  apex  of  the  fissure  in  the  hard  palate  may  lap  over  upon  the  floor 
of  one  or  both  nares.  Such  a  projection  is  seen  in  Fig.  395,  marked  B. 
and  a  like  process  is  seen  in  Fig.  406,  but  not  lettered.  Were  it  not 
for  this  process  in  the  first  uase,  the  palate  would  drop  from  the  fissure 
into  the  mouth,  the  single  clasp  at  the  extreme  anterior  edge  not  being 
sufficient  to  keep  the  whole  appliance  in  place  throughout  its  entire 
length.  Caution  must  be  exercised  that  this  projection  entering  the 
nares  be  not  too  large,  or  it  will  obstruct  the  passage,  and  give  a  dis- 
agreeable nasal  tone  to  the  voice. 

All  the  peculiarities  described  must  be  provided  for  in  the  gutta- 
percha model,  which,  after  having  been  carefully  formed  upon  the  cast, 
may  be  tried  in  the  mouth  to  ascertain  its  length  or  necessary  varia- 
tions. When  its  ultimate  form  has  been  determined,  provision  must  be 
made  to  duplicate  it  in  soft  rubber.  A  familiar  illustration  of  the  pro- 
cess here  to  be  adopted  is  found  in  the  parallel  process  employed  when 
a  set  of  teeth  is  made  on  the  vulcanite  base.  A  model  form  is  made 
of  wax  and  gutta-percha,  bearing  the  teeth ;  and  in  all  its  prominent 
characteristics  has  the  shape  desired  in  the  completed  denture,  the 
rubber  duplicate  being  vulcanized  in  a  plaster  mould.  In  like  manner 
the  rubber  duplicate  of  the  palate,,  as  before  described,  may  be  made  in 
a  plaster  mould. 

If  plaster  is  used  for  the  moulds,  it  must  be  worked  so  that  the 
surface  shall  be  free  from  air-bubbles,  or  the  rubber  palate  will  be  cov- 
ered with  excrescences  that  cannot  readily  be  removed.  By  covering 
the  surface  of  the  mould  with  collodion  or  liquid  silex,  it  will  be  much 
improved.  But,  ordinarily,  plaster  moulds  will  be  found  too  trouble- 
some for  general  use.  They  may  be  put  to  a  most  excellent  use,  how- 
ever,- by  using  one  to  make  a  duplicate  of  the  gutta-percha  in  hard 
rubber.  This  is  not  necessary  with  those  who  have  had  much  experi- 
ence, but  Avith  beginners  it  will  be  difficult  to  work  up  the  gutta-percha 
as  nicely  as  may  be  desired :  a  duplicate  in  vulcanite  will  enable  the 
operator  to  make  a  more  artistic  model  of  the  palate,  and  one  which 
can  be  handled  with  greater  freedom. 


782 


DEFECTS  OF  THE  PALATINE  ORGANS. 


As,  in  the  course  of  a  lifetime,  a  considerable  number  of  elastic  pal- 
ates will  be  required,  the  mould  which  produces  them  should  be  made 
of  some  durable  material.  The  type-metal  of  commerce  is  admirably 
adapted  to  this  use.  A  very  complete  mould  is  one  made  of  four 
pieces,  which  will  })roduce  a  jjalate  in  one  continuous  piece.  Such  a 
mould  requires  very  nice  mechanical  skill  in  fitting  all  the  parts  accu- 
rately, and  unless  the  operator  has  had  experience  in  such  a  direction 
it  is  better  to  simplify  the  matter.     Fig.  40-i  shows  a  mould  in  four 

JFio.  404. 


Fig.  405. 


pieces.  The  blocks  C,  C  are  accurately  adapted  to  the  body  of  the 
mould,  marked  A,  and  are  prevented  from  coming  into  inaccurate  con- 
tact with  each  other  by  the  flanges  D,  D,  which  overlap  and  rest  upon 
the  sides  of  the  main  piece.  B  shows  the  top  of  the  mould,  and  the 
groove  E  provides  for  the  surplus  rubber  in  packing.  Such  a  mould 
makes  as  perfect  an  appliance  as  can  be  produced.  The  palate  is  one 
homogeneous  and  inseparable  piece.  The  cut  will  sufficiently  indicate 
the  form  of  the  several  parts.  Each  of  these  pieces  is  first  made  in 
plaster,  having  exactly  the  form   desired  in '  the   type-metal.     They 

are  then  moulded  in  sand,  and 
the  type-metal  cast  as  in  making 
an  ordinary  die  for  swaging. 
When  in  use,  a  clamp  similar  to 
Fig.  405  is  placed  around  the 
mould  to  keep  the  several  parts 
firm  in  their  position. 

Fig.  406  shows  the  palate  com- 
plete, with  its  attachment  t6  the 
teeth.     The  palate  is  secured  to 
the  plate  by  a  pin  of  gold  passing 
1^  through  a  hole  of  the  same  size  in 


the  palate  •;  the  head  on  the  pin  being  larger  than  the  hole  through 
which  it  is  forced. 


DEFECTS    OF    THE    PALATINE    ORGANS. 


783 


By  making  the  palate  in  two  pieces,  to  be  joined  after  vulcanizing, 
as  shown  in  Fig.  407,  the  mould  may  be  made  in  only  two  pieces,  and 

Fig.  407. 
Fig.  406. 


with  very  little  trouble.  When  in  use,  the  two  pieces,  as  here  repre- 
sented, are  bound  together  at  the  forward  part  by  the  gold  pin  before 
referred  to  ;  and  a  few  stitches  of  silk  secure  it  at  the  posterior  part. 

The  instrument  then  becomes  identical  with  that  shown  in  Fig.  406. 

Fig.  408  shows  the  mould  or  flask  in  Avhich  it  is  vulcanized.     These 

Fig.  408. 


flasks  were  made  expressly  for  this  purpose  ;  but  they  are  not  so  unlike 
the  flasks  in  common  use  in  dentists'  laboratories  that  the  latter  will 
not  answer.     The  common  flask  is  simply  unnecessarily  thick  or  deep. 

The  mould  is  readily  produced  in  the  following  manner :  Imbed  the 
two  pieces  of  the  palate  in  plaster  in  one-half  of  the  flask ;  when  the 
plaster  is  set  and  trimmed  into  form,  duplicate  it  in  type-metal  by  re- 
moving the  palate,  varnishing  the  surface,  moulding  in  sand,  and  cast- 
ing. In  making  the  sand  mould,  take  a  ring  of  sheet-iron  of  the  same 
diameter  as  the  flask  and  three  or  four  inches  high  :  slip  it  over  the 
flask,  and  pack  full  of  sand.  Separate  them,  remove  the  plaster,  return 
the  flask  to  the  sand  mould,  and  fill  with  the  melted  metal  through  a 
hole  made  in  the  side  or  bottom  of  the  flask.  Having  thus  made  one- 
half,  substantially  the  same  process  will  produce  the  counterpart. 

Fig.  409  shows  the  mould  which  produces  the.  palate  illustrated  by 
Fig.  397.     It  is  the  most  simple,  and  at  the  same  time  the  most  com- 


784 


DEFECTS  OF  THE  PALATINE  ORGANS. 


plete,  of  any  mould  yet  invented.     The  mould  is  made  in  three  pieces, 
and  is  enclosed  in  a  flask  exactly  the  same  as  Fig.  408,  but  with  this 


improvement:  the  latter  mould  yields  a  piece  formed  of  two  sepa- 
rate parts  of  rubber,  which  must  be  afterward  joined  by  stitching  or 
otherwise  :  whilst  the  former  (Fig.  409)  produces  an  appliance  in  one 
piece,  and  as  perfectly  finished  as  by  the  more  complicated  mould  of 
four  pieces,  shown  in  Fig.  404.  Letter  A  represents  the  base  of  the 
mould  ;  B,  the  middle  section,  which  is  placed  on  the  top  of  A ;  and 
the  third  section,  or  top,  C,  completes  it. 

The  mechanical  processes  by  which  this  mould  is  made  are  substan- 
tially the  same  as  given  for  making  those  before  described.  The  pack- 
ing of  the  mould  with  rubber  should  be  done  in  the  same  manner  as 
when  hard  rubber  is  used  for  a  dental  base,  wuth  which  process  it  is 
assumed  that  the  reader  is  familiar.  By  washing  the  surface  of  the 
mould  Avith  a  thick  solution  of  soap  previous  to  packing,  the  palate 
will  be  more  easily  removed  after  vulcanizing.  The  rubber  used  for 
this  purpose  must  be  a  more  elastic  compound  than  that  for  a  dental 
base-plate.  The  composition  used  for  the  elastic  fabrics  of  commerce 
will  answ^er,  if  made  of  selected  materials.  There  is  also  on  sale  at  the 
dental  depots  a  soft,  elastic  compound  admirably  adapted  to  the  pur- 
pose, with  accompanying  instructions  for  vulcanizing. 


THE  END. 


INDEX. 

Single  references  will  be  found  under  leading  word  of  title  :  many  subjects  are 
referred  to  under  each  word  of  title,  and  sometimes  under  its  synonym.  Princi- 
pal subjects  are  alphabetically  arranged ;  but  details  and  sub-divisions  are  usually 
given  in  the  order  of  description  in  the  text,  so  as  to  present  a  full  synopsis  of 
the  subjects  indexed. 


ABNORMAL  development  and  ar- 
rangement of  teeth,  418. 

Abrasion  of  teeth,  chemical,  264;  me- 
chanical, 266. 

Abscess,  alveolar,  233  ;  causes  and  med- 
ical treatment,  235  ;  surgical  treat- 
ment, 237;  effects  in  lower  jaw, 
238. 

Absorption  of  alveolar  walls  around 
teeth;  244;  time  required  after  ex- 
traction of  teeth,  505. 

Acids,  effects  on  teeth,  Westcott's  experi- 
ments, 280;  use  in  refining  gold, 
523  ;  for  pickling  gold  plate,  603. 

Actual  cautery  for  destroying  nerve,  370. 

Adhesion,  of  gum  to  cheek,  177  ;  of  con- 
tact, 625  ;  of  vacuum-cavity,  502 ; 
of  partial  pieces,  621,  627. 

Adhesive  gold  foil,  296,  325,  842,  348. 

Adjustment  of  porcelain  teeth,  to  gold 
plate,  589-600;  to  aluminum  plate, 
673 ;  to  vulcanite  plate,  685. 

.Esthetics  in  selection  and  arrangement 
of  teeth,  598;  rules  and  illustra- 
tions, 726-734. 

Alkalies,  action  on  teeth,  Westcott's  ex- 
periments, 280;  for  cleansing  gold 
plate,  603;  cheoplastic  plate,  658; 
in  composition  of,  dental  porcelain, 
717,  continuous  gum,  686. 

Alloys,  for  gold  plate,  528,  formulas, 
531 ;  for  dies,  561,  properties  and 
formulas,  564  ;  of  tin,  for  plates, 
644;  stannic  alloys,  658. 

Aluminum,  history  and  properties,  659  ; 
refining,  675 ;  swaged  plates  and 
solder,  660 ;  durability  in  mouth, 
677 ;  as  a  material  for  flasks  and 
vulcanizers,  689. 
Bean's  alumino-plastic  process,  661- 
672 ;  impression,  662 ;  first  model, 

50 


663  ;  plaster  mould,  664 ;  matrix- 
model,  665 ;  arranging  teeth  and 
wax  plate,  666;  moulding-flask, 
668 ;  preparing  and  heating  matrix, 
670;  pouring  metal,  671 ;  trimming 
and  polisning  plate,  6/2;  soldering 
process,  674;  lower  plates,  675:  re- 
pairs, 675;  attachment  of  teeth  by 
vulcanite,  710. 

Alveolar  processes,  anatomy,  52  ;  necro- 
sis and  exfoliation,  240;  absorption, 
around  teeth,  244  ;  after  extraction, 
505 ;  hypertropy  of  walls,  247  ;  peri- 
ostitis, 230. 

Amalgam,  for  filling  teeth  ;  instruments 
for  using,  301. 

Anaesthesia,  general,  410;  ether  and 
chloroform,  411;  hydrate  of  chlo- 
ral, bichloride  of  methylene,  414; 
nitrous  oxide  and  apparatus,  412. 

Anassthesia,  local;  congelation;  hypo- 
dermic injection,  415 ;  electro-mag- 
netism, 416;  spray  apparatus,  418. 

Anatomy  and  Physiology  of  the  mouth 
and  face  46. 

Annealing,  gold  plate,  567. 

Antagonism  of,  artificial  teeth,  590  ;  na- 
tural teeth,  99. 
Anthracite  coal,  for  melting  gold,  525  ; 

for  porcelain  furnace,  741. 
Antimony,  eff"ect  on  gold,  522 ;  as  alloy 

for  metallic  dies,  561,  565. 
Antrum  Highmorianum,  50  ;  diseases  of 

and  treatment,  181,  187,  460. 
Aqua  regia  process  for  refining  gold, 

523. 
Arsenious  acid,  action  on  nerve  pulp, 

215,  371. 
Arteries  of  mouth  and  face;    internal 

carotid,    70 ;    external  carotid  and 

branches,  70-74. 

785 


786 


INDEX. 


Articulation,  of  natural  tpcth  (gomplio- 
sis),  98;  of  artificial  teeth,  571- 
677,  importance  of  accuracy  in, 
577,  600,  684. 

Articulators,  metallic,  570,  684;  plas- 
ter, 572,  646,  654,  684. 

Artificial,  palates  or  vela.  766:  teeth, 
necessity  ami  utility,  488;  prepara- 
tion for  inserting,  504;  metiiods  of 
inserting,  495 ;  difl'erent  kinds  of, 
491. 

Asbestos,  over  exposed  nerve.  217;  use 
in  soldering,  586  :  continuous-gum, 
636 ;   porcelain,  744. 

Atmospheric  pressure;  history  of  appli- 
cation to  plates.  501,  628;  illustra- 
tion of  principle,  500,  622;  adhe- 
sion of  contact,  625 ;  vacuum  cav- 
ity, 628. 

Atrophy  of  teeth,  248. 

BACKING  porcelain  teeth;  prepara- 
tion for,  596;  different  forms  and 
processes  for  gold-plate,  597,  603; 
pivot  teeth,  513  ;  teeth  for  vulcanite 
plates,  688. 

Bichloride  of  methylene  for  anaesthesia, 
414. 

Bile,  45. 

Biscuiting  porcelain  teeth,  720. 

Bismuth,  use  as  alloy  for  metallic  dies, 
564. 

Bleaching  necrosed  teeth,  257. 

Block-teeth,  porcelain,  589;  manufac- 
ture of,  720  :  special  block-carving, 
736. 

Blood-vessels  of  mouth  and  face,  70. 

Blow-pipe,  mouth,  method  of  using,  580 ; 
alcoholic  or  self-acting,  Parmly's. 
581;  mechanical,  Elliott's,  583; 
Somerby's,  584;  hydrostatic,  vari- 
eties of,  585;  Count  Richmont's; 
Macomber's  gas  blow-pipe,  586. 

Body,  porcelain,  formulas  of  composi- 
tion, 636-719. 

Bone,  composition  and  development,  47; 
maxillary,  superior,  49,  inferior, 
54 ;  palate,  56, 

Borax,  use  in  melting  gold,  525-529 ; 
in  soldering,  578-588;  in  composi- 
tion of  contiguous  gum,  636 ;  por- 
celain, 720. 

Britannia  impression-cups,  538. 

Broaches  for  nerve-filling,  370;  for 
backing  teeth,  596. 

Brush-wheels  for  polishing,  604. 

Building  up  whole  or  part  of  crown  of 
tooth,  355. 


Burnishers,  for  fillings,  332 ;  for  plate 

work,  604. 
Burr-drills,  for  excavating  teeth,   305; 

for  backing  teeth,  598. 

C1ANALICULI  of  bone,  form  and  func- 
)  tion,  48;   cenientum,  120. 

Calcined  plaster,  543 ;  silex  and  feld- 
spar, 720. 

Calculus,  salivary:  black,  193;  dark- 
brown,  194;  white,  195;  dark- 
green,  196  ;  excessive  deposit,  197; 
chemical  composition,  197;  origin, 
198;  effects  on  teeth,  gums,  and 
alveoli,  200;  instruments  and  man- 
ner of  removal,  202. 

Cancrum  oris,  147. 

Carat  valuation  of  gold,  formulas  and 
tables,  530. 

Caries  of  the  teeth.  270  ;  liability  to, 
273;  causes.  278;  prevention,  281; 
surgical  treatment,  285;  prosthetic 
treatment  (see  filling),  295. 

Carving  block-teeth,  737  ;  Calvert's  me- 
thod, 741. 

Carrier  for  files,  294;  tape,  831. 

Cassius,  purple  of,  719. 

Cavities  in  teeth  (see  filling),  303;  va- 
cuum, 502,  628. 

Cells,  structure  and  development  of,  33; 
views  of  Schleiden  and  Schwann, 
35,  Goodsir.  Huxley,  37,  Henle, 
Kollicker,  Barrj%  36,  Bennett, 
Todd,  and  Bowman,  38,  Carpenter, 
Virchow,  39,  Lionel  Beale,  Tyson, 
41  ;  of  dentinal  pulp,  113;  of  en- 
amel, 118. 

Cementation  process  for  refining  gold, 
524. 

Cementum,  origin,  formation,  and  struc- 
ture, 120;  Beale"s  views,  121. 

Ceramic  art,  dental,  594,  722;  materials 
and  processes,  716. 

Ceramo-plastic  work,  642. 

Charcoal  as  fuel.  525,  741 ;  ingot-mould, 
532  ;   for  soldering,  586. 

Cheap  dentistry,  487,  607.  (See  Ethics.) 

Chemical  abrasion  of  teeth,  266. 

Cheoplastic  process,  history:  formation 
of  model,  645;  articulation,  646, 
654;  arranging  teeth  and  wax- 
plate,  648;  making  matrix,  650; 
finishing  and  repairing,  652. 

Chloral-hydrate,  414. 
Chloride  of,  gold.  523;  zinc,  216,  366. 
Chloroform,  for  sensitive  dentine,  297; 
use  in  extraction,  411. 


INDEX. 


787 


Clamps,  for  swaging,  568 ;  for  solder- 
ing. 627. 

Clasps:  value  and  conditions  of  use, 
487,  697;  teeth  suitable  for,  608; 
shaping  and  adjusting,  610  ;  method 
of  Fogle,  611,  Noble,  612,  Spalding, 
613,  Austen,  614 ;  gold,  for  vulcan- 
ite plates,  707. 

Clasp-plates,  shape  of,  615;  for,  inci- 
sors, 616;  six  front  teeth;  bicus- 
pids, 618;  ten  teeth,  619;  alternate 
spaces,  620. 

Classification  of  teeth :  anatomical,  93  ; 
structural,  123  ;  pathological,   186. 

Cleft-palate,  accidental,  745-771  ;  con- 
genital, 746-751. 

Cobalt,  oxide  of;  action  on  dental  pulp, 
216;  coloring  material  for  porce- 
lain, 717. 

Coke,  as  fuel,  525,  741. 

Coloring  materials  of  porcelain,  718. 

Combination  of  vulcanite  with  metal  for 
dental  plates,  708. 

Condensing  instruments  used  in  filling 
teeth,  317. 

Congelation,  as  an  anaesthetic,  413 

Continuous-gum  work,  633 ;  history, 
634;  properties,  635-640;  compo- 
sition, 636;  swaging  and  bacl^ing, 
638 ;  applying  gum  and  baking,  639. 

Copper,  as  alloy,  for  gold,  528  ;  for  zinc 
and  tin,  565. 

Corallite,  679. 

Cork  over  sensitive  nerve,  218. 

Corundum-wheels,  590. 

Counter-dies,  561 ;  fusible  and  type- 
metal,  557 ;  lead,  563  ;  partial,  567. 

Creosote,  use  in  nerve-operation,  368. 

Crown  of  tooth :  artificial,  355,  509 ; 
building  up,  with  adhesive  or 
sponge  gold,  355 ;  excising,  for 
pivot  tooth,  507. 

Crucibles,  Hessian,  525,  671. 

Crucing,orbiscuiting  porcelain,  720,  739. 

Crusta-petrosa,  120. 

Crystal,  or  sponge  gold,  299;  instru- 
ments and  manner  of  using,  327,342. 

Cuticle,  development  of,  44. 

Cylinder  filling,  321. 

Cystic  diseases,  181,  184. 

Cytoblastj  35. 

D'ARCET'S  inetal,  298. 
Defects  of  the  palatine  organs,  745. 
Dental  caries  (see  caries),  270;  groove, 


primitive,  103,  secondary,  105; 
pulp  (see  pulp),  213 ;  porcelain, 
716;  substitutes,  491. 

Denies  sapientige.  98;  time  of  eruption, 
108;  extraction  of,  403;  irregular- 
ity of,  434. 

Dentifrice,  Harris's  formula,  282. 

Dentine,  92;  origin  and  formation, 
views  of  Bell,  Purkiuje.  Schwann, 
112,  Nasmyth,  Owen,  113,  KoUicker, 
Lent,  Thomas,  114,  Huxley,  116, 
Beale,  Johnston,  117;  treatment  of 
sensitive,  216,  296. 

Diamond  drill,  594. 

Dies  and  counter-dies:  Clark's  process, 
556;  fusible  metal,  556;  dipping 
process,  Dunning's  process,  557; 
sand  moulding,  558;  for  partial 
sets,  562 ;  full  counter-dies,  563, 
partial,  567 ;  metals  and  alloys 
suitable  for,  560-566. 

Dislocation  of  lower  jaw,  452. 

Draw-plate,  535. 

Drills,  for  excavating  teeth,  305 ;  for 
laboratory  use,  594. 

Drill -stock:  jNIaynard's,  McDowell's, 
306  ;  Lewis',  Chevallier's,  Merry's, 
307. 

Drying  cavities  in  teeth,  316. 

Ducts,  salivary :  Steno's,  84;  Wharton's, 
85,  sublingual,  86. 

ELECTRO-MAGNETISM,  as  an  anses- 
thetic,  417. 
Elephant  ivory,  for  dentures,  473. 
Elevator,  for  extracting  roots,  404. 
Emery-wheels,  590  ;  cloth,  653. 
Enamel:    formation,    117;    characteris- 
tics, 119;   chisels  for  cutting,  291  ; 
continuous  -  gum,    636 ;    porcelain, 
719. 

Epulis,  178. 

Erosion  of  the  teeth,  249. 

Ether,  as  an  anaesthetic,  410. 

Ethereal  solution  of  collodion,  700. 

Ethics  of  dentistry  (see  introductory 
chapter) :  influence  of  patent 
rights,  713,  of  vulcanite,  710,  713, 
715;  use  of  words  "temporary" 
and  "permanent,"  506;  cheap  ma- 
terial and  careless  work,  487,  607, 
677,  713,  737,  745;  careless  swag- 
ing, 568,  and  articulation,  577,  684; 
neglect  of  aesthetics,  733. 

Excavators,  304,  308. 

Excising  forceps,  507. 

E.xtraction,    of   permanent   teeth,    386, 


788 


INDEX. 


300,  temporary  teeth,  406.  roots, 
402,  teeth  and  roots  for  artilicial 
work,  504 ;  instruments  of.  key, 
389;  forceps  (see  forceps),  392. 

Exfoliation  of  alveolar  ridge,  240. 

Exostosis  of  teeth,  258. 

Exposed  nerve:  destruction  of,  370; 
extirpation,  372;  iilliug  over,  3ljl ; 
treatment  of,  214,  361. 

FASCIA,  69. 
Fauces,  34,  40.   • 

Feldspar:  composition,  717;  use  for 
cheoplastic  models,  646;  a  compo- 
nent of  continuous-gum,  636,  por- 
celain, 720. 

Fibres,  muscular,  58. 

Fifth  pair  of  nerves,  75. 

File-carriers,  293. 

Files,  separating,  290;  V-shaped,  293; 
for  finishing  tillings,  331,  355,  Vul- 
canite, 704. 

Filing  teeth,  285. 

Filling  teeth,  295;  materials:  gold,  non- 
adlvesive  foil,  297,  adhesive  foil, 
298,  crystal  or  sponge,  299;  tin- 
foil, 300;  Avcet's  and  Wood's  met- 
als, 300  ;  amalgam,  301 ;  mastic  ; 
OS-art ificiel,  303,  366;  gutta-percha. 
Hill's  stopping,  812. 
formation  of  cavity,  309  ;  separating 
teeth,  311 ;  excluding  moisture, 
saliva  pump,  313,  Dibble's,  314; 
tongue-  and  duct  compressors,  315  ; 
drying  cavities,  316. 

introducing  gold;  non-adhesive  foil, 
319,  roll,  rope,  or  band,  320,  cylin- 
ders, 321,  pellets,  325;  adhesive 
foil,  325,  heavy  foil,  326 ;  crystal 
or  sponge  gold,  327. 

condensation  with  mallet,  328;  fin- 
ishing with  files,  331,  355  ;  iDurn- 
ishing,  332 ;  non-conductors  over 
sensitive  nerve,  296,  332. 

filling  special  cavities:  in  superior 
incisors  and  cuspids,  334,  same,  with 
adhesive  foil  and  sponge  jrold,  342  ; 
superior  bicuspids  and  molars,  343. 
same,  with  adhesive  foil  and  sponge 
gold,  348;  inferior  incisors  ami 
cuspids,  349,  inferior  bicuspids  and 
molars,  351 ;  building  up  crown, 
355,  360. 

filling  over  exposed  or  sensitive 
nerve,  361 ;  method  of  Foster, 
Fitch,  368,  Elliott,  365,  HuUihen, 
366;  use  of  os-artificiel,  366. 

filling   nerve-cavity   and    root-canal,  I 


367 ;  destruction  of  pulp  by  cau- 
tery, 370,  by  arsenic,  871,  by  ex- 
tirpation, 372;  method  of  Dunning, 
Foster,  373,  Maynard,  374,  Arthur, 
Harris,  375  ;  Gorgas'  treatment  of 
cavity,  375 ;  Arrington's  nerve-ex- 
tractors, 876 ;  Palmer's  excavators, 
Hunter's  nerve-pluggers,  877. 

Finishing,  surface  of  filings,  329;  gold 
work,  604;  cheoplastic  work,  652; 
aluminum  work,  672 ;  vulcanite 
work,  704. 

Fineness  of  gold,  528 ;  of  gold  solder, 
537  ;  formulas  and  tables  for  calcu- 
lation, 529. 

Fissure,  of  Glasserius,  56 ;  spheno- 
maxillary, pterygormaxillary,  49. 

Flask,  moulding:  wooden,  558;  Bail- 
ey's, 550,  Hawes',560,  Bean's,  668; 
cheoplastic,  653,  vulcanite,  690, 
Kingsley's,  for  palate,  782. 

Flux  for  melting  and  soldering  gold, 
529,  578,  588;  continuous-gum, 
636 ;  porcelain,  720. 

Fluids  of  the  mouth,  205. 

Foil,  gold  (see  filling),  297;  tin,  300. 

Forceps,  extracting;  for  molars,  Snell's, 
Harris',  894,  Wolverton's,  395, 
right  and  left,  396 ;  for  incisors 
and  cuspids,  896 ;  for  wisdom  teeth, 
398 ;  for  roots,  897 ;  Parmly's  al- 
veolar, 399,  with  screw,  406,  May- 
nard's,  407  ;  excising,  507  ;  Flagg's 
plugging,  347;  plate-cutting,  566; 
punch,  597,  Mallett's,  598. 

Formulas  for,  Harris'  mouth-wash,  169; 
alloying  gold,  531  ;  gold  solder, 
537;  continuous-gum,  636;  por- 
celain body  and  enamel,  719;  flux 
and  frit,  720. 

Fracture,  of  the  jaws,  455  ;  of  the  teeth, 
267. 

Foramen,  anterior  mental,  54 ;  infra- 
orbital, 49  ;  posterior  dental,  55  ; 
posterior  palatine,  57  ;  stylo-mas- 
toid,  81. 

Follicles,  dental,  104. 

Frenum  linguae,  54,  88. 

Fuel  and  furnaces  for  melting  gold,  525  ; 
for  porcelain,  740. 

Fusible,  metal  for  dies,  556;  alloys,  564. 

Fusibility  of  gold  solder,  537 ;  of  tin, 
lead,  &c.,  563,  564. 

G1  AUGE-PLATE,  535. 
r  Gangrene  of  the  mouth,  147. 
Ganglion;  Casserian,  76;  Meckel's;  sub- 
maxillary, 78. 


INDEX. 


789 


Generation,  spontaneous,  38,  42. 

Germinal  matter ;  synonyms,  41 ;  char- 
acteristics, 42;  of  dentine,  115. 

Glands,  salivary ;  parotid,  83,  submax- 
illary, 85,  sublingual,  86 ;  conglom- 
erate, 83 ;  mucous,  86. 

Gold,  for  filling  teeth;  foil,  297,  crystal 
or  sponge,  299;  for  base-plate; 
value,  521,  necessity  and  elfect  of 
alloys,  521,528;  refining,  522,  by 
nitric  acid  process,  by  aqua-regia 
process,  523 ;  by  cementation  pro- 
cess, 524,  by  fire,  526  ;  pouring  in- 
got, 527 ;  ingot-moulds,  532  ;  roll- 
ing-mills, 534 ;  gauge-  and  draw- 
plates,  tube- wire,  585 ;  spiral 
springs,  solder,  586;  soldering, 
577,  588 ;  teeth  attached  to,  by 
vulcanite,  707;  clasps  for  vulcan- 
ite, 707 ;  oxide  of,  for  porcelain 
gum-color,  719. 

Grinding  porcelain  teeth,  590,  685. 

Groove,  dental,  primitive,  103 ;  second- 
ary, 105. 

Gums,  anatomy,  71,  89;  general  pathol- 
ogy, 153;  inflammation,  160;  hy- 
pertrophy, 170  :  mercurial  inflam- 
mation, 172;  ulceration,  175;  ad- 
hesion to  cheek,  177 ;  tumors  of, 
178. 

Gum,  continuous-,  633. 

Gum  teeth,  589  :  single,  595  ;  blocks  or 
sections,  716-744. 

Gutta-percha,  over  sensitive  nerve,  218  ; 
for  filling  teeth,  302;  for  impres- 
sions, 543,  value  of,  547  ;  for  im- 
pression-cups, 540;  for  articulating 
rims,  573 ;  for  palate  models,  780. 

HAMMER,  wood,  horn,  or  lead,  for 
first  swaging,  567 ;  iron,  for  final 

swaging,  569. 
Hand-lathes,  510,  591. 
Hard  rubber  (see  Vulcanite),  679. 
Harris'    dentifrice,    282 :    mouth-wash, 

169. 
Heavy  gold  foil,  826. 
Hemorrhage  after  extraction,  408. 
Hickory  wood  for  pivots,  410. 
Hill's  stopping,  302. 
Hippopotamus  ivory,  493. 
Hollow  wire,  515,  535. 
Hook  for  extracting  roots,  404. 
Human  teeth  "attached  to  artificial  plate, 

491. 
Hydrate  of  chloral,  414. 


Hydrostatic  blow-pipes,  585. 
Hypertrophy    of    cementum,    136;    of 
gums,  170  ;  of  walls  of  alveoli,  247. 

TMPRESSION-CUPS:    metallic,    538; 

J_  Franklin's,  539,  gutta-percha,  hard- 
rubber,  porcelain,  540 ;  Beau's 
swaged,  544,  662 ;  false  economy 
in  use  of,  540. 
materials ;  properties  and  classifica- 
tion, 541;  beeswax  and  compounds, 
541;  gutta-percha,  plaster,  543; 
comparative  value,  547. 

Impressions:  method  of  taking,  Bean's, 
544,  Austen's,  545  ;  preparation  for 
model,  546,  removal  from  model, 
554  :  for  vulcanite,  682,  for  obtura- 
tor, 766  ;  for  artificial  palate,  778. 

Incorruptible  teeth,  494. 

India-rubber,  678 ;  for  regulating  teeth, 
438,  for  separating  teeth,  312;  sul- 
phurated, 679. 

Inferior  maxilla,  54 ;  dislocation  and 
fracture  of,  454;  protrusion  of, 
452. 

Inflammation  of,  gums,  160;  dental 
pulp,  219;  periosteum,  235;  max- 
illary sinus,  466. 

Ingot,  method  of  pouring,  527;  moulds; 
iron,  soapstone,  charcoal,  532. 

Insertion  of,  artificial  teeth  (organic 
prosthesis),  different  methods  of, 
495  ;  gold  in  dental  cavities  (struct- 
ural prosthesis),  difi'erent  methods 
of,  319. 

Instruments  for,  forming  cavities  in 
teeth,  303;  introducing  gold,  817, 
823,  827 ;  finishing  fillings,  331  ; 
nerve-operations,  378  ;  manner  of 
using,  336-378 ;  for  extraction  of 
teeth,  389,  roots,  404. 

Investment,  of  plaster  preparatory  to 
backing  teeth,  596 ;  asbestos  (or 
sand)  and  plaster,  preparatory  to 
soldering,  587,  602. 

Irregularity  of  natural  teeth,  in  form, 
420;  osseous  union,  422  :  supernu- 
merary teeth,  424;  third  dentition, 
425 ;  in  arrangement,  434 ;  treat- 
ment and  apparatus  for,  436-449; 
use  of  vulcanite  for,  447. 

Irregular  arrangement  of  artificial 
teeth,  594,  731. 

KAOLIN,    718;    use   in   continuous- 
gum,    636 ;    in    dental    porcelain, 
720. 
Key  of  Garengeot,  389. 


790 


INDEX. 


LAISIPS:  soldering,  578;  vulcanizing, 
Hayes',  0',)2,  Franklin's,  G'JG. 

Lancing  the  gums,  401. 

Lathes  for  grinding  teeth,  &c. ;  hand, 
510,  591,  foot,  590. 

Lavater's  classification  of  tempera- 
ments, 131. 

Lead,  for  filling  cavities  in  teeth,  300; 
for  counter-dies,  560 ;  alloys  of, 
5G1,  564;  effect  of  antimony,  565; 
for  swaging-hammer,  567. 

Liability  of  teeth  to  decay,  273. 

Ligament,  dental.  00;  external  lateral, 
spheno-maxillary,  stylo-maxillary, 
66. 

Lining  root-canal  with  gold,  515. 

Lips,  symptomatology  of,  207. 

Lower  jaw,  excess  of  teeth  in,  450;  pro- 
trusion, 452  ;  dislocation,  454;  frac- 
ture, 457. 

ll^'rAGNET,    for   refining   gold-filings. 

Magnetism,  electro-,  as  an  anaesthetic, 
417. 

Malleability  of  gold,  296,  -521. 

Mallet,  force  in  condensation  of  gold, 
328 ;  hand  and  automatic,  329 ; 
.  pluggers,  330. 

Manganese,  oxide  of;  coloring  material 
of  porcelain,  719. 

Manufacture  of  porcelain  teeth,  720. 

Materials;  for  filling  teeth,  297;  used 
as  dental  substitutes,  491 ;  for  im- 
pressions, 541 ;  for  swaged  plates, 
521,  632 ;  for  plastic  or  moulded 
plates,  640;  for  dental  porcelain, 
707. 

Matrix  of  bone,  48 ;  sand,  for  dies,  558; 
cheoplastic,  650;  alumino-plastic, 
664;  brass,  for  moulding  teeth, 
720 ;  plaster,  for  moulding  blocks, 
738,  742. 

Maxilla,  superior,  49:  excision  of,  191 ; 
inferior,  54  (see  lower  jaw). 

Mechanical  abrasion  of  teeth,  266. 

Mechanics,  or  mechanism  of  dentistry; 
classification,  485;  literature  of, 
490. 

Membrana  preformativa,  119,  125. 

Metallic  impression-cups ;  britannia, 
538,  swaged,  544,  copper,  556;  dies 
and  counter-dies  (see  dies),  556. 

Metals,  for  filling  teeth,  299 ;  for  swaged 
plates,  632,  for  plastic  plates,  643; 
for  dies  and  counter-dies,  561. 


Metallo-plastic  work,  643  ;  cheoplastic, 
645 ;  stanno-plastic,  656  ;  alumino- 
plastic,  662. 

Methylene,  bichloride  of,  414. 

Mercurial  stomatitis,  150  ;  inflammation 
of  gums,  172;  amalgam,  301;  ac- 
tion of  vulcanite,  681. 

Model,  plaster,  549;  diff"erent  forms  of 
for  swaging,  550,  cheoplastic,  045, 
vulcanite,  683;  Bean's  first  model, 
663,  second  model  and  matrix-mo- 
del, 665;  sectional  model,  West- 
cotl's,  552,  Bean's,  553,  663  ;  artic- 
ulating, 646,  654,  571. 

Molecular  force,  38. 

Moulding-flasks,  559,  668;  sand,  spat- 
ula, 558. 

Mouth,  anatomy  and  physiology  of,  46; 
bones,  49,  muscles,  58,  blood-ves- 
sels, 70,  nerves,  glands,  75,  mucous 
membrane,  88,  fluids  of,  205;  rela- 
tions of,  90;  treatment  of  prepar- 
atory to  artificial  work,  503;  im- 
pression of,  538. 

Mouth-wash  ;  Fitch's,  Koecker's,  Bell's, 
168,  Harris',  169,  Garretson's,  174. 

Mucous  membrane  of  mouth,  88;  dis- 
eases, 143;  deposit  of  on  teeth, 
204. 

Muscles  of  the  mouth  and  face,  58 ; 
classification  of,  60. 

NECROSIS  of  alveolar  walls,  240 ;  of 
the  teeth,  255. 

Nerve,  exposed;  filling  over,  361,  and 
instruments  for,  376  ;  destruction 
and  removal  of,  367  ;  inflammation 
of,  379. 

Nerves  of  the  mouth  and  face  ;  fifth  pair 
(trigemini),75;ophthalmicbranches, 
superior  maxillary  branches,  77 ; 
inferior  maxillary  branches,  79 ; 
facial  nerve  (porti  dura  of  the 
seventh  pair)  and  branches,  80. 

Nitrate  of  potash  for  refining  gold,  525. 

Nitric  acid  process,  523. 

Nitro-muriatic  acid  process,  525. 

Nitrous  oxide  gas  and  apparatus,  for 
anaesthesia,  412 ;  as  a  blowpipe,  585. 

Nucleolus  and  nucleus  of  cell,  develop- 
ment of,  35,  38. 

OBTURATOR,  762;  Delabarre's  for 
hard  palate,  764;  Kingsley's  for 
soft  palate,  765  ;  taking  impression 
for,  766,  combined  with  artificial 
palate,  775. 


INDEX. 


791 


Odontalgia,  379. 

Odontatropia,  250. 

Odontitis,  380. 

Operations  in  organic  prosthesis,  485 ; 

in  structural  prosthesis,  295,  367. 
Organic  prosthesis,   or  replacement  of 

dental  organs,  485,  488. 
Origin  and  formation  of  teeth,  100;  of 

salivary  calculus,  198. 
Os-artificiel,  303,  218,  366. 
Ossification  of  dental  pulp,  28L 
Osteology,  47. 
Osteo-dentine  267,  362. 
Osteo-sarcoma,  188. 

Outline  form  of  partial  plates,  616-621. 
Oxide  of  cobalt,  216;  gold,  manganese, 

titanium,  and  uranium,  719. 
Oxidation  of  eighteen  carat  gold,  521 ; 

of  cheoplastic  metal,  645  ;  of  other 

tin  alloys,  644. 
Oxychloride  of  zinc,  303,  218,  366. 

PALATE,  hard,  56,  soft,  69 ;  muscles 
of,  68,  750. 

Palates,  artificial,  766;  Kingsley's,  767- 
784,  Stenrn's,  771.  773,  780,  Sere- 
comb's  principle,  769; 
for   accidental  loss,   Kingsley's    case 

first,  767;  case  second,  769; 
for  congenital  fissure,  771,  case  first, 
772,  case  second,  773,  case  third, 
774  ;  features  common  to  all,  774  ; 
combined  with  stapbyloraphy,  777  ; 
Kingsley's  method  of  constructing : 
impression,  778,  model,  779,  gutta- 
percha pattern,  780,  matrix,  made 
of  plaster,  781,  made  of  type-metal, 
782,  improved  forms  of  matrix, 
783. 

Palatine  organs,  defects  of:  accidental, 
745,  749,  751 ;  treatment  by  obtu- 
rators and  artificial  palates,  762- 
771,  by  stapbyloraphy,  759. 
congenital :  nature  and  development 
of,  746 :  effect  on  mastication  and 
deglutition,  747.  on  vocal  articula- 
tion, 749  ;  treatment  by  stapbylor- 
aphy, 749,  by  obturators  and  arti- 
ficial palates,  762-784. 

Palladium  for  base-plates,  638. 

Paning  (or  peening)  gold  band  for  rim- 
ming or  backing,  710. 

Papillae,  of  tongue,  circumvallate,  fun- 
giform, 88;  dental,  100,  104,  109. 

ParaflBne  with  wax,  for  impressions,  541. 


Partial,  counter-dies,  567 ;  clasps,  or 
stays,  614. 

Partial  plates  ;  dies  for,  562  ;  swaging, 
5G6 ;  outline  forms,  615-621  ;  re- 
tention of,  627;  of  vulcanite,  707; 
of  stannic  alloys,  658. 

Parotid  gland,  83. 

Periosteum,  alveolo-dental,  89 ;  suppu- 
ration of,  233. 

Periostitis,  alveolar,  230. 

Permanent  teeth,  93 ;  extraction  of, 
386. 

Phosphor-necrosis,  243. 

Physiognomy,  importance  of  assthetie 
study  of,  594,  725. 

Pickling  gold  plate,  to  remove  borax, 
603,  lead  and  other  swaging  me- 
tals, 569  ;  surface  alloy,  604. 

Pivot  teeth :  value  and  conditions  of 
use,  495 ;  excision  of  crown  for, 
507;  treatment  of  nerve,  508^  se- 
lection of  crown,  509;  wooden  pi- 
vot, 510,  inserting  and  removing; 
same,  511;  metallic  pivot,  512-52(1, 
Bean's  method,  516,  Thomas'  me- 
thod, 519 ;  comparison  of  wood 
and  metal,  views  of  Fitch,  513, 
Koecker,  Harris,  514,  Austen,  520; 
Austen's  method  by  use  of  vulcan- 
ite, 711. 

Plaster,  calcined  :  for  impressions,  543, 
manner  of  using,  545,  comparative 
value,  547,  683,  778;  for  models, 
549,  663 ;  for  temporary  investing 
band,  after  grinding  teeth,  596, 
686  ;  for  soldering-batter,  587,  601. 

Plastic-work,  640;  ceramo-plastic,  642, 
743,  cheoplastic,  645,  stanno-plas- 
tic,  656,  alumino-plastic,  661,  vul- 
cano-plastic,  678. 

Plate,  swaged  for  dental  "base :  classifi- 
cation, 487  ;  swaging,  566  ;  adjust- 
ing teeth  to,  589 ;  articulating, 
671 ;  soldering  teeth  to,  587,  601 ; 
comparison  of  different  kinds,  632. 

Platina,  as  alloy  of  gold,  522 ;  precipi- 
tation of,  524;  backings  for  gold- 
plate,  601  ;  for  ordinary  swaged 
plate,  633 ;  for  continuous-gura 
work,  638  ;  sponge  for  coloring  por- 
celain, 719 ;  pins  for  teeth,  how  in- 
serted, 720;  White's  foot-shaped, 
721. 

Plugging  forceps,  347  ;  pliers,  319 ;  in- 
sti-uments,  318,  Redman's  for  cyl- 
inder filling,  323,  for  sponge  gold, 
327,  for  use  with  mallet,  329,  for 
nerve  cavities,  377. 


792 


INDEX. 


Polishing  fillings,  332 ;  gold  plate,  608 
(see  finishing). 

Polypus  of  antrum,  187. 

Porcelain  impression-cups,  640. 

Porcelain  plates,  C42,  743. 

Porcelain  teeth,  494:  kinds  of,  589; 
aesthetic  rules  for  selection  of,  594  ; 
variety  and  beauty  of,  722;  re- 
quirements of,  721) ;  illustrations 
of  different  styles  of,  726-733 ;  ad- 
justment to  metal  plates,  589-600; 
vulcanite  blocks,  708;  wholesale 
manufacture  of,  720 ;  in  blocks 
carved  for  special  cases,  737. 

Portio  dura  of  the  seventh  pair  (facial 
nerve),  80. 

Potassium,  bromide  of,  to  deaden  sen- 
sibility of  fauces,  755. 

Preparation,  of  nerve-cavity  and  root 
for  filling,  367  ;  of  moutli  for  arti- 
ficial work,  503  ;  of  root  for  artifi- 
cial crown,  507. 

Prevention  of  caries,  281. 

Process:  alveolar,  malar,  nasal,  palate, 
52 ;  mental,  54 ;  coronoid,  condy- 
loid, processus  gracilis,  66  ;  orbital, 
57. 

Prosthesis  (see  introductory  chapter) 
of  structure,  295;  of  organs,  488; 
ethical  considerations,  489. 

Protection  against  saliva,  313. 

Protoplasm,  40. 

Protrusion  of  lower  jaw,  452. 

Ptyaline,  87. 

Pulp-cavity,  filling  (see  nerve),  367. 

Pulp,  dental,  93,  102,  109,  116;  diseases 
of,  213,  irritation,  214,  inflamma- 
tion, 219,  224,  fungous  growth, 
228,  ossification,  229;  treatment 
of  exposed,  223 ;  destruction  and 
removal  of,  370 ;  action  of  arsenic, 
215,  cobalt,  oxide  of  zinc,  216. 

Pulp,  enamel,  118. 

Pumice  for  dentifrice,  282  ;  for  support 
in  soldering,  587;  for  Bean's  ma- 
trix-model, 665,  668;  for  stanno- 
plastic  model,  657;  for  finishing 
vulcanite  plates,  704. 

Punch  for  marking  backings,  593  ;  for- 
ceps, 592;  for  extracting  roots, 
404. 

Purple  of  Cassius,  719. 

Purulent  engorgement  of  maxillary  si- 
nus, 468. 

Pus,  formation  of,  44. 

Pyrometer,  741. 


RECIPES,  for  dentifrice,  282 ;  mouth- 
wash, 167;  alloying  gold  plate, 
631,  gold  solder,  637  ;  continuous- 
gum,  636,  porcelain  body  and  en- 
amel, 719,  flux,  gum-frit,  and  gum- 
enamel,  720. 

Refining  gold,  by  acid  processes,  523 ; 
by  fire,  526. 

Repairing  continuous-gum  work,  640 ; 
cheoplastic  work,  655 ;  stannic  al- 
loys, 658;  vulcanite,  706,  710; 
alumino-plastic  work,  075. 

Replacement  of  teeth  (organic  prosthe- 
sis), 488  ;  order  of  operations,  485. 

Retention  of  artificial  work,  495,  605 ; 
pivot,  495,  507  ;  clasps,  497,  607  ; 
spiral  springs,  499,  606  ;  atmos- 
pheric pressure,  600,  622  ;  adhesion 
of  contact,  500,  625;  vacuum-cavity, 
502,  628. 

Ring  socket,  for  excavators,  305. 

Rolling-mills,  534, 

Root,  orris,  for  dentifrice,  282. 

Roots  of  teeth,  filling  canal  of,  367;  ex- 
traction of,  404 ;  necessity  of  re- 
moval for  artificial  work,  504;  pre- 
paration for  pivot  tooth,  496,  507. 

Rubber-dam,  Barnum's,  316. 

Rubber,  India,  679 ;  bands  for  correct- 
ing irregularity,  449. 

SALIVA,  composition,  86;  function 
87;  symptomatology,  206;  pumps 
for  removal  of,  314. 

Salivary  calculus  (see  calculus),  193. 

Sand  moulding,  558;  with  plaster  for 
soldering  batter,  601. 

Scalers  for  removing  tartar,  202. 

Screw  for  roots,  405 ;  forceps,  406. 

Scorbutus,  151. 

Secondary  dental  groove,  105. 

Second  dentition,  teeth  of,  92 ;  method 
of  directing,  430. 

Secretion,  nature  of,  45 ;  parotid,  85  ; 
submaxillary,  86. 

Sections,  porcelain,  wholesale  manufac- 
ture, 720;  for  special  cases,  737. 

Self-acting  blowpipes,  580. 

Sensitive  dentine,  215,  296. 

Separating  teeth  by  filing,  311  ;  by 
wedges  or  rubber,  312. 

Shears,  plate,  566. 

Shrinkage  of  metallic  dies,  561 ;  of  alu- 
minum, 662;  of  porcelain  paste  in 
baking,  720,  738. 

Silica  in  porcelain,  717. 


INDEX. 


793 


Silver,  as  alloy  of  gold,  528 ;  as  base- 
plate, 632 ;  use  in  composition  of 
cheoplastic  metal,  645. 

Soapstone,  ingot  mould,  523 ;  powder 
with  plaster,  657. 

Socket-handle,  Forbes',  303 ;  ring,  305. 

Soft  palate  (see  palate),  69. 

Solder,  gold,  536,  formulas,  537 ;  for 
aluminum,  660  ;  for  vulcanite,  705. 

Soldering  :  conditions  of  success,  577  ; 
process,  587,  602 ;  clamps  for,  586, 
627;  lamps  for,  579;  blowpipes  for, 
580;  preparation  of  clasps  for,  613. 

teeth  to  backings,  601  ;  backings  to 
plate,  602,  588;  double  plates,  627; 
teeth  to  cast  aluminum,  674. 

Spar  (feldspar)  in  porcelain,  717 ;  mixed 
with  plaster,  613. 

Spiral  springs,  499,  606. 

Spray  apparatus  for  anaesthesia,  418  ; 
as  a  blowpipe,  582. 

Springing  of  plates  in  soldering,  587, 
600. 

Stannic  (tin)  alloys,  for  metallic  dies, 
564 ;  for  base-plates,  656  ;  use  in 
Bean's  process,  674. 

Staphyloplasty,  759. 

Staphyloraphy,  749;  history,  752;  ear- 
lier forms  of  operation,  753 ;  Fergus- 
son's  first  operation,  754;  his  later 
method,  757 ;  Cartwright's  prepara- 
tion of  patient,  754 ;  combination 
with  Kingsley's  artificial  palate, 
760;  comparison  of,  with  mechan- 
ism, 761. 

Steno,  duct  of,  84. 

Stomatitis,  143;  erythematic,  144;  ul- 
cerative, 145  ;  gangrenous,  146  ; 
mercurial,  150  ;  scrofulous.  151. 

Submaxillary  glands,  85. 
Sublingual  glands,  86. 

Substitutes  for  teeth  ;  human  teeth,  491 ; 
teeth  of  cattle  ;  ivory,  493  ;  porce- 
lain, 494,  720. 

Substitution,  or  replacement  of  teeth 
(organic  prosthesis),  488;  classifi- 
cation of  operations,  485. 

Sulphur,  combination  of,  with  gutta- 
percha, 678 ;  with  India-rubber, 
679  ;  action  on  vulcanizers,  695. 

Sulphuric  acid,    action  on  teeth,  280; 

process  for  refining  gold,  524 ;  for 

pickling  gold  plate,  603. 
Superior  maxilla,  48. 
Supernumerary  teeth,  424. 


Swaged  woi'k,  operations  of  classified, 

487  ;  metals  used  for,  632. 
Swaging  process,  566. 
Syringe  hypodermic,  415. 


TABLES  :  for  ascertaining  fineness  of 
gold,  530 ;  for  alloying  gold,  530 ; 
of  fusible  alloys,  561,  564 ;  of  fusi- 
bility and  specific  gravity,  563  ;  of 
steam  pressure  and  temperature, 
694 ;  of  time  and  temperature  in 
vulcanizing,  702. 

Tartar  (see  calculus),  193. 

Teeth  :  anatomical  classification  and  de- 
scription, 92  ;  origin  and  formation, 
100;  structure  of,  112. 
pathological  classification,  136;  dis- 
eases of,  248-281 ;  caries,  270 ;  fill- 
ing (structural  prosthesis),  295- 
378;  extraction,  386-419;  irregu- 
larity, 420-452. 
replacement  of  loss  of  (organic  pros- 
thesis), 488;  substitutes  for,  491; 
methods  of  replacing,  495;  articu- 
lation or  antagonism  of;  anatomi- 
cal, 98,  prosthetic,  671;  suitable  for 
clasping,  607;  grinding  and  adjust- 
ing to  plate,  589 ;  manufacture  of 
porcelain,  716;  various  forms  and 
aesthetic  study  of,  722. 

Temporary  teeth,  92  ;  extraction  of,  406. 

Temporary  investing  rims  of  plaster, 
after  grinding  teeth,  696,  686. 

Temperaments,  classification  of,  131. 

Third  dentition,  425. 

Time  after  extraction,  for  insertion  of 
artificial  teeth,  506. 

Tin,  and  its  alloys;  for  swaging,  561; 
for  base-plates,  644,  656. 

Tin-foil:  for  filling  teeth,  300;  for  in-^ 
vesting  impressions,  550;  for  pat- 
terns of  plate,  566  ;  for  temporary 
articulating  plates,  and  for  tempo- 
rary use  in  grinding  teeth,  684. 

Titanium,  oxide  of,  for  coloring  porce- 
lain, 719. 

Tooth-ache  (odontalgia),  379. 

Tongue,  87;  compressors  of,  313;  symp- 
tomatology of,  219. 

Tonsils,  69. 

Trial  of  teeth  before  soldering,  601 ;  un- 
necessary after  correct  articula- 
tion, 684. 

Tube-wire,  535. 

Tumors,  of  the  gums  and.  jaws,  178; 
cystic,  181. 


794 


INDEX. 


Type-metal:  for  metallic  dies,  565 ;  for 
Kingsley's  palate  matrix,  782. 

URANIUM,  oxide  of,  for  coloring  por- 
celain, 719. 
Ulceration  of  the  gums,  175. 
Uvula,  69,  750;  loss  of,  751,  767. 

VACUUM-cavity:  history,  628;  form 
and  position,  630;  objections  to 
use,  502,  632. 

Varnishes  for  plaster  impressions  and 
models,  544,  555,  640,  663,  700. 

Views  of  the  mouth  and  face,  74. 

Vela,  artificial,  762. 

Vulcanite,  679-715;  composition  and 
varieties  of,  680 ;  efFect  of  the  ver- 
milion in,  681;  impressions,  682; 
models,  683  ;  articulation,  684  ; 
grinding  and  arranging  teeth,  685; 
making  matrix-plate,  687  ;  packing 
and  preparing  flasks,  697  ;  time  of 
vulcanizing,  701 ;  removal  from 
flask  and  finishing,  703  ;  repairs  of, 
706;  Stuck's  method,  705. 
teeth  suitable  for,  688,  708,  721,  724- 
735 ;  partial  sets  and  gold  clasps 
for,  701 ;  attaching  teeth  to  metal 
plates  by,  718  ;  for  pivot  teeth,  710  ; 
for  correcting  irregularity,  447. 
durability  of,  712;  Goodyear's  and 
other  patents,  713  ;  merits  and  de- 
merits of,  714. 


Vulcanizers,  688;  Hayes',  691;  Iron- 
clad, Buckeye,  Whitney's,  Frank- 
lin's, 692;  flasks  for,  690,  and  flask 
press,  700;  packing -boiler,  098; 
safety-lamp,  Hayes',  692,  Frank- 
lin's, 096. 

regulation  of  temperature  by  steam- 
gauge,  693  ;  by  thermometer,  694  ; 
steam  high-pressure  tables,  694  ; 
strength  of  vulcanizers,  695;  time- 
table, 702. 

WAX :  for  impressions,  541 ;  com- 
parative value,  547  ;  for  articu- 
lating plates  and  rims,  573 ;  for 
matrix-plates,  686. 

Warping  of  plates,  587,  600. 

Wedges  for  separating  teeth,  312. 

Wedgewood's  porcelain,  718;  pyrome- 
ter, 741. 

Weston's  and  Wood's  fusible  metals,  056. 

W^estcott's  experiments  on  acids  and 
alkalies,  279. 

Wharton's  duct,  86. 

W^ood's  metal  for  filling,  300. 

ZINC  :  use  in  gold  solder  ;  for  metal- 
lic dies  made  by  pouring  in  impres- 
sion, 556,  made  by  sand-moulding, 
558 ;  contraction  of,  501  ;  advan- 
tages of,  for  die,  560,  503. 
Zinc,  oxy-chloride,  210,  303  ;  white  ox- 
ide of,  for  polishing,  704 


THE   END. 


CLASSIFIED  INDEX 

(BY  SUBJECTS) 


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tiiioncr. 

"  It  would  be  difficult  to  point  out  anything  that  can- 
not be  found  in  Aitken." — Glasg'ow  Medical  "jfournal. 


"The  representative  book  of  Medical  science  and 
practice." — London  Lancet. 

"  The  additions  that  have  been  made  by  the  Ameri- 
can Editor  are  copious  and  important." — Ajnericati 
yournal  Medical  Science. 

ALLEN,  COMMERCIAL  ORGANIC  ANALYSIS. 

An  Introduction  to  the  Practice  of  Commercial  Organic  Analysis.     By  Alfred 
H.  Allen,  f.c.s.    Vol.  i.     Cyanogen  Compounds,  Alcohols  and  their  Deriva- 
tives, Phenols,  Acids,  etc.     8vo.  Price  $3.50 
Vol.  H  now  ready.     8vo.  Price  $5.00 
Being  a  treatise  on  the  Properties,  Analytical  Examination,  and  Modes  of 
Assaying  the  various  Organic  Chemicals  and  Preparations  employed  in  the 
Arts,  Manufactures,  Medicine,  etc. 
ALLAN,  FEVER  NURSING. 

Notes  on  Fever  Nursing.  Addressed  to  nurses  in  hospital  and  private  life. 
By  James  W.  Allan,  m.d.     i2mo.     Illustrated.  Price  .75 

ALLINGHAM,  DISEASES  OF  THE  RECTUM. 

Fistula,  Haemorrhoids,  Painful  Ulcer,  Stricture,  Prolapsus,  and  other  Diseases 
of  the  Rectum,  their  Diagnosis  and  Treatment.  By  William  Allingham, 
F.R.C.S.     Fourth  Edition,  enlarged.     8vo.  Price  I3.00 

"  No  book  on  this  special  subject  can  at  all  approach    1  "It  is,  as   indeed  the  verdict  of  the  profession  has 

Mr.  Allingham's  in  precision,  clearness  and   practical  already  pronounced  it,  one  of  the  very  best  works  on 

good  sense." — London  Medical  Times  and  Gazette.        i  Disease."^  of  the    Rectum." — Atnerican    yournal   o/ 

\  Medical  Science. 

ALTHAUS,  MEDICAL  ELECTRICITY. 

A  Treatise  on  Medical  Electricity,  Theoretical  and  Practical,  and  its  Use  in 
the  Treatment  of  Paralysis,  Neuralgia,  and  other  Diseases.  By  Julius  Althaus, 
M.D.     Third  Edition,  Enlarged.     246  Illustrations.     8vo.  Price  ;g6.oo 

In  revising  this  new  edition  the  author  has  carefully  brought  each  section  up 
with  the  latest  knowledge  of  the  subject. 


PUB  Lie  A  TIONS. 


5 


ANDERSON,  ON  ECZEMA. 

The  Pathology  and  Treatment  of  the  various  Eczematous  Affections  or  Erup- 
tions of  the  Skin.  By  McCall  Anderson,  m.d.  Third  Revised  and  Enlarged 
Edition.     8vo.  Price  $2.50 

ANSTIE,  STIMULANTS  AND  NARCOTICS. 

With  special  researches  on  the  Action  of  Alcohol,  Ether  and  Chloroform  on 
the  Vital  Organism.     By  Francis  E.  Anstie,  m.d.      8vo.  Price  $3.00 

"  He  is  an  original  worker  and  independent  thinker.     His  opinions  and  conclusions  are  valuable,  and  cannot 
be  neglected." — Ainerican  Medical  yourjial, 

ATTHILL,  DISEASIES  OF  WOMEN. 

Clinical  Lectures  on  Diseases  Peculiar  to  Women.  By  Lombe  Atthill,  m.d. 
5th  edition,  revised  and  enlarged,  with  numerous  illustrations.     i2mo.     Cloth. 

Price  $2.25 

"  It  is  the  concentrated  essence  of  the  knowledge  of  one  who  has  become  wise  by  reason  of  long  and  well- 
digested  experience  in  the  subjects  treated." — American  yournal  of  Medical  Science. 
"  The  work  is  one  of  great  value  to  the  general  practitioner." — Americaft  yourncd  of  Obstetrics. 

AVELING,  POSTURE  IN  OPERATIONS. 

The  Influence  of  Posture  on  Women  in  Gynecic  and  other  Operations.  By 
J.  H.  AvELiNG,  M.D.     Illustrated.     8vo.  Price  $2.00 

A  subject  which  hitherto  has  received  but  little  attention  is  here  treated  in  a 
very  thorough  manner,  showing  the  importance  of  certain  postures,  and  the 
various  diseases  produced  by  awkward  and  unhealthy  positions. 


By  G.  W.  Balfour, 
^Preparing. 


BALFOUR,  ON  THE  HEART  AND  AORTA. 

Clinical  Lectures  on  Diseases  of  the  Heart  and  Aorta. 
M.D.     Illustrated.     2d  Edition. 

"  The  whole  work  reflects  much  credit  on  its  author,  and  firmly  establishes  his  reputation  as  an  authority  on  the 
important  diseases  of  which  he  treats." — London  Practitioner . 

BARTH    AND    ROGER,    AUSCULTATION    AND    PERCUS- 
SION. 

A  Manual  for  the  Student.  By  M.  Earth  and  M.  Henri  Roger.  Trans- 
lated from  the  6th  French  Edition.     i2mo.  Price  $1.00 

BIBLE  HYGIENE; 

Or,  Health  Hints.  By  a  Physician.  This  book  has  been  written,  first,  to  im- 
part in  a  popular  and  condensed  form  the  elements  of  Hygiene  ;  second,  to  show 
how  varied  and  important  are  the  Health  Hints  contained  in  the  Bible,  and  third, 
to  prove  that  the  secondary  tendency  of  modern  Philosophy  runs  in  a  parallel 
direction  with  the  primary  light  of  the  Bible.    i2mo.  Price  $1.00 

"  The  scientific  treatment  of  the  subject  is  quite  abreast  of  the  present  day,  and  is  so  clear  and  free  from  unne- 
cessary technicalities  that  readers  of  all  classes  may  peruse  it  with  satisfaction  and  advantage." — Edinburgh 
Medical  Journal. 

BIDDLE,  MATERIA  MEDICA.     Eighth  Edition. 

Materia  Medica  for  the  Use  of  Students.  By  John  B.  Biddle,  m.d.,  Late  Pro- 
fessor of  Materia  Medica  at  Jefferson  Medical  College,  Philadelphia.  8th 
edition.  Revised,  Enlarged  and  Illustrated.     8vo.  Price  $4.00 


"  The  additions  are  valuable,  and  we  must  congrat- 
ulate the  author  upon  having  improved  what  was 
already  so  useful  a  work,  both  to  the  student  and  phy- 
sician."— Phila.  Medical  and  Surgical  Reporter. 

"  It  has  been  the  design  of  the  author  to  present  in 
his  work  a  text-book  for  the  student.  It  fs  brief,  and 
yet  sufliciently  comprehensive.  His  style  is  clear  and 
yet  succinct.  He  covers  the  ground — covers  it  well, 
and  cumbers  lUs  work  with  nothing  -superfluous." — 
Atlanta  Medical  and  Surgical  yaurnal. 


"  One  thing  that  particularly  recommends  this  work 
to  the  student  is,  that  the  book  is  not  so  large  as  to  dis- 
courage and  cause  him  to  feel  that  it  is  impossible  for 
him  to  get  over  it  and  so  much  else  in  the  short  time 
before  him." — St.  Louis  Medical  and  Surgical  Jour- 
nal. 

"  It  contains,  in  a  condensed  form,  all  that  is  valu- 
able in  materia  medica,  and  furnishes  the  medical 
student  with  a  complete  manual  on  this  'subject."^ 
Canada  Lancet. 


PRESLEY  BLAKISTON'  S 


BLACK,  THE  REPRODUCTIVE  AND  RENAL  ORGANS. 

The  Functional  Diseases  of  the  Renal,  Urinary  and  Reproductive  Organs, 
with  a  General  View  of  Urinary  Pathology.  By  D.  Campbell  Black,  m.d., 
F.R.c.s.     i2mo.  Price  $2.00 

"  The  title  of  this  book  sufficiently  indicates  its  character  and  scope.  Some  of  the  chapters  are  almost  ex- 
haustive of  their  topics.  Thus,  in  the  chapter  on  spermatorrhoea,  the  whole  philosophy  and  therapeutics 
of  this  vexatious  coiidition  is  given  with  unusual  clearness." — Cincinnati  Lancet  and  Observer. 

BY    SAME    AUTHOR. 

DISEASES  OF  THE  KIDNEYS. 

Lectures  on  Bright's  Disease  of  the  Kidneys.  Delivered  at  the  Royal  Infirmary, 
•Glasgow.     With  20  illustrations.     8vo.  Price  51.50 

BLOXAM.  CHEMISTRY,Inorganic  and  Organic.  Fourth  Edition. 

With  E.xperiments.  By  Charles  L.  Bloxam,  Professor  of  Chemistry  in 
King's  College,  London,  and  in  the  Department  for  Artillery  Studies,  Wool- 
wich.    Fourth  edition.     With  nearly  300  Engravings.     8vo.  Price  54.00 

A  most  complete  Text-Book  for  Schools  and  Colleges. 

"  Professor  Bloxam  has  given  us  a  most  excellent  and  useful  practical  treatise.  His  666  pages  (now  700)  are 
crowded  with  facts  and  experiments,  nearly  all  well  chosen,  and  many  quite  new,  even  to  scientific  men  .  .  . 
It  is  astonishing  how  much  information  he  often  conveys  in  a  few  paragraphs.  We  might  quote  fifty  instances  of 
this." — Chemical  Nevus. 

BLOXAM.     LABORATORY  TEACHING.     Fourth  Edition. 

Progressive  Exercises  in  Practical  Chemistry.  By  Charles  L.  Bloxam, 
Professor  of  Chemistry  in  King's  College,  London,  etc.  Fourth  edition.  With 
89  engravings.     i2mo.  Price  $1.75 

This  work  is  intended  for  use  in  the  Chemical  Laboratory,  by  those  who  are 
commencing  the  study  of  Practical  Chemistry.     It  contains : — 

I.  A  series  of  simple  Tables  for  the  analysis  of  unknown  substances  of  all 
kinds.  .  2.  A  brief  description  of  all  the  practically  important  single  substances 
likely  to  be  met  with  in  ordinary  analysis.  3.  Simple  directions  and  illustra- 
tions relating  to  Chemical  Manipulation.  4.  A  system  of  Tables  for  the  detec- 
tion of  unknown  substances  with  the  aid  of  the  Blowpipe.  5.  Short  instructions 
upon  the  purchase  and  preparation  of  the  tests  intended  for  those  who  have  not 
access  to  a  Laboratory. 

"  a  great  amount  of  valuable  practical  information  is  here  condensed  into  a  book  of  260  pages,  such  as  only  a 
practical  teacher  could  prepare." — New  England  journal  of  Education. 

BRUEN.     PHYSICAL  DIAGNOSIS.    Just  Ready. 

A  Pocket  Book  of  Physical  Diagnosis,  for  Physicians  and  Students.  By 
Edward  T.  Bruen,  m.d.,  Asst.  Prof,  of  Clinical  Medicine,  University  of  Penn'a. 
Illustrated  by  Original  Wood  Engravings.    i2mo.    Extra  Cloth.  Price  $2.00 

BENNETT.     NUTRITION  IN  HEALTH  AND  DISEASE. 

A  Contribution  to  Hygiene  and  Clinical  Medicine.  By  J.  Henry  Ben- 
nett, M.D.     Third  Edition,  Revised  and  Enlarged.     Cloth.  Price  $2.50 

BY  SAME   AUTHOR. 

THE    TREATMENT    OF     PULMONARY     CONSUMPTION 
BY  HYGIENE,  CLIMATE  AND  MEDICINE. 

With  an  Appendix  on  the  Sanitaria  of  the  United  States,  Switzerland  and 
the  Balerfic  Islands.     Third  Edition  much  Enlarged.  Price  ^2.50 

"Any  physician  may  take  it  up  with  every  feeling  of  confidence  that  the  views  enixnclated  by  the  author  will  be 
found  to  be  able,  honest  and  orthodox." — Medico- Chirurgical  Review. 

BERKART,  ASTHMA. 

The  Pathology  and  Treatment  of  Asthma.  By  JOSEPH  B.  Berkart,  m.d. 
8vo.  Price  %2-lo 


PUB  Lie  A  TIONS. 


BEALE  ON  SLIGHT  AILMENTS. 

Slight  Ailments,  Their  Nature  and  Treatment.  By  Lionel  S.  Beale,  m.d., 
F.R.S.,  Professor  of  Practice,  King's  Medical  College,  London.    i2mo.   Price  ^t  .75 

OUTLINE   OF   CONTENTS. 
Introductory.    The  Tongue  in  Health  and  Slight  Ailments.   Appetite.    Nausea.    Thirst.    Hunger.    Indigestion, 
its  Nature  and  Treatment.     Constipation,  its  Treatment.     Diarrhoea.     Vertigo.     Giddiness.     Biliousness.     Sick 
Headache.     Neuralgia.     Rheumatism.     The  Teverish  and  Inflammatory  State.     Of  the  Actual  Changes  in  Fever 
and  Inflammation.     Common  Forms  of  Slight  Inflammation,  etc.,  etc. 

"  We  venture  to  say  that  among  the  numerous  medical  publications  issued  during  1880,  there  has  been  none 
which  will  prove  more  useful  to  the  young  general  practitioner,  for  whom  it  is  really  intended,  than  this  volume, 
while  the  time  of  the  older  physician  might  be  much  more  unprofitably  spent." — American  yourncU  qf  Medical 
Science. 

BY  SAME  AUTHOR. 

ON  LIFE  AND  VITAL  ACTION  IN  HEALTH  AND  DISEASE. 
i2mo.  .  Price  $2.00 

THE  USE  OF  THE  MICROSCOPE  IN  PRACTICAL  MEDI- 
CINE. 

For  Students  and  Practitioners,  with  full  directions  for  examining  the  various 
secretions,  etc.,  in  the  Microscope.  Fourth  Edition.  50x3  Illustrations.  Much 
enlarged.     8vo.  Price  $7.50 

"  We  have  before  us  Prof  Beale's  work,  The  Micro- 
scope in  Medicine,  a  book  which  it  gives  us  pleasure  to 
recommend  to  every  student  of  microscopy,  whether  he 
be  a  physician  or  naturalist." — Journal  of  the  Frank- 
lin Institute,  Philadelphia. 


"As  a  microscopical  observer,  and  a  histological 
manipulator,  his  (Dr.  Beale)  skill  and  eminence  are 
generally  conceded." — Popular  Science  Monthly. 


HOW  TO  WORK  WITH  THE  MICROSCOPE. 

A  Complete  Manual  of  Microscopical  Manipulation,  containing  a  full  descrip- 
tion of  many  new  processes  of  investigation,  with  directions  for  examining  ob- 
jects under  the  highest  powers,  and  for  taking  photographs  of  microscopic 
objects.  Fifth  Edition.  Containing  over  400  Illustrations,  many  of  them  colored. 
Octavo.  Price  $7.50 

"The  Encyclopaedic  character  of  this  last  edition  of  Dr.  Beale's  well  known  work  on  the  Microscope  renders 
it  impossible  to  present  an  abstract  of  its  contents  ;  sufiiee  it  to  say,  that  anything  in  his  department  upon  which 
the  physican  can  desire  such  information  will  be  found  here,  and  much  more  in  addition.  It  is,  moreover,  a  store- 
bouse  of  facts,  most  valuable  to  the  physician,  and  is  indispensable  to  every  one  who  uses  the  microscope." — 
American  Journal  of  Medical  Science. 

BIOPLASM. 

A  Contribution  to  the  Physiology  of  Life,  or  an  Introduction  to  the  Study  of 
Physiology  and  Medicine,  for  Students.     With  numerous  Illustrations. 

Price  ;^2.25 
PROTOPLASM;  or  MATTER  AND  LIFE. 

Third  Edition,  very  much  enlarged.  Nearly  350  pages.  Sixteen  Colored 
Plates.  Part  I.  Dissentient.  Part  11.  Demonstrative.  Part  in.  Suggestive. 
One  volume.  Price  $3.00 

LIFE    THEORIES ;    Their  Influence   upon  Religious    Thought. 

Six  Colored  Plates.  Price  $2.00 

ONE  HUNDRED  URINARY  DEPOSITS, 

On  two  sheets,  for  the  Hospital,  Laboratory,  or  Surgery.  Each  Sheet  ^i.oo,  or 
on  Rollers,  '  Price  ^1.25 

BERNAY,  CHEMISTRY. 

Notes  for  Students  in  Chemistry.  Compiled  fromFowne's  and  other  manuals. 
By  Albert  J.  Bernay,  PH.D.     Sixth  Edition.     i2mo.  Price  ^1.25 

BOCK,  ANATOMY. 

An  Atlas  af  Human  Anatomy.  By  Prof.  C.  E.  BocK,  of  Berlin.  Thirty-seven 
Colored  Plates,  containing  about  200  figures.    Quarto.    Half  Roan.    Price  $15-00 

This  is  one  of  if  not  the  best  Anatomical  Atlas  now  to  be  had,  and  its  produc- 
tion in  Germany  makes  it  certainly  the  cheapest. 


PRESLEY  BLAKISTON'  S 


BEASLEY.  THE  BOOK  OF  PRESCRIPTIONS. 

Containing  over  3100  Prescriptions,  collected  from  the  Practice  of  the  most 
Eminent  Physicians  and  Surgeons — English,  French  and  American ;  a  Com- 
pendious History  of  the  Materia  Medica,  Lists  of  the  Doses  of  all  Officinal  and 
Established  Preparations,  and  an  Index  of  Diseases  and  their  Remedies.  By 
Henry  Beasley.     Fifth  Edition,  Revised  and  Enlarged.  Price  $2.25 

BY    SAME   AUTHOR. 

THE  DRUGGIST'S  GENERAL  RECEIPT-BOOK. 

Comprising  a  copious  Veterinary  Formulary;  numerous  Recipes  in  Patent 
and  Proprietary  Medicines,  Druggists'  Nostrums,  etc.;  Perfumery  and  Cos- 
metics; Beverages,  Dietetic  Articles  and  Condiments;  Trade  Chemicals,  Scien- 
tific Processes,  and  an  Appendix  of  Useful  Tables.    Eighth  Edition.    Price  $2.25 

THE  POCKET  FORMULARY  and  Synopsis  of  the  British  and 
Foreign  Pharmacopoeias. 

Comprising  Standard  and  Approved  Formula;  for  the  Preparations  and  Com- 
pounds   Employed   in    Medical   Practice.      Tenth    Edition.     511    pp.      i8mo. 

Price  $2.25 

BENTLEY  AND  TRIMEN'S  MEDICINAL  PLANTS. 

A  New  Illustrated  Work,  containing  full  botanical  descriptions,  with  an  account 
of  the  properties  and  usesof  the  principal  plants  employed  in  medicine,  especial 
attention  being  paid  to  those  which  are  officinal  in  the  British  and  United  States 
Pharmacopoeias.  The  plants  which  supply  food  and  substances  required  by  the 
sick  and  convalescent  are  also  included.  By  R.  Bentley,  f.r.s..  Professor  of 
Botany,  King's  College,  London,  and  H.  Trimen,  m.b.,  f.h.s..  Department  of 
Botany,  British  Museum.  Each  species  illustrated  by  a  colored  plate  drawn 
from  nature.     In  Forty-two  parts.     Eight  colored  plates  in  each  part. 

Price  $2  each,  or  handsomely  bound  in  4  volumes,  Half  Morocco,  $90.00 

"  It  would  be  impossible  to  enumerate  all  the  new 
plants  that  are  here  delineated.  The  result  is  a  work 
which,  from  all  points  ofview,isa  credit  to  the  scientific 
literature  of  the  day." — London  Lancet. 

It  is  an  indispensable  work  of  reference  to  every  one 


"  This  work  may  be  recommended  as  a  most  useful 
one  to  druggists,  and  all  who  desire  to  be  familiar 
with  the  Botany  of  Medicinal  Plants." — Druggists' 
Circular. 

"  The  work  when  complete  (it  is  now  complete) 
will  be  the  most  valuable  corapend  of  Medical  Botany 
ever  published." — Boston  yournal  of  Cheynistry. 


interested  in  pharmaceutical  Botany." — London  Fliar- 
7>taceutical  yoiirnal. 

BRADLEY,  ANATOMY. 

Comparative  Anatomy  and  Physiology.  By  S.  M.  Bradley,  f.r.c.s.  Sixty 
Illustrations.     Third  Edition.  Price  $2.00 

BRUNTON,  ACTION  OF  MEDICINES. 

Experimental  Investigation  of  the  Action  of  Medicines.  Part  I,  Circulation. 
By  T.  Lauder  Bruntox,  m.d.,  f.r.s.     Second  Edition.  {^Preparing. 

BYFORD.     DISEASES  OF  WOMEN.     New  Revised  Edition. 

The  Practice  of  Medicine  and  Surgery,  as  applied  to  the  Diseases  of  Women. 
By  W.  H.  Byford,  a.m.,  m.d..  Professor  of  Obstetrics  and  The  Diseases  of  Wo- 
men and  Children,  in  the  Chicago  Medical  College.  Third  Edition.  Revised 
and  Enlarged,  much  of  it  rewritten,   with  numerous  additional  illustrations. 

Price,  in  Cloth  $5.00 ;  Leather,  $6.00 

"  The  author  is  an  experienced  writer,  an  able  teach, 
er  in  his  department,  and  has  embodied  in  the  present 
work  the  results  of  a  wide  field  of  practical  observa- 
tion. We  have  not  had  time  to  read  its  pages  critically, 
but  freely  commend  it  to  all  our  readers,  as  one  of  the 
most  valuable  practical  works  issued  from  the  Ameri- 
I    oan  press." — Chicago  Medical  Escatniner. 

BY    SAME  AUTHOR. 

ON  THE  UTERUS.    The  Chronic  Inflammation  and  Displace- 
ment of  the  Unimpregnated  Uterus. 

An  Enlarged  Edition,  with  Illustrations.     8vo.  Price  I2.50 

"A  good  book  from  a  good  man." — American  Journal  Medical  Science. 

"  It  i^  a  sensible,  practical  work,  and  cannot  fail  to  be  raad  with  interest  and  -profA."— -Boston  Medical  and 
Surgical  yournal. 


"  The  treatise  is  as  complete  a  one  as  the  present 
state  of  our  science  will  admit  of'being  written.  We 
commend  it  to  the  diligent  study  of  ^very  practitioner 
and  student,  as  a  work  calculated  to  inculcate  sound 
principles  and  lead  to  enlightened  practice. — New 
York  Medical  Record. 


PUB  Lie  A  TIONS. 


BRAUNE,  TOPOGRAPHICAL  ANATOMY. 

An  Atlas  of  Topographical  Anatomy.  Thirty-four  Full-page  Plates,  Photo- 
graphed on  Stone,  from  Plane  Sections  of  Frozen  Bodies,  with  many  other  illus- 
trations. By  WiLHELM  Braune,  Professor  of  Anatomy  at  Leipizig.  Translated 
and  Edited  by  Edward  Bellamy,  f.r.c.s..  Lecturer  on  Anatomy,  Charing 
Cross  Hospital,  London.     Quarto.     Price,  Cloth,  gio.oo;  Half  Morocco,  |i2,oo 

"  As  a  whole  the  work  cannot  fail  to  meet  with  a  hearty  reception  by  every  progressive  student  of  the  human 
body.  To  the  surgeon  it  is  a  contribution  to  the  study  of  topographical  anatomy  which  needs  to  be  known  to  be 
properly  appreciated  To  such  practitioners  who  reside  in  large  cities,  where  anatomy  can  be  studied  upon  the 
cadaver,  it  will  afford  a  valuable  aid,  while  to  those  who  are  without  such  means  of  study  it  is  an  almost  indis- 
pensable addition  to  a  working  library." — New  York  Medical  Record. 

"  We  commend  the  book  most  heartily  to  the  Profession." — American  yournal  of  Medical  Science.  ' 

BUCKNILL  AND  TUKE  ON  INSANITY. 

A  Manual  of  Pyschological  Medicine :  containing  the  Lunacy  Laws,  the 
Nosology,  QEtiology,  Statistics,  Description,  Diagnosis,  Pathology  (including 
morbid  Histology),  and  Treatment  of  Insanity.  By  John  Charles  Bucknill, 
M.D.,  F.R.S.,  and  Daniel  Hack  Tuke,  m.d,,  f.r.c.p.  Fourth  Edition,  much 
enlarged,  with  twelve  lithographic  plates,  and  numerous  illustrations.     Octav.o. 

Price  |8.oo 

"  We  have  read  no  book  in  any  language,  and  certainly  none  in  English,  which   ought  to  be  preferred  to    this 
for  a  text  book,  by  those  who  wish  to  make  a  thorough  study  of  the  subject. — EditUmrgh  Medical  yournal. 
"  We  can  heartily  commend  the  work. — American  yournal  of  Insanity. 

BURDETT,  HOSPITALS. 

Pay  Hospitals  and  Paying  Wards  throughout  the  World.  Facts  in  support 
of  a  rearrangement  of  the  system  of  Medical  Relief.  By  Henry  C.  Burdett. 
8vo.  Price  ^2.25 

"  Mr.  Burdett  displays  and  discusses  the  whole  scheme  of  Hospital  accomiBodation  with  a  comprehensive 
understanding  of  its  nature  and  extent. — Am.erican  Practitioner. 

BY  SAME  AUTHOR. 

COTTAGE  HOSPITALS. 

General,  Fever,  and  Convalescent :  their  Progress,  Management,  and  Work. 
Second  Edition,  rewritten  and  much  Enlarged,  with  many  Plans  and  Illustra- 
tions.    Crown  8vo.  .     Price  $4.50 

Contents. — Chap. — i.  Origin  and  Growth  of  the  Cottage  Hospital  System.  2.  Comparative  Success  of 
Treatment  in  large  and  small  Hospitals.  3.  Finance.  4.  Cottage  Hospital  Construction  and  Sanitary  Arrange* 
ments.  5.  The  Medical  and  Nursing  Departments.  6.  Domestic  Supervision  and  General  Management.  7. 
Cottage  Hospital  Appliances  and  Fittings.  8.  Cottage  Fever  Hospitals.  9.  Midwifery  in  Cottage  Hospitals.  10. 
Remunerative  Paying  Patients.  11.  Convalescent  Cottages .  12.  Cottage  Hospitals  in  America.  13.  Mortu- 
aries. 14.  A  more  Detailed  Account  of  certain  Cottage  Hospitals,  with  Plans  and  Elevations.  15.  Selected  and 
Model  Plans  criticised  and  compared,  with  a  detailed  description  of  various  Hospitals.  16.  Peculiarities  and 
Special  Features  in  the  Working  of  Cottage  Hospitals.  With  an  Appendix  containing  much  statistical  and  useful 
information. 

"  Mr.  Burdett's  book  contains  a  mass  of  information,  statistical,  financial,  architectural,  and  hygienic,  which  has 
already  proved  of  great  practical  utility  to  those  interested  in  cottage  hospitals,  and  we  can  confidently  recom- 
mend this  second  edition  to  all  who  are  in  search  of  the  kind  of  information  which  it  contains." — Lancet. 

BUZZARD,  SYPHILITIC  NERVOUS  AFFECTIONS. 

Clinical  Aspects  of  Syphilitic  Nervous  Affections.  By  Thos.  Buzzard,  m.d. 
i2mo.  Price  $1.75 

CARPENTER,  THE  MICROSCOPE.     Sixth  Edition. 

The  Microscope  and  its  Revelations.  By  W.  B.  Carpenter,  m.d.,  f.r.s. 
Sixth  Edition.     Revised  and  Enlarged,  with  over  500  Illustrations.     Price  $5.50 


"  Not  only  the  student  of  medicine,  but  amateurs, 
and  others  interested  in  the  study  of  natural  history, 
will  find  this  volume  one  of  great  practical  value." — ■ 
Nev)  York  Medical  yournal. 

"  It  is  by  far  the  most  complete  and  useful  treatjse 
now  accessible  to  the  student." — The  Technolosisi. 


"As  a  text  book  of  Microscopy  in  its  special  relation 
to  natural  history  and  general  science,  the  work  before 
us  stands  confessedly  firstj  and  is  alone  sufficient  to 
supply  the  wants  of  the  ordinary  student." — American 
yournal  of  Microscopy. 


PRESLEY  B  LA  K IS  TON'S 


Oazeaux's  Great  Work  on  Obstetrics. 

•  THE  MOST  COMPLETE  TEXT-BOOK  NOW  PUBLISHED. 

GBEATLY  ENLARGED  AND  IMPROVED. 

CONTAINING   175    ILLUSTRATIONS. 

A.  Theoretical  and  Practical  Treatise  on  Midwifery,  including  the  Diseaset 
of  Pregnancy  and  Parturition,  by  P.  Cazeaux,  Member  of  the  Impetnai 
Academy  of  Medicine ;  Adjunct  Professor  in  the  Faculty  of  Medicine  of 
Paris,  etc.,  etc.  Revised  and  Annotated  by  S.  Tarnibr,  Adjunct  Pro- 
fessor in  the  Faculty  of  Medicine  of  Paris ;  Former  Clinical  Chief  of  the 
Lying-in-Hospital,  etc.,  etc.  Sixth  American  from  the  Seventh  French  Edv 
tion.  Translated  by  Wm.  R.  Bullock,  M.  D.  In  one  volume  Royal  Oc- 
tavo, of  over  1100  pages,  with  numerous  Lithographic  and  other  Illustra 
tions  on  Wood. 

Price,  bound  in  Cloth,  bevelled  boards,  .         .         .         $6.00 

"  "        Leather,  .  .        .        .        .        .      7.00 

M.  Cazeaux's  Great  Work  on  Obstetrics  has  become  classical  in  its  character,  and 
almost  an  Encyclopaedia  in  its  fulness.  Written  expressly  for  the  use  of  students  of 
medicine,  and  those  of  midwifery  especially,  its  teachings  are  plain  and  explicit,  present- 
ing a  condensed  summary  of  the  leading  principles  established  by  the  masters  of  the 
obstetric  art,  and  such  clear,  practical  directions  for  the  management  of  the  pregnant, 
parturient,  and  puerperal  states,  as  have  been  sanctioned  by  the  most  authoritative 
practitioners,  and  confirmed  by  the  author's  own  experience.  Collecting  his  materials 
from  the  writings  of  the  entire  body  of  antecedent  writers,  carefully  testing  their  correct- 
ness and  value  by  his  own  daily  experience,  and  rejecting  all  such  as  were  falsified  by 
the  numerous  cases  brought  under  his  own  immediate  observation,  he  has  formed  out  of 
them  a  body  of  doctrine,  and  a  system  of  practical  rules,  which  he  illustrates  and  enforces 
in  the  clearest  and  most  simple  manner  possible. 

OPmiONS  OF  THE  PRESS. 

"  It  is  unqueationably  a  work  of  the  highest  excellence,  rich  in  information,  and  perhaps  fuller  in  details 
than  any  text-book  with  which  we  are  acquainted.  The  author  has  not  merely  treated  of  every  ques- 
tion which  relates  to  the  business  of  parturition,  but  he  has  done  so  with  judgment  and  ability." 
British  and  Foreign  Medico- Chirurgical  Review. 

"  The  translation  of  Dr.  Bullock  is  remarkably  well  done.  We  can  recommend  this  work  to  those 
especially  interested  in  the  subjects  treated,  and  can  especially  recommend  the  American  edition." 
Medical  Times  and  Gazette. 

"  The  edition  before  us  is  one  of  unquestionable  excellence.  Every  portion  of  it  has  undergoa«  » 
thorough  revision,  and  no  little  modification ;  while  copious  and  important  additions  have  been  made  to 
nea-'ly  every  part  of  it.  It  is  well  and  beautifully  illustrated  by  numerous  wood  and  lithograj)hic 
engravings,  and,  in  typographical  execution,  will  bear  a  favorable  comparison  with  other  works  of  the 
sama  class." — A7neriean  Medical  Journal. 

"  In  the  multitudinous  collection  of  works  devoted  to  the  propagation  of  human  beings,  and  to  t-hf 
details  of  parturition,  none,  in  our  estimation,  bears  any  comparison  to  the  work  of  Cazeaux,  in  its 
entire  perfectness ;  and  if  we  were  called  upon  to  rely  alone  on  one  work  on  accouchments,  our  ohoiot 
would  fall  upon  the  book  before  us  without  any  kind  of  hesitation." —  West.  Jour,  of  Med.  and  Surgery. 

"  We  do  not  hesitate  to  say,  that  it  is  now  the  most  complete  and  best  treatise  on  the  subject  in  th» 
English  language." —  Buffalo  Medical  Journal. 

"We  know  of  no  work  on  this  all-important  branch  of  our  profession  that  we  can  recommend  to  th* 
nadent  or  practitioner  as  a  safe  guide  before  this." — Chicago  Medical  Journal. 


PUBLICA  TIONS. 


CHARTERIS,  PRACTICE  OF  MEDICINE. 

Hand-Book  of  the  Practice  of  Medicine.  By  M.  Charteris,  m.d.,  Member 
of  Hospital  Staff  and  Professor  in  University  of  Glasgow.  With  Microscopic  and 
other  illustrations.  Price  $2.00 

"  We  have  not  often  met  with  a  book  which  can  be  so  confidently  recommended  to  physicians  or  men  in  gen&ral 
practice." — Lancet. 

"  The  style  in  which  it  is  written  is  clear  and  attractive.  The  illustrations  are  a  marked  feature  in  it.  It  can 
be  recommended  as  a  very  reliable,  handy  book,  weU  adapted  for  ready  reference." — New  Retnedies. 

CHAVASSE  ON  CHILDREN. 

The  Mental  Culture  and  Training  of  Children.     By  Pye  Henry  Chavasse. 

i2mo.  Price  $1.00 

The  mental  culture  and  training  of  children  is  of  immense  importance.     Many 

children  are  so  wretchedly  trained,  or  rather  not  trained  at  all,  and  so  mismanaged, 

that  a  few  thoughts  on  this  subject  cannot  be  thrown  away,  even  upon  the  most 

careful. 

CLAY  ON  OBSTETRIC  SURGERY.    Third  Edition. 

A  complete  Hand-Book  of  Obstetric  Surgery,  with  Rules  for  every  Emergency 
and  Descriptiens  of  the  more  difficult  as  well  as  the  every  day  operations.  By 
Charles  Clay,  m.d.,  with  numerous  illustrations.  From  the  Third  London  Edi- 
tion.    i2mo.  Price  ;^2.oo 

"It  is  a  useful  and  convenient  book  of  reference;  the  illustrations  are  good,  and  the  book  will  be  found  of  value 
to  the  student  and  young  practitioner,  as  well  as  to  the  skilled  Obstetrician." — American  yournal  of  Obstetrics. 

CLEVELAND,  POCKET  DICTIONARY. 

A  Pronouncing  Medical  Lexicon,  containing  correct  Pronunciation  and  Defi- 
nition of  terms  used  in  medicine  and  the  collateral  sciences.  By  C.  H.  Cleve- 
land, M.D.     Twenty-sixth  Edition.     i6mo. 

Price,  Cloth,  75  cents  ;  Tucks  with  Pocket,  $1.00 
This  is  a  most  convenient  size  for  the  pocket,  and  contains  all  the  principal  words 
in  use,  together  with  rules  for  pronunciation,  abbreviations  used  in  prescriptions,  list 
of  poisons,  their  antidotes,  etc. 

COHEN,  INHALATION.     Enlarged  Edition. 

Inhalation,  its  Therapeutics  and  Practice,  including  a  Description  of  the  Ap- 
paratus Employed,  etc.  By  J.  SoLis  Cohen,  m.d.  With  cases  and  Illustrations. 
A.  New  Enlarged  Edition.     8vo.  Price  $2.50 

"  The  book  has  the  merit  of  containing  much  information  that  cannot  be  found  elsewhere." — N.  Y.  Medical 
yournal. 
"  One  of  the  best  treatises  we  have  seen  on  this  subject." — Medical  Times  and  Gazette. 

BY  SAME  AUTHOR. 

CROUP, 

In  its  Relation  to  Tracheotomy.     8vo.  Price  $1.00 

CLARKE,  SURGERY. 

Outlines  of  Surgery  and  Surgical  Pathology,  including  the  Diagnosis  and 
Treatment  of  Obscure  and  Urgent  Cases.  By  F.  LeGross  Clarke,  f.r.s. 
Second  Edition.     8vo.  Price  $2.00 

COBBOLD,  PARASITES. 

A  Treatise  on  the  Entozoa  of  Man  and  Animals,  including  some  account  of 
the  Ectozoa.  By  T.  Spencer  Cobbold,  m.d.,  f.r.s.  With  85  illustrations. 
8vo.  .  Price  I5.00 


PRESLE  Y  BLAKISTOX'S 


DAY  ON    CHILDREN. 

A  SECOND  EDITION.    JUST  READY. 

The  Diseases  of  Children.  A  Practical  and  Systematic  Treatise,  for  Practitioners 
and  Students.  By  Wm.  Henry  Day,  m.d.  Second  Edition.  Enlarged.  8vo. 
752  pp.  Price,  Clotli,  §5.00 ;  Sheep,  $6.0' 

What  Prominent  Professors  Say  of  It. 


"  The  more  I  read  Dr.  Day's  book,  the  more  I  like 
it.  I  shall  recommend  it  to  the  students  of  George- 
town College."— Prof.  J.  Tabee  Johnson,  Washington, 
D.  C. 

"  I  pronotince  the  book  a  good  one,  and  one  that 
promisee  to  be  useful  to  both  practitioners  and  stu- 
dents."— Prof.  W.  A.  Edmu.nds,  St.  Louis. 

"  I  think  it  admirably  adapted  to  the  uses  of  practi- 
tioners and  students  of  medicine." — Prof.  Hannah  T. 
Choasdale,  Woman's  Medical  College,  Philadelphia. 

"  Believing  the  work  well  adapted  to  meet  the  wants 
of  the  student  as  well  as  the  practitioner,  it  will  give 
mo  pleasure  to  recommend  it  to  the  classes  of  Eush 
Medical  College." — Prof.  De  Leskie  JIillee,  Chicago. 

"It  is  the  work  for  which  we  have  so  long  felt  the 
want  and  need.  I  take  pleasure  in  recommending  it." 
— Prof.  C.  T.  Bedford,  Indianapolis,  Ind. 

"  The  practitioner  can  confidently  rely  upon  finding 
in  its  pages  the  very  best  and  latest  knowledge  con- 


cerning the  diseaaea  of  children." — Prot  W.  J.  Conv 
LIN,  Dayton,  0. 

"  It  is  just  what  a  student  and  a  busy  practitioner 
needs.  I  can  heartily  recommend  it."— Prof.  J.  M. 
DtraHAM,  Columbus,  0. 

"  It  is,  in  my  judgment,  the  most  satisfactorily  ar- 
ranged and  eminently  practical  work  upon  the  fiil- 
ments  of  infancy  and  childhood  yet  published  in  the 
English  language." — Prof.  F.  L.  Sim,  Memphis,  Tenn. 

"  It  is  especially  to  be  recommended  for  judlciouB 
comments  nn  infant  feeding,  etc." — Prof.  H.  6.  IiAN- 
Dis,  Columbiis,  0. 

"  An  excellent  practical  treatise,  superior  to  any  of 
the  reprints  in  the  departirent  of  Diseases  of  Children 
that  I  have  seen." — Prof.  E.  0.  F.  Eoler,  Chicago. 

"  It  is  fairly  entitled  to  the  highest  rank  among  the 
text-books  on  Diseases  of  Children,"— -Prof.  J.B.  Kings- 
ley,  St.  Louis. 


PRESS  OPINIONS. 


"A  careful  examination  of  this  book  leads  us  to 
characterize  it  as  a  plain,  straightforward  treatise  on 
the  subject  upon  which  it  treats,  ....  giving 
sound  practical  advice." — Philadelphia  Medical  Tim^s. 

"We  heartily  recommend  this  book  to  tke  profession 
as  a  safe  and  reliaVile  guide  in  thedepartmentof  which 
it  treats." — Medical  and  Surgical  Reporter. 

"The book  is  wonderfully  readable." — British  Medi- 
cal Journal. 

"  The  article  on  the  true  diseases  of  children,  those 
of  the  pulmonary,  circulatory  and  renal  apparatus,  and 
the  nervous  system,  are  in  many  parts  exhaustive.  . 
,  .  The  writing  is  clear  and  forcible,  ajid  to  the 
point."^.4jn«rica»  Journal  of  Medical  Sciences. 

"We  have  no  doubt  it  vrill  be  read  with  interest, 
■which  its  style,  as  well  as  its  matter,  deserves." — I)uh- 
lin  Medical  Journal. 

"  Taking  the  book  as  a  whole,  its  correct  classifio*- 
tion,  its  perfect  style,  and  its  comprehensiveness  place 
it  in  advance  of  nil  other  books  upon  the  same  sub- 
ject."—  Walsh's  Betrospect. 
"""  A  safe  guide  for  the  student  and  practitioner." — 
College  and  Clinical  Eeoord. 

"  One  ©f  the  most  useful  and  valuable  additions  to 
the  medical  literature  of  the  present  day.  Ko  medical 
library  should  be  without  this  book  on  its  shelves." — 
Medical  Bulletin. 

"Dr.  Day  brings  to  his  task  a  large  experience,  and 
evidences  a  very  thorough  knowledge  of  the  litera- 
ture, native  and  foreign,  pertaining  to  this  special 
branch  of  medicine.  The  book  has  been  written  with 
great  care,  and  the  author  is  a  good  writer.  The  pub- 
lisher's part  of  the  task  has  also  been  excellently  per- 
formed."— Boston  Medical  and  Surgical  Joitmal. 

"We  advise  every  physician  to  have  a  copy." — 
Braithicaite's  Quarterly  Epitome. 


"  Altogether  we  can  heartily  commend  this  volume 
to  any  students  of  this  subject  that  desire  to  obtain  the 
latest  and  most  judicious  compend  of  our  knowledge 
of  Children's  Diseases." — Detroit  Lancet. 

"One  of  the  most  satisfactory  guides  in  the  diagnosis 
and  treatment  of  disr^ases  peculiar  to  children  to  be  had 
in  the  language." — New  Remedies. 

"  Tliig  volume,  from  the  title-page  to  the  end  of  the 
last  chapter,  abounds  in  just  such  practical  and  well- 
put  information  as  every  man,  in  the  course  of  his 
treatment  of  children's  diseases,  must  oftentimes  feel 
the  need." — Medical  Herald,  Ixmismlle. 

"  We  commend  it  particularly  for  its  practical  worth, 
beins  full  of  valuable  hints  in  regard  to  dlagnosisand 
treatment." — Medical  Annals,  Albany,  N.  Y. 

"  It  should  be  in  the  library  of  every  medical  stu- 
dent aud  practitioner." — SouHteni  Medical  Record. 

"  It  is  full  of  valuable  facts  and  suggestions  that  win 
make  a  welcome  addition  to  the  working  library  of 
every  practitioner." — Ohio  Medical  Journal. 

"  Plain,  full  and  eminently  practical." — Southern 
Clinic. 

"The  book  is  up  to  the  times,  and  we  cordially  com- 
mend it  to  those  for  whom  it  is  written,  but  especial- 
ly the  studeat." — Therapeutic  Gazette. 

"  A  safe  guide  in  practice." — Pacific  Medical  and  Sur- 
gical  Journal. 

"It  is  not  too  much  to  say  of  it  that  it  is  probably 
not  equaled,  and  certainly  not  excelled,  by  any  other 
book  on  its  subject." — Michigan  Medical  News. 

"  A  thoroughly  practical  work." — Independent  Prao- 
tilieyier, 

"  It  is  just  such  a  book  as  is  wanted  by  the  general 
practitioner." — Medical  Brief. 


Price !  Olotli,  $5.00 ;  Leather,  $6.00.   For  sale  by  all  booksellers, 
or  sent  to  any  address,  postpaid,  on  receipt  of  price.  / 


PUBLICATIONS.  13 


COULSON,  THE  BLADDER.     Sixth  Edition. 

Diseases  of  the  Bladder  and  Prostate  Gland.  By  Walter  J.  Coulson,  f.r.c.s. 
Sixth  Edition.     Revised  and  Enlarged,  with  22  Engravings.     8vo.      Price  $6.40 

CRIPPS,  THE  RECTUM. 

Cancer  of  the  Rectum.  Its  Pathology,  Diagnosis  and  Treatment.  By.  W. 
Harrison  Cripps,  f.r.c.s.     Illustrated  by  Plates,     8vo.  Price  $2.40 

CORMACK.     CLINICAL  STUDIES. 

Illustrated  by  Cases  Observed  in  Hospital  and  Private  Practice.  By  Sir 
John  Rose  CoRMACK,  M.D.,  K.B.,  etc.    Illustrated.    2  vols.    1127  pp.    Price  $5.00 

Contents. — Vol.  i. — Chapter  i.  Relapsing  Fever,  n.  Cholera,  iii.  Scarlatinous  Nephritis,  rv-.  Puerperal 
Convulsions,  v.  Glandular  Degeneration  of  the  Kidney,  and  Its  Relation  to  Scrofula,  vi.  Infantile  Remittent 
Fever,  vii.  Labor  Complicated  with  CauUflower  Excrescence  of  the  Uterus.  \t;ii.  Value  of  the  Dark  Abdominal 
Line  as  a  Test  of  Recent  Delivery,  ix.  Dystocia  from  Cystous  Kidney  in  the  Mature  Foetus,  x.  Hernia  of  the 
Uterus. 

Vol.  II. — Chapter  i.  Air  in  the  Organs  of  Circulation,  n.  Refle-x  Convulsions  in  Infancy,  iii.  Pharyngo- 
Laryngo-Tracheal  Diphtheria,  iv.  Diphtheria,  v.  Paralytic  Affections,  vi.  Paralytic  Affections  in  Enteric 
Fever,  vii.  Treatment  of  Paralytic  Affections.  w\\.  Non- Venereal  Discharges  from  the  Urethra,  ix.  Scarla- 
tinal Vaginitis,  x.  Congenital  Syphilis,  xi.  Chronic  Poisoning  by  Chloroform,  xii.  Resection  of  the  Shoulder 
Joint.     XIII.  Concussion  of  the  Brain,     xiv.  General  Paralysis  with  Insanity,    xv.  Short  Attacks  of  Insanity. 

DAY  ON   HEADACHES. 

The  Nature,  Causes,  and  Treatment  of  Headaches.  Third  Edition.  Illus- 
trated.    By  Wm.  Henry  Day,  m.d.  Price  |2.oo 

Summary  of  Contents. — Headache  from  Cerebral  Anaemia,  Cerebral  Hyperaemia,  Sympathetic,  Congestive, 
Dyspeptic  or  Bilious  Headaches,  Headache  from  Plethora,  from  Exhaustion,  from  Change  in  Cerebral  Tissue, 
from  Affections  of  the  Periosteum,  Nervous  and  Nervo-Hyperaemic  Headache,  To.xsemic,  Rheumatic,  Arthritic 
or  Gouty  Headache,  Neuralgic  Headache,  and  Headaches  of  Childhood,  Early  and  Advanced  Life. 

"  Well  worth  reading.    The  remarks  on  treatment  are  very  sensible." — Boston  Medical  and  Surg.  Journal. 

DALBY,  ON  THE  EAR. 

The  Diseases  and  Injuries  of  the  Ear,  By  W.  B.  Dalby,  m.d.,  Surgeon  and 
Lecturer  on  Aural  Surgery,  St.  George's  Hospital.     With  Illustrations.     i2mo. 

Price  S1.50 

'A safe  and  readable  introduction  to  aural  surgery."  ]        "The  lectures   occupy  226  pages,  are  clearly  and 

Medical  Press  and  Circular.  consisely  written,  contain  a  number  of  good  illustrations, 

"  Dr.  Dalby  has  presented  us  with  a  very  readable  ^"^  are  well  worth  the  careful  study  of  both  student 

little  book,  which  is  destined  to  render  much  service  in  ^°d  practitioner.     To  aunsts  the  work  will  be  most 

Xh<ts3.-w\Tx%ai^x%."—N.Y.  Medical  Journal.  I    welcome  and  valuable.    —SJ>ecuilut. 

DILLINGBERGER,     WOMEN     AND     CHILDREN'S     DIS- 
EASES. 

A  Hand-Book  of  the  Treatment  of  the  Diseases  Peculiar  to  Women  and  Chil- 
dren.    By  Dr.  Emil  Dillingberger.     i2mo.  Price  $1.50 

"  It  is  a  magnum  in  parvo.  The  style  is  simple,  clear,  lucid,  and  free  from  theoretical  discussion.  No  one  will 
regret  the  small  outlay  for  this  volume. — Richtnond  and  Louisville  Medical  Journal. 

DUNGLISON,  THE  PHYSICIAN'S  REFERENCE  BOOK. 

The  Practitioner's  Reference  Book,  containing  Therapeutical  and  Practical 
Hints,  Dietetic  Rules,  and  General  Information.  By  Richard  J.  Dunglison, 
M.D.     Second  Edition.     8vo.  '  Price  $3.50 

"  We  can  heartily  commend  this  book  as  one  that  I  "The  demand  for  a  second  edition  so  soon  after  the 
must  prove  very  useful  to  the  general  practitioner." —  publication  of  the  first  volume  shows  that  this  work  is 
The  Medical  Record.  \    appreciated  by  the  profession." — Canada  Lancet. 

DURKEE,  VENEREAL  DISEASES.     Sixth  Edition. 

Gonorrhoea  and  Syphilis.  By  Silas  Durkee,  m.d.  Sixth  Edition.  Revised 
and  Enlarged,  with  Portrait  and  Eight  Colored  Illustrations.     8vo.     Price  I3.50 

"  We  may,  finally,  recommend  Dr.  Durkee's  book  as  eminently  practical,  well  written,  fuU  of  excellent  counsel, 
and  worthy  of  being  cons-.ilted  by  every  member  of  the  profession.  A  late  number  of  the  London  Midica.1  Times 
and  Gazette  also  speaks  of  the  book  in  terms  of  the  highest  3.^^rov3.\."^Boston  Medical  and  Surgical  Jour?tal, 


14  PRESLE V  BLAKISTON'S 

DAGUENET,  OPHTHALMOSCOPY. 

A  Manual  of  Ophthalmoscopy,  for  the  Use  of  Students.  By  Dr.  Daguenet. 
Translated  from  the  French,  by  Dr.  C.  S.  Jeaffreson,  f.r.c.s.e.  Illustrated. 
i2mo.  Price  $1.50 

"Its  portable  size,  the  condensed  nature  of  its  text,  and  the  admirably  systematic  arrangement  of  its  contents, 
render  it  extremely  useful  as  a  pocket  manual  for  Students. —  Translator  s Pre/ace. 

DOBELL,  WINTER  COUGH  AND  CATARRH. 

On  Winter  Cough,  Catarrh,  Bronchitis,  Emphysema,  Asthma,  etc.  By 
Horace  Dobell,  m.d..  Lecturer  at  the  Royal  Hospital  for  Diseases  of  the 
Chest,     Third  Edition.     With  Colored  Plates.     8vo.  Price  $3. 50 

BY    same   author. 

ON  LOSS  OF  WEIGHT.     Revised  Edition. 

Blood  Spitting  and  Lung  Disease.  Colored  Frontispiece  of  Lung.  Tabular 
Map,  etc.     Second  Edition  Enlarged.     8vo.  Price  $4.00 

DOMVILLE,  ON  NURSING. 

A  Manual  for  Hospital  Nurses  and  others  engaged  in  attending  to  the  sick. 
4th  Edition.     With  Recipes  for  Sick  Room  Cookery,  etc.  Price  $\.oo 

DRUITT'S  MODERN  SURGERY.     Eleventh  Edition. 

The  Surgeon's  Vade  Mecum;  a  Manual  of  Modern  Surgery.  By  Robert 
Druitt,  f.r.c.s.  Eleventh  Enlarged  Edition,  with  369  Illustrations.  864  pp. 
1878.  Price  $5.00 

This  is  a  most  complete,  accurate,  and  trustworthy  Hand,  or  Text-Book  of  Sur- 
gery. Unrivaled  as  a  book  for  the  Student.  Fully  illustrated,  and  brought  up  to 
the  present  state  of  the  science.     In  use  in  many  Medical  Colleges. 

DULLES,  ACCIDENTS. 

What  to  do  First,  in  Accidents  and  Poisoning.  By  C.  W.  Dulles,  m.d.  Il- 
lustrated.    i6mo.  Price  .50 

"  So  plain  and  sensible  that  it  ought  to  be  introduced 
into  every  female  seminary. — Evening  Chronicle , 
Pittsburgh. 


"  Its  usefulness  entitles  it  to  a  wide  and  permanent 
circulation." — Boston  Gazette. 

"  A  complete  guide  for  sudden  emergencies. — Phila- 
delphia Ledger. 


EDWARDS,  BRIGHT'S  DISEASE.     New  Edition. 

How  a  Person  Affected  with  Bright's  Disease  Ought  to  Live.     By  Jos.  F.  Ed- 
wards, M.D.     Second  Edition.     i2mo.  Price  .75 

BY   SAME   author. 

DYSPEPSIA.    Just  Ready. 

How  to  Avoid  It.     i2mo.  .75 

Contents.— Chap.  I. — Food.     n.  Digestion,     iii.  How  to  Cook  Food.    iv.  How  and  What  We  Ought  to  Eat. 

CONSTIPATION.     New  Edition. 

Plainly  Treated  and  Relieved  Without  the  Use  of  Drugs.     Second  Edition. 
l2mo.  Price  .75 

MALARIA. 

Malaria  :  What  It  Means ;    How  to  Escape  It ;    Its  Symptoms ;   When  and 
Where  to  Look  for  It.     i2mo.  "  Price  .75 

These  are  invaluable  little  treatises  upon  subjects  that  enter  painfully  into  the 
life  experiences  of  a  large  majority  of  the  human  family.  Dr.  Edwards  shows  not 
only  how  they  may  be  avoided,  but  in  plain  and  simple  language  he  tells  those 
already  afflicted  with  them  how  they  may  find  relief.  Many  learned  works  have  been 
written  upon  their  treament ;  but  the  authors  have,  in  nearly  every  case,  neglected 
to  show  to  the  public  how  to  avoid  them. 


PUB  Lie  A  TIONS. 


15 


EKIN,  WATER  ANALYSIS. 

Potable  Water.     How  to  Form  a  Judgment  on  the  Suitableness  of  Water  for 
Drinking  Purposes.     By  Charles  Ekin.     Second  Edition.     i2mo.        Price  .75 

ELLIS,  DISEASES  OF  CHILDREN. 

A  Practical  Manual  of  the  Diseases  of  Children,  with  a  Formulary.     By  Ed- 
ward Ellis,  m.d.      Late   Physician   to  the   Victoria   Hospital    for   Children, 


London.     Fourth  Edition  Enlarged.     Now  Ready. 


Price  $3.50 


BY   SAME  AUTHOR. 

WHAT  EVERY  MOTHER  SHOULD  KNOW. 

i2mo.  Price  .75 

"  It  is  only  too  true  that  our  children  have  to  dodge  through  the  early  part  of  life  as  through  a  labyrinth.  We 
must  be  thankful  to  meet  with  such  a  sensible  guide  for  them  as  Dr.  Ellis." — Pall  Mall  Gazette. 

FENNER,  ON  VISION. 

Vision ;  Its  Optical  Defects,  the  Adaptation  of  Spectacles,  Defects  of  Accommo- 
dation, etc.  By  C.  S.  Fenner,  m.d.  With  Test  Types  and  74  Illustrations. 
8vo.  Price  $3.50 

FENWICK,  THE  PRACTICE  OF  MEDICINE. 

Outlines  of  the  Practice  of  Medicine.  With  Appropriate  Formulse  and  Illus- 
trations.    By  Samuel  Fenwick,  m.d.,  Physician  to  the  London  Hospital.    i2mo. 

Price  |2.oo 

"  This  little  work  displays  a  sound  judgment  in  the  arrangement  of  its  subject  matter,  and  an  intimate  acquaint- 
ance with  the  practice  of  medicine  possessed  by  but  few  writers,  and  should  have  been  elaborated  into  a  more 
comprehensive  work.     Of  all  the  hand-books  we  have  seen,  this  is  certainly  one  of  the  best." — Medical  Herald. 

"  It  is  an  eminently  practical  little  treatise,  pervaded  with  much  common  sense,  and  will  doubtless  be  found 
useful,  particularly  by  advanced  students." — Boston  Medical  and  Sicrgical  yournal. 

BY   SAME   AUTHOR. 

ON  THE  STOMACH. 

The  Morbid  State  of  the  Stomach  and  Duodenum,  and  Their  Relations  to 
Diseases  of  Other  Organs.     With  10  Plates.     8vo.  Price  M-25 

Atrophy  of  the  Stomach  and  Its  Effect  on  the  Nervous  Affections  of  the  Digest- 
ive Organs.     8vo.  Price  $3.20 


FOTHERGILL,  ON  THE  HEART.     Second  Edition. 

The  Heart  and  Its  Diseases.  With  Their  .  Treatment.  Including  the  Gouty 
Heart.  By  J.  Milner  Fothergill,  m.d.,  Associate  Fellow  of  the  College  of 
Physicians  of  Philadelphia,      Second  Edition,   Entirely   Re-written.     Octavo. 

Price  $3.50 


"  It  is  the  best,  as  well  as  the  most  recent  work  on 
the  subject  in  the  English  language." — Medical  Press 
and  Circular. 

"  The  most  interesting  chapter  is  undoubtedly  that 
on  the  gouty  heart,  a  subject  which  Dr.  Fothergill  has 
specially  studied,  and  on  which  he  entertains  views 
such  as  are  likely,  we  think,  to  be  generally  accepted 
by  clinical  physicians,  although  they  have  not  before 
been  stated,  so  far  as  we  are  aware,  with  the  same 
breadth  of  view  and  extended  illus'tration," — British 
Medical  yournal. 


"  To  many  an  earnest  student  it  will  prove  a  Kght  in 
darkness ;  to  many  a  practitioner  cast  down  with  a 
sense  of  his  powerlessness  to  cope  with  the  rout  and 
demoralization  of  Nature's  forces,  a  present  help  in 
time  of  trouble." — Philadelphia  Medical  Times. 

"  The  work  throughout  is  a  masterpiece  of  graphis, 
lucid  writing,  fiill  of  good,  sound  teaching,  which  will 
be  appreciated  alike  by  the  practitioner  and  the  stu- 
dent."— Students'  journal. 


FULTON,  ON  PHYSIOLOGY. 

A   Text-Book  of   Physiology.    By  J.   Fulton,  m.d.,  Professor  at   Trinity 
Medical   College,   Toronto.     Second   Edition,  Illustrated  and  Revised.     Svo. 

Price  $4.00 


i6  PRESLEY  BLAKISTON'S 

FLOWER,  DIAGRAMS  OF  THE  NERVES. 

Diagrams  of  the  Nerves  of  the  Human  Body.  Exhibiting  their  Origin, 
Divisions,  and  Connections,  with  their  Distribution  to  the  various  Regions  of  the 
Cutaneous  Surface,  and  to  all  the  Muscles.  By  William  H.  Floaver,  f.r.c.s., 
F.R.S.,  Hunterian  Professor  of  Comparative  Anatomy,  and  Conservator  of  the 
Museum  of  the  Royal  College  of  Surgeons.  Third  Edition,  thoroughly  revised. 
With  six  Large  Folio  Maps,  or  Diagrams.     Royal  Quarto.  Price  $3.50 

"Admirably  arranged,  and  will  be  of  incalculable  aid  to  the  student  of  anatomy.  Each  of  the  large  and 
beautiful  plates  is  accompanied  with  explanatorj-  text." — N.  Y.  Medical  Record. 

"  The  nerves  and  ganglia  are  clearly  represented.  The  impressions  are  well  made,  and  no  doubt  the  diagrams 
wiH  prove  useful." — Medical  and  Surgical  Reporter. 

FLAGG,  PLASTIC  FILLING. 

Plastics  and  Plastic  Filling;  As  Pertaining  to  the  Filling  of  all  Cavities  of  De- 
cay in  Teeth  below  Medium  in  Structure,  and  to  Difficult  and  Inaccessible 
Cavities  in  Teeth  of  all  Grades  of  Structure.  With  some  beautifully  executed 
Illustrations.  By  J.  Foster  Flagg,  d.d.s.,  Professor  of  Dental  Pathology  and 
Therapeutics  in  Philadelphia  Dental  College.     Octavo.  Price  $3.00 

CoKTBNTS. — Introductory.  Article  i.  Plastic  Filling.  2.  Amalgam.  3.  Amalgam  continued.  4.  Amalgam 
continued.  5.  Attributes  of  Metals  used  for  Amalgam  Alloys.  6.  The  Making  of  Amalgam  Alloys.  7.  Tests 
for  Amalgam.  8.  Preparation  of  Cavities.  9.  The  Making  of  Amalgam.  10.  Instrument  for  the  Insertion  of 
Amalgam  Fillings.  11.  The  Insertion  of  Amalgam  Fillings.  12.  General  Considerations  Pertaining  to  Amalgam. 
13.  Gutta-percha.  14.  O.xj'-chloride  of  Zinc.  15.  Oxy-sulphata  of  Zinc,  16.  Zinc  Phosphate.  17.  Temporary 
Stopping.     18.  Technicalities.     Conclusion. 

FOSTER,  CLINICAL  MEDICINE. 

Lectures  and  Essays  on  Clinical  Medicine.  By  Balthazar  Foster,  m.d. 
Illustrated.     8vo.  Price  S3.00 


"No  one  can  peruse  the  thoughtful  comments  of  our 
author  upon  every  subject  he  considers,  without  feeling 
himself  a  wiser  man  for  his  pains." — N.  Y.  Medical 
yournal. 


"  It  is  the  record  of  honest  work,  such  as  Dr.  Foster 
may  be  proud  of;  we  can  recommend  it  to  the  profession; 
it  may  be  read  with  profit  and  advantage  by  both  prac- 
titioner and  student. — Edinburgh  Medical  yournal. 


FOX,  ATLAS  OF  SKIN  DISEASES. 

Complete  in  Eighteen  Parts,  each  containing;  Four  Chromo-Lithographic  Plates, 
with  Descriptive  Text  and  Notes  upon  Treatment.  In  all  72  large  colored  Plates. 
By  Tilbury  Fox,  m.d.,f.r.c.p..  Physician  to  the  Department  for  Skin  Diseases 
in  University  College  Hospital.     Folio  Size. 

Price  |2.oo  each,  or  complete,  bound  in  cloth,  $30.00 

No  Atlas  of  Skin  Diseases  has  been  issued  in  this  country  for  many  years,  and  no 
complete  work  of  the  kind  is  now  procurable  by  the  Profession.  This  one,  brought 
out  under  the  editorial  supervision  and  care  of  Dr.  Tilbury  Fox  (the  most  distin- 
guished writer  on  Cutaneous  Medicine  now  in  the  English  language),  is  partly  based 
upon  the  classical  work  of  Willan  and  Bateman  (now  entirely  out  of  print),  but  com- 
pletely remodeled,  so  as  to  represent  fully  the  Dermatology  of  the  present  day. 

"  Preference  will  be  given  to  this  work  over  Hebra  ;  not  simply,  however,  because  it  is  a  home  production,  but 
by  reason  of  the  manner  of  its  execution,  the  excellent  delineation  of  disease,  and  the  natural  coloring  of  the  plates. 
.  .  .  The  letter-press  is  entirely  new.  In  the  accuracy  of  the  latter  the  subscriber  may  have  the  fullest  confi- 
dence, since  it  is  from  the  pen  of  Dr.  Tilbury  Fox." — British  and  Foreign  Medico- Chirurgical  Review. 

FRANKLAND,  WATER  ANALYSIS. 

Water  Analysis,  For  Sanitary  Purposes,  with  Hints  for  the  Interpretation  of 
Results.     By  E.  Frankland,  m.d.,  f.r.S.     Illustrated,     i2mo.  Price  $1.00 

" The  author's  world-wide  reputation  will  commend  I        "The  work  is   one  which  physicians  practicing  im 

this  manual  to  all  sanitarians,  and  they  will  not  be  dis-  the  country  and   in   villages   and  towns  remote  front 

appointed  in  finding  all  the  essentials  of  the  important  medical  centres  cannot  afford  to  be  without." — Medical 

subject  of  which  it  treats." — The  Sanitariafi.  \    and  Surgical  Reporter. 

BY  SAME   AUTHOR. 

CHEMISTRY. 

How  to  Teach  Chemistry;  being  Six  Lectures  to  Science  Teachers,  Edited 
by  G.  George  Chaloi^er,  f.c.s.     Illustrated.     i2mo.  Price  $1.25 


PUBLIC  A  TIONS. 


17 


FOX,  WATER,  AIR  AND  FOOD. 

Sanitary  Examinations  of  Water,  Air  and  Food. 
M.D.     94  Engravings.     8vo. 


By  Cornelius  B.  Fox, 
Price  ^4.00 


GAi^LABIN,  DISEASES  OF  WOMEN. 

The  Student's  Guide  to  the  Diseases  of  Women.     By  A.  Lewis  Gallabin,  m.a., 
M.D.,  F.R.c.P.     Illustrated  with  63  Engravings.     i2mo.  Price  $2.00 


"Among  all  the  various  works  on  diseases  of  women 
with  which  we  are  acquainted,  there  is  none  which  so 
nearly  approaches  the  perfection  of  what  a  student's 
text-book  should  be  .  .  .  The  work  is  well  illustrated." 
— Students'  jfournal. 

"Though  the  book  is  a  small  one  and  the  subject  ex- 
tensive, yet  so  admirable  is  the  style  of  the  writer,  and 
so  careftil  his  selection  of  words,  that  each  disease  is 
thoroughly  treated  of." — Philadelphia  Medical  Times. 


"  Its  style  is  clear,  elegant,  and  concise.  It  contains 
a  great  amount  of  information ;  indeed,  we  do  not  think 
the  student  or  practitioner  will  find  any  book  which 
will  convey  to  him  in  so  small  a  compass  so  much  accu- 
rate knowledge  about  the  pathology  and  diagnosis  of 
the  diseases  peculiar  to  women." — Medical  Times  and 
Gazette. 


GROSS,  BIOGRAPHY  OF  JOHN  HUNTER. 

John  Hunter  and  His  Pupils.  By  S.  D.  Gross,  m.d..  Professor  of  Surgery  in 
Jefferson  Medical  College,  Philadelphia.  With  a  beautifully  executed  full  length 
Portrait  of  the  Author  in  his  Study.  A  Handsome  Octavo  volume.  Bound  in 
Beveled  Cloth.  Price  §1.50 

"  It  is  refreshing  to  read  the  story  of  a  life  so  fully  devoted  to  science,  and  the  reader  will  readily  appreciate 
Professor  Gross's  enthusiasm  for  his  subject,  which  led  him  to  extend  what  was  originally  intended  for  an  essay  to 
its  present  size. 

"  The  phototj'pe  of  Sharp's  well-known  engraving  of  Sir  Joshua  Reynold's  portrait  is  an  excellent  reproduction, 
and  forms  a  fitting  and  handsome  frontispiece. 

"  The  volume  will  prove  an  ornament  to  the  study  table,  where  it  will  be  a  constant  incentive  to  whatever  is 
best,and  noblest  in  a  noble  profession." — Baston  Med.  and  Surgical  yournai. 

BY   SAME  AUTHOR. 

AMERICAN  MEDICAL  MEN. 

American  Medical  Biography  of  the  Nineteenth  Century,  with  portrait  of  Dr. 
Benjamin  Rush.     Large  8vo.  Price  $3.50 

GANT,  A  SYSTEM  OF  SURGERY.     Enlarged  Edition. 

The  Science  and  Practice  of  Surgery,  including  Special  Chapters  by  different 
Authors.  By  Frederick  James  Gant,  f.r.c.s..  Senior  Surgeon  to  the  Royal 
Free  Hospital.  Second  Edition,  rewritten  and  much  enlarged  throughout. 
Illustrated  by  969  wood  engravings.     In  two  Octavo  volumes. 

Price,  Cloth  $11.00;  Leather  $13.00 

"  This  new  and  magnificent  work  on  surgery  sup- 
plies all  that  can  be  required,  whether  for  the  most  com- 
plete study  or  for  constant  reference  in  practice." — 
London  Medical  Press  and  Circular. 

"  The  reader  has  the  advantage  of  mature  experience 
in  treating  of  special  subjects,  that  are  either  omitted 
or  very  lightly  referred  to  in  ordinary  works  on  sur- 
gery."— London  Lancet. 


"  After  the  most  patient  analysis  our  limited  time 
has  permitted,  we  fsel  compelled  to  say  that  this  book 
is  a  valuable  and  eomprehensive  addition  to  the  surgical 
literature  of  the  profession  and  a  monument  to  the  care- 
ful, conscientious  and  painstaking  industry  of  the 
author." — Cincinnati  Lancet  and  Observer. 


ON 


BY   SAME  AUTHOR. 

THE  BLADDER  AND  PROSTATE. 

Diseases  of  the  Bladder  and  Prostate  Gland  and  Urethra,  including  a  Practical 
View  of  Urinary  Diseases,  Deposits  and  Calculi.  Fourth  Edition,  Revised  and 
Enlarged,  with  New  Illustrations.     i2mo.  Price  $3.00 

GIBBES,  STUDENT'S  PATHOLOGY. 

Practical  Histology  and  Pathology.  By  Hexeage  Gibbes,  m.b.  i2mo. 
Cloth.  Price  $1.00 

Chap.  i.  Introduction.  2.  On  Preparing  Tissues  for  Examination.  3.  On  Cutting  Sections.  4.  On  Staining. 
5.  On  Double  Staining^  6.  On  Mounting.  7.  Method  of  Obtaining  Animal  Tissues,  etc.  Practical  Histology, 
Pathology,  Memoranda  and  Formulae. 

"  This  excellent  little  work  is  admirably  adapted  to  fulfill  the  purpose  for  which  it  has  been  written.  It  is 
short,  clear,  and  eminently  practical.  The  author  is  evidently  an  accomp^shed  histptegist,  and  his  book  conveys 
the  impression  that  it  is  based  upon  his  own  personal  experience." — The  London  Medical  Record. 


PRESLEY  BLAKISTON'S 


GODLEE'S  ATLAS  OF  HUMAN  ANATOMY. 

Illustrating  most  of  the  Ordinary  Dissections  and  many  not  usually  practiced 
by  the  Student.  Accompanied  by  References  and  an  Explanatory  Text.  Com- 
plete. Folio  Size.  48  Colored  Plates.  By  Rickman  John  Godlee,  m.d., 
F.R.c.S.  Forming  a  large  Folio  Volume,  with  References,  and  an  Octavo 
Volume  of  Letter-press. 

Price  of  the  two  Volumes,  Atlas  and  Letter-press,  Cloth,  $30.00 

"  It  is  likely  tx)  prove  as  useful  to  the  physician  and  I  "  The  explanatory  text  is  concise,  well  written,  and 
surgeon  as  to  the  anatomist." — Medical  Times  and  contains  many  valuable  suggestions  for  the  surgeon." 
Gazette.  |    — Loiidon  Lancet. 

GOWERS,  SPINAL  CORD. 

Diagnosis  of  Diseases  of  the  Spinal  Cord.  With  Colored  Plates  and  Engrav- 
ings. A  Second  Edition.  Revised  and  Enlarged.  By  William  R.  Cowers, 
M.D.,  Assistant  Professor  Clinical  Medicine,  University  College,  London.     8vo. 

Price  Jti.50 

BY   SAME  AUTHOR. 

OPHTHALMOSCOPY. 

A  Manual  and  Atlas  of  Medical  Ophthalmoscopy.  With  16  Colored  Auto" 
type  and  Lithographic  Plates  and  26  Wood  Cuts,  comprising  112  Original  Illus- 
trations of  the  Changes  in  the  Eye  in  Diseases  of  the  Brain,  Kidneys,  etc.   8vo. 

Price  $6.00 
GREENHOW,  BRONCHITIS. 

On  Chronic  Bronchitis,  especially  as  connected  with  Gout,  Emphysema,  jind 
Diseases  of  the  Heart.     By  E.  Headlam  Greenhow,  m.d.  izmo.      Price  $\.%o 

BY    SAME  AUTHOR. 

ADDISON'S  DISEASE. 

Being  the  Croonian  Lectures,  delivered  before  the  Royal  College  of  Physi- 
cians, London.     Revised  and  Illustrated  by  Plates  and  Reports  of  Cases.     Svo. 

Price  $3.00 

"The  book  forms  a  most  interesting  and  valuable  monograph,  comprehensive  and  exhaustive." — Britith 
Medical  yournal. 

GLISAN,  TEXT-BOOK  OF  MODERN  MIDWIFERY. 

A  Text-Book  of  Modern  Midwifery.  By  Rodney  Glisan,  m.d..  Emeritus 
Professor  of  Midwifery  and  Diseases  of  Women  and  Children  in  the  Medical 
Department  of  Willamette  University,  Portland,  Oregon,  and  Late  President 
of  the  Oregon  State  Medical  Society.  With  129  Illustrations.  One  Volume, 
octavo,  624  pp.  Price,  in  Cloth  $4.00;  in  Leather  ;^ 5. 00 

Many  years  have  elapsed  since  the  appearance  of  an  original  American  text-book 
of  obstetrics.  The  author  of  this  one,  believing  that  there  is  a  demand  for  a  work 
thoroughly  representing  American  obstetrical  practice,  ventures  to  present  this  con- 
densed treatise  to  the  medical  students  and  practitioners  of  his  own  country.  Many 
years'  experience  as  a  practitioner  and  several  as  a  teacher  of  midwifery,  warrants 
this  effort  to  supply  the  demand  for  a  book  fully  brought  up  to  the  present  time, 
faithfully  representing  the  peculiarities  of  American  practice,  and  adapted  to  the  wants 
of  obstetric  teachers  and  busy  practitioners. 

The  book  is  freely  illustrated  wherever  its  value  and  usefulness  can  be  thus  en- 
hanced, and  being  brought  out — owing  to  the  unavoidable  absence  of  the  author — 
under  the  supervision  of  the  well-known  obstetrician.  Dr.  Robert  P.  Harris,  of 
Philadelphia,  the   publishers  very  confidently  anticipate  for  it  a  favorable  reception. 

GILL,  ON  INDIGESTION.     Second  Edition. 

Indigestion ;  What  It  Is ;  What  It  Leads  To  ;  and  a  New  Method  of  Treating 
It.    By  John  Beadnell  Gill,  m.d.     Second  Edition.     i2mo.  Price  $i.>5 


PUB  Lie  A  TIONS.  19 


HABERSHON,  ON  THE  STOMACH. 

On  Diseases  of  the  Stomach — The  Varieties  of  Dyspepsia — Their  Diagnosis 
and  Treatment.  By  S.  O.  Habershon,  m.d.,  f.r.c.p.,  Senior  Physician  to,  and 
Late  Lecturer  on,  the  Principles  and  Practice  of  Medicine  at  Guy's  Hospital. 
Third  Edition,  Revised.     Crown  8vo.  Price  ^1.75 

"  As  an  expression  of  the  results  of  long  personal  experience  in  both  hospital  and  private  practice,  conveyed  in 
agreeable  though  not  always  perspicuous  diction,  this  contribution  of  Dr.  Habershon's  has  special  value  of  its 
own,  and  is  so  far  entitled  to  the  favorable  consideration  of  the  practitioner,  as  is  already  testified  by  a  demand  for 
a  third  edition." — American  journal  of  Medical  Sciences. 

"  It  is  divided  into  twenty  chapters,  fifteen  of  which  are  devoted  to  a  consideration  of  the  different  forms  of 
Dyspepsia,  while  the  remaining  treat  of  Degeneration,  Ulceration,  Cancerous  Diseases,  and  Spasms  of  the 
Stomach."     We  can  cordially  recommend  this  book  of  Dr.  Habershon's  to  the  profession." — Medical  Record. 

HALE,  ON  CHILDREN. 

The  Management  of  Children  in  Health  and  Disease.  A  Book  for  Mothers. 
By  Mrs.  Amie  M.  Hale,  m.d.  Abounding  in  valuable  information  and  com- 
mon-sense advice.     New  Enlarged  Edition.     i2mo.  Price  .75 

"  We  shall  use  our  influence  in  the  introduction  of  this  work  to  families  under  our  care.'and  we  urge  the  profession 
generally  to  follow  our  example." — Buffalo  Medical  and  Surgical  yournal. 

HARDWICH  AND  DAWSON,  PHOTOGRAPHIC   CHEMIS- 
TRY. 

Hardwich's  Manual  of  Photographic  Chemistry.  Illustrated.  Eighth  Edition. 
Rearranged  by  G.  Dawson.     i2mo.  Price  $2.00 

HARDWICKE,  MEDICAL  EDUCATION. 

Medical  Education  and  Practice  in  All  Parts  of  the  World.  Containing 
Regulations  for  Graduation  at  the  Various  Universities  throughout  the  World. 
By  Herbert  Junius  Hardwicke,  M.D. ,  M.R.c.p.     8vo.  Price  $3.00 

"  Dr.  Hardwicke's  book  will  prove  a  valuable  source  of  information  to  those  who  may  desire  to  know  the 
conditions  upon  which  medical  practice  is  or  may  be  pursued  in  any  or  every  country  of  the  world,  even  to  the 
remotest  comers  of  the  earth.  The  work  has  been  compiled  with  great  care,  and  must  have  required  a  vast 
amount  of  labor  and  perseverance  on  the  part  of  its  author." — Dublin  Medical  yournal. 

HARRISON,  STRICTURE  OF  THE  URETHRA. 

On  Stricture  and  Other  Diseases  of  the  Urinary  Organs.  By  Renegall 
Harrison,  f.r.c.s.     With  numerous  Illustrations.     8vo.  Price  $2.75 

HAYDEN,  ON  THE  HEART. 

The  Diseases  of  the  Heart  and  Aorta.  By  Thomas  Hayden,  m.d.  With  81 
Illustrations.     2  vols.     1232  pp.     8vo.  Price  $6.00 

"The  author  evidently  has  had  a  very  wide  and  well  used  experience  in  that  of  which  he  writes  ;  is  well  versed 
in  modern  physiology  and  pathology,  and  holds  a  fluent  pen,  consequently  the  book  is  an  excellent  one,  and  as 
the  teachings  of  the  text  are  abundantly  illustrated  by  the  reports  of  one  hundred  and  fifty  cases.  Dr.  Hayden's 
effort  will  probably  attain  the  popularity  it  deserves." — PhiladelJ>kia  Medical  Times. 

"  There  is  not  an  unnecessary  page  in  Dr.  Hayden's  work." — N.  V.  Medical  Record. 

HOLDEN,  HUMAN  OSTEOLOGY.     Sixth  Edition. 

Comprising  a  Description  of  the  Bones,  with  Colored  Delineations  of  the  At- 
tachments of  the  Muscles.  The  General  and  Microscopical  Structure  of  Bone 
and  its  Development.  By  the  Author  and  A.  Doran,  f.r.c.s.,  with  Lithographic 
Plates,  etc.  By  Luther  Holden,  f.r.c.s.  Numerous  Illustrations.  Sixth 
Edition,  carefully  Revised.  Price  ^5.50 

BY   SAME   author. 

ANATOMY. 

Manual  of  Dissections  of  the  Human  Body.  Fourth  London  Edition.  With 
170  Illustrations.  Price  ^5.50 

LANDMARKS. 

Landmarks,  Medical  and  Surgical.  Third  London  Edition.  Revised  and 
Enlarged.  Price  ^1.25 

"  Mr.  Holden  is  the  happy  possessor  of  the  faculty  of  writing  interesting  works  on  Anatomy.  A  part  of  the 
charm  consists  in  the  frequent  references  to  practical  points,  and  in  the  explanation  of  the  advantages  and  objects 
of  details  of  structures." — Boston  Medical  and  Surgical  journal. 


PRESLE  V  BLA KISTON ' S 


HEATHS  OPERATIVE  SURGERY. 

A  Course  of  Operative  Surgery,  consisting  of  a  Series  of  Plates,  each  plate 
containing  Numerous  Figures,  Drawn  from  Nature  by  the  Celebrated  Anatomi- 
cal Artist,  M.  Leveille,  of  Paris,  Engraved  on  Steel  and  Colored  by  Hand, 
under  his  immediate  superintendence,  with  Descriptive  Text  of  Each  Operation. 
By  Christopher  Heath,  f.r.c.S.,  Surgeon  to  University  College  Hospital,  and 
Holme  Professor  of  Clinical  Surgery  in  University  College,  London.  One  Large 
Quarto  Volume.  Price  $14.00 

The  author  has  embodied  in  this  work  the  experience  gained  by  him  during 
twenty  years  of  surgical  teaching.  It  comprises  all  the  operations  that  are  required 
in  ordinary  surgical  practice.  He  has  selected  for  illustration  and  description  those 
methods  which  appear  to  give  the  best  results  in  practice,  referring  to  the  errors 
likely  to  occur  and  the  best  methods  of  avoiding  them. 

BY    SAME   AUTHOR. 

THE   STUDENT'S  GUIDE  TO  SURGICAL   DIAGNOSIS. 

i2mo.  Price  $1.50 

"  Mr.  Heath  is  so  well  known,  both  as  a  practical  surgeon,  teacher  and  writer,  that  anything  from  his  pen  re- 
quires no  introduction  from  the  hands  of  reviewers,  and  scarcely  any  notice  but  the  announcement  of  the  fact  that 
he  has  written  a  book." — Medical  Record. 

A  MANUAL  OF    MINOR    SURGERY   AND   BANDAGING. 

Sixth    Edition,    Revised    and   Enlarged.      With    115    Illustrations.       l2mo. 

Price  $2.00 

"This  excellent  work  should  not  be  termed  a  '  Minor'  Surgery,  but  it  really  consists  cf  tte  sum  and  substance 
of  Practical  surgery.     We  would  not  exchange  it  for  any  book  in  our  possession." — Southern  Clinic. 

HEATH'S  PRACTICAL  ANATOMY.     Fifth  London  Edition. 

Practical  Anatomy.  A  Manual  of  Dissections.  Fifth  London  Edition.  24 
Colored  Plates,  and  nearly  300  other  Illustrations.     Just  Ready.  Price  $5-Oo 

INJURIES  AND  DISEASES  OF  THE  JAWS. 

The  Jacksonian  Prize  Essay  of  the  Royal  College  of  Surgeons  of  England, 
1867.     Second  Edition,  Revised,  with   over   150  Illustrations.     Octavo. 

Price  $4.25 
HOOD,  ON  GOUT  AND  RHEUMATISM. 

A  Treatise  on  Gout,  Rheumatism,  and  the  Allied  Affections.  Their  Treat- 
ment, Complications,  and  Prevention.  By  Peter  Hood,  m.d.  Second  Edi- 
tion, Revised  and  Enlarged.     With  some  Considerations  on  Longevity.  Octavo. 

Price  $3.50 

"  f  he  Observations  on  Treatment  are  specially  to  be  commended." — London  Lancet. 

HOLDEN,  THE  SPHYGMOGRAPH. 

The  Sphygmograph.  Its  Physiological  and  Pathological  Indications.  By 
Edgar  Holden,  m.d.  Illustrated  by  Three  Hundred  Engravings  on  Wood. 
8vo.  Price  $2.00 

HOLMES,  THE  LARYNGOSCOPE. 

A  Guide  to  the  Use  of  the  Laryngoscope  in  General  Practice.  By  Gordon 
Holmes,  m.d.,  Physician  to  the  Throat  and  Ear  Infirmary.     i2mo.     Price  $1.00 

BY  same  author. 

VOCAL  PHYSIOLOGY. 

Vocal  Physiology  and  Hygiene.  With  reference  to  the  Cultiration  and 
Preservation  of  the  Voice.     Illustrated.     i2mo.  Price  $2.00 

HOFF,  ON  H.^MATURIA. 

Haematuria  as  a  Symptom  of  the  Diseases  of  the  Genito-Urmary  Organs.  By 
O,  HoFF,  M.D.     Illustrated.     i2mo.  Price  .75 


PUBLICATIONS.  21 

HUNTER,  MECHANICAL  DENTISTRY. 

A  Practical  Treatise  on  the  Construction  of  the  Various  kinds  of  Artificial 
Dentures,  with  Formulae,  Receipts,  etc.  By  Charles  Hunter,  d.d.s.  100 
Illustrations.     i2mo.  Price  ^2.25 

"It  is  the  outcome  of  his  own  experience  of  some  twenty  years  as  a  Mechanical  Dentist,  and  contains,  moreover, 
much  derived  from  practical  knowledge  of  other  dentists.  The  value  of  the  book  is  also  much  added  to  by  illus- 
trations. It  will  be  very  useiiil  to  the  Dental  Student,  and  to  all  Mechanical  Dentists." — London  Medical  Times 
•ind  Gazette. 

HUTCHINSON'S    ILLUSTRATIONS    OF    CLINICAL   SUR- 
GERY.    First  Volume  Complete. 

Consisting  of  Plates,  Photographs,  Woodcuts,  Diagrams,  etc.  Illustrating 
Surgical  Diseases,  Symptoms,  and  Accidents;  also  Operations  and  other 
Methods  of  Treatment.  With  Descriptive  Letter-press.  By  Jonathan  Hutch- 
.  INSON,  F.R.C.S.,  Senior  Surgeon  to  the  London  Hospital,  Surgeon  to  the  Moor- 
fields  Ophthalmic  Hospital,  and  to  the  Hospital  for  Diseases  of  the  Skin,  Black- 
friars.  In  Quarterly  Fasciculi.  Imperial  4to.  Volume  i.  (Ten  Fasciculi)  bound 
complete  in  itself.  Price  $25.00.  Parts  Eleven,  Twelve,  Thirteen,  and  Fourteen 
of  Volume  2,  Now  Ready.  Each  $2.50 

HEWITT,  DISEASES  OF  WOMEN.     Third  Edition. 

The  Diagnosis,  Pathology,  and  Treatment  of  Diseases  of  Women,  Including 
the  Diagnosis  of  Pregnancy.  Founded  on  a  Course  of  Lectures  Delivered  at  St. 
Mary's  Hospital  Medical  School.  By  Graily  Hewitt,  m.d.,  Lond.,  m.r.c.p., 
Physician  to  the  British  Lying-in  Hospital ;  Lecturer  on  Midwifery  and  Diseases 
of  Women  and  Children  at  St.  Mary's  Hospital  Medical  School;  Honorary 
Secretary  to  the  Obstetrical  Society  of  London,  etc.  The  Third  Edition.  Re- 
vised and  Enlarged,  with  New  Illustrations.     Octavo. 

Price,  Cloth  ^.oo;  Leather  ^5.00 

"  The  excellent  work  of  Dr.  Hewitt  presents — in  a 
form  well  adapted  to  conduct  the  student  to  a  knowledge 
of  the  Diseases  of  Women,  and  to  assist  the  young 
practitioner  in  his  study  of  these  diseases  at  the  bedside 
of  the  patient — a  very  full  and  clear  exposition  of  the 
views  entertained  by  the  most  authoritative  teachers  as 
to  their  pathological  treatment  and  their  correct  Diag- 
nosis."— Amer.  Med.  yournal. 

YiPCI,  SARCOMATOUS  TUMOR. 

History  of  a  Case  of  Recurring  Sarcomatous  Tumor  of  the  Orbit  in  a  Child. 
By  Thomas  Hay,  m.d.    Illustrated.     Paper.  Price  .50 

HEWSON,  EARTH  IN  SURGERY. 

Earth  as  a  Topical  Application  in  Surgery,  Being  a  Full  Exposition  of  its  LTse 
in  Cases  Requiring  Topical  Apphcations.  By  Addinell  Hewson,  m.d.  Illus- 
trated.   8vo.  Price  $2.50 

HODGE,  ON  ABORTION. 

On  Foeticide  or  Criminal  Abortion.     By  Hugh  L.  Hodge,  m.d. 

Price,  Paper,  .30;  Cloth,  .50 
HODGE,  CASE-BOOK. 

Note-Book  for  Cases  of  Ovarian  Tumors.  By  H.  Lennox  Hodge,  m.d.  With 
Diagrams.  Price,  Paper,  .50 

HIGGINS,  DISEASES  OF  THE  EYE. 

A  Hand-Book  of  Ophthalmic  Practice.  By  Charles  Higgins,  e.r.c.s. 
Ophthalmic  Assistant  Surgeon    at  Guy's  Hospital.      Second  Edition.      i6mo. 

Price  .60 

Contents. — Section  1.  Discharge  from  the  Eyes.  ii.  Intolerance  of  Light,  in.  Iritis  and  Glaucoma,  iv. 
Diseases  of  the  Eyelids,  v.  Watering  of  the  Eye.  VT.  Acuteness  of  Vision,  Field  of  Vision,  Anomalies  of  Re- 
fraction, Astigmatism,  Accommodation,  Presbyopia,  vii.  Disturbance  of  Vision,  Use  of  the  Ophthalmoscope, 
Normal  and  Morbid  Appearances,     viii.  Injuries. 

"We  have  rarely  seen  so  much  important  information  condensed  in  so  short  a  space." — American  Medical 
y<^rnal. 


"  Readers  of  the  former  editions  will  not  require  to 
be  told  that  the  additions  now  made  are  of  the  highest 
possible  excellence."— Times  and  Gazette. 

"  It  is  one  of  the  most  useful,  practical,  and  compre- 
hensive works  upon  the  subject  in  the  English  language, 
a  true  guide  to  the  student,  and  an  invaluable  means  of 
reference  for  the  teacher." — N.  Y.  Medical  Record. 


PRESLEY  BLAKISTON'S 


HARRIS.  THE  PRACTICE  OF  DENTISTRY.    Tenth  Edition. 

The  Principles  and  Practice  of  Dentistry.  Tenth  Revised  Edition.  In  great 
part  Rewritten,  Rearranged,  and  with  many  new  and  important  Illustrations. 
By  Chapin  a.  Harris,  m.d.,  d.d.s.  Edited  by  P.  H.  Austen,  m.d.,  Professor 
of  Dental  Science  and  Mechanism  in  the  Baltimore  College  of  Dental  Surgery. 
With  nearly  400  Illustrations.     Royal  Octavo.    Price,  Cloth,  ;J6. 50;  Leather,  ;J7. 50 

This  new  edition  of  Dr.  Harris'  work  has  been  thoroughly  revised  in  all  its  parts, 
more  so  than  any  previous  edition.  So  great  have  been  the  advances  in  many 
branches  of  dentistry  that  it  was  found  necessary  to  rewrite  the  articles  or  subjects, 
and  this  has  been  done  in  the  most  efficient  manner  by  Professor  Austen,  for  many 
years  an  associate  and  friend  of  Dr.  Harris,  assisted  by  Professor  Gorgas  and  Thomas 
S.  Latimer,  m.d.  The  publishers  feel  assured  that  it  will  now  be  found  the  most 
complete  text-book  for  the  student,  and  guide  for  the  practitioner  in  the  English 
language. 

BY    SAME  AUTHOR. 

MEDICAL  AND  DENTAL  DICTIONARY.     Fourth  Edition. 

A  Dictionary  of  Medical  Terminology,  Dental  Surgery,  and  the  Collateral 
Sciences.  Fourth  Edition,  Carefully  Revised  and  Enlarged.  By  Ferdinand 
J.  S.  Gorgas,  m.d.,  d.d.s.,  Professor  of  Dental  Surgery  in  the  Baltimore  College, 
etc.     Royal  Octavo.  Price,  Cloth,  $6.50;  Leather,  ;^7. 50 

This  Dictionary,  having  passed  through  three  editions,  and  been  for  some  time 
out  of  print,  has  been  again  carefully  revised  by  F.  J.  S.  Gorgas,  m.d.,  Dr.  Harris' 
successor  as  Professor  of  Dental  Surgery  in  the  Baltimore  College  of  Dental  Surgery. 
In  his  preface  to  this  new  edition,  the  editor  says  : — 

"  The  object  of  the  reviser  has  been  to  bring  the  book  thoroughly  up  to  the  pres- 
ent requirements  of  the  profession,  the  Medical  ^or\Jion  having  been  as  carefully  re- 
vised and  added  to  as  that  devoted  more  especially  to  Dental  Science,  while  a 
number  of  obsolete  terms  and  methods  have  been  omitted.  In  nearly  every  one  of 
the  seven  hundred  and  forty-three  pages  of  the  former  edition  corrections  and  addi- 
tions have  been  made,  and  many  new  processes,  terms  and  appliances  described, 
some  of  which  are  not  found  in  any  other  work  published." 

HANDY,  ANATOMY. 

Text-Book  of  Anatomy  and  Guide  to  Dissections.  For  the  Use  of  Students. 
By  W.  R.  Handy,  m.d.     312  Illustrations.  Price  $3.00 

HILLIER,  DISEASES  OF  CHILDREN. 

A  Clinical  Treatise  on  the  Diseases  of  Children.  By  Thomas  Hillier,  m.d. 
8vo.  Price  $2.00 

HUFELAND,  LONG  LIFE. 

The  Art  of  Prolonging  Life.  By  C.  W.  Hufeland.  Edited  by  Erasmus 
Wilson,  m.d.     i2mo.  Price  $1,00 

"We  wish  all  doctors  and  all  their  intelligent  clients  would  read  it,  for  surely  its  perusal  would  be  attended 
with  pleasure  and  benefit." — American  Practitioner. 

"  It  certainly  should  be  in  the  library  of  every  physician." — Medical  Brief. 

HUNTER,  PORTRAIT  OF. 

Portrait  of  John  Hunter.  From  Sharp's  well-known  Engraving ;  a  copy  of 
Sir  Joshua  Reynold's  Portrait.  For  Framing.  Large  size,  9x11;  sheet  16x20. 
Price,  in  the  Sheet,   sent  free  by  mail,  50  cents  ;    or,  Handsomely   Framed^ 

Price  $2cx> 


PUBLIC  A  TIONS.  13 


HEADLAND,  THE  ACTION  OF  MEDICINES.    Sixth  Edition. 

On  the  Action  of  Medicines  in  the  System.  By  F.  W.  Headland,  m.d. 
Sixth  American  Edition,  Revised  and  Enlarged.     8vo.  Price  $3.00 

"  It  displays  in  every  page  the  evidence  of  extensive  knowledge  and  of  sound  reasoning ;  it  will  be  useful  alike 
to  those  who  are  just  commencing  their  studies,  and  to  those  who  are  engaged  in  the  active  pursuits  of  pro- 
fessional \\ie.."— Medical  Times. 

"  The  very  favorable  opinion  which  we  were  amongst  the  first  to  pronounce  upon  this  essay  has  been  fully 
confirmed  by  the  general  voice  of  the  profession,  and  Dr.  Headland  may  now  be  congratulated  on  having  pro- 
duced a  treatise  which  has  been  weighed  in  the  balance,  and  found  worthy  of  being  ranked  with  our  standard 
medical  works." — London  Lancet. 

JAMES,  SORE  THROAT. 

On  Sore  Throat,  Its  Nature,  Varieties  and  Treatment,  Including  its  Con- 
nection with  other  Diseases.  By  Prosser  James,  m.r.c.p.  Fourth  Edition, 
Revised  and  Enlarged.     With  Colored  Plates  and  Numerous  Wood-cuts.     i2mo. 

Price  ^2.25. 

"  We  can  confidently  recommend  his  therapeutic  teachings  as  well  worthy  of  the  careful  consideration  of  the 
Profession,  for  they  set  forth  the  practice  of  an  enthusiastic  worker,  whose  special  experience  has  been  large  and 
lengthened." — British  Medical  yournal. 

"  The  practitioner  who  buys  Dr.  James'  unpretending  little  book  wiU  provide  himself  with  awise  and  practical 
clinical  commentary,  and  with  a  well  arranged  digest  of  long  and  varied  e.^^mcnU." —Westminster  Review. 

BY  SAME  AUTHOR. 

LARYNGOSCOPY  AND  RHINOSCOPY. 

Including  the  Diagnosis  of  Diseases  of  the  Throat  and  Nose.  Third  Edition. 
With  Colored  Plates.     i8mo.  Price  $2.00. 

"  It  gives  in  a  succinct  form  the  approved  methods  of  examination  and  treatment  of  diseases  of  the  nose,  throat, 
and  larynx.  The  plan  pursued  is  one  well  adapted  to  the  needs  of  the  general  practitioner." — American  Medical 
yournal. 

JONES,  AURAL  ATLAS. 

An  Atlas  of  Diseases  of  the  Membrana  Tympani.  Being  a  Series  of  Colored 
Plates,  containing  62  Figures.  With  appropriate  Letter-press  and  Explanatory 
Text.  By  H.  Macnaughton  Jones,  m.d.,  Surgeon  to  the  Cork  Ophthalmic  and 
Aural  Hospital.     4to.  Price  $6.00. 

"  The  cases  are  well  selected,  the  drawings  executed  from  life,  highly  artistic  and  very  conscientious,  and  the 
commentaries  indicate  familiarity  with  the  subject  and  good  judgment  in  dealing  with  it." — British  Medical 
yournal. 

BY   SAME   AUTHOR. 

AURAL  SURGERY. 

A  Practical  Hand-Book  on  Aural  Surgery.     Illustrated.     i2mo.      Price  $1.50. 

JONES,  SIEVEKING  AND  PAYNE,  PATHOLOGICAL  AN- 
ATOMY. 

A  Manual  of  Pathological  Anatomy.  By  C.  Handfield  Jones,  m.d,,  and 
Edward  H.  Sieveking,  m.d..  Physician  to  St.  Mary's  Hospital.  A  New  En- 
larged Edition.  Edited  by  J.  F.  Payne,  m.d..  Lecturer  on  Morbid  Anatomy  at 
St.  Thomas'  Hospital.     With  Numerous  Illustrations.     Demi  8vo.     Price  $5.50. 

JONES,  ON  SIGHT  AND  HEARING. 

The  Defects  of  Sight  and  Hearing,  their  Nature,  Causes,  and  Prevention.  By 
T.  Wharton  Jones,  m.d.     Second  Edition.     i6mo.  Price  .50. 

KIRBY,  ON  PHOSPHORUS.     Fifth  Edition. 

Phosphorus  as  a  Remedy  for  Functional  Diseases  of  the  Nervous  System. 
By  E.  A.  KiRBY,  m.d.     Fifth  Edition.     Svo.  Price  $1.00 

KOLLMEYER,  KEY  TO  CHEMISTRY. 

Chemia  Coartata,  or  Key  to  Modern  Chemistry.  By  A.  H.  Kollmeyer,  m.d. 
With  Numerous  Tables,  Tests,  etc.  Price  $2.25 

KIRKE,   PHYSIOLOGY.     Revised  up  to  1881. 

A  Hand-book  of  Physiology.  By  Kirke.  Tenth  London  Edition.  By  W. 
MORRANT  Baker,  m.d.     420  Illustrations.  Price  I5.00 


PRESLEY  BLAKISTON'S 


KANE,  THE  OPIUM,  MORPHINE  AND  SIMILAR  HABITS. 

Drugs  that  Enslave.  The  Opium,  Morphine,  Chloral,  Hashisch  and  Similar 
Habits.     By  H.  H.  Kane,  M.D.,  of  New  York.     With  Illustrations.     Price  ^1.50 

"  It  contains  a  large  amount  of  information  collected  with  much  labor  and  presented  tn  a  systematic  manner. 
The  subject  of  the  chloral  habit  has  not  been  investigated  by  any  one,  we  believe,  so  thoroughly  as  Dy  Dr.  Kane." 
— Medical  Record. 

"  It  deserves  to  be  read  by  those  who  feel  an  interest  in  discouraging  ihc  use  of  these  dangerous  drugs.  The 
book  is  embellished  by  an  excellent  phototype  frontispiece  of  Laocoon." — Americatt  yournal  of  Pharmcuy. 

"  A  work  of  more  than  ordinary  ability  and  careful  research.  .  .  .  For  the  first  time,  reliable  statistics  on 
the  use  of  chloral  are  classified  and  published,  .  .  .  and  it  is  shown  that  the  use  of  c\\\ox3\  causes  a  more 
complete  and  rapid  ruin  of  mind  and  body  than  either  opium  or  morphine." — Druggists'  Circular  and  Gazette. 

KIDD,  THERAPEUTICS. 

The  Laws  of  Therapeutics ;  or,  the  Science  and  Art  of  Medicine.  By  Joseph 
KiDD,  M.D.     i2mo.     Cloth.  Price  %\.i^. 

Dr.  Joseph  Kidd,  who,  by  the  way,  was  Lord  Beaconsfield's  medical  adviser,  and 
an  eminent  physician  of  the  regular  school,  briefly  but  clearly  sketches  the  history  of 
medicine  from  the  earliest  period.  He  shows  that  the  chief  mistakes  have  been 
made  through  deference  to  theory  and  negligence  of  the  teachings  of  facts.  Thence 
he  passes  to  an  assertion  of  the  value  of  the  homoeopathic  principle  of  similia  simili- 
bus  in  the  treatment  of  many  diseases.  He  is  not  a  follower  of  Hahnemann,  and 
does  not  believe  in  innnitessimal  doses,  but  he  claims,  and  enforces  his  position  by 
the  citation  of  cases  in  his  own  practice,  that  the  homoeopathic  principle  has  performed 
wonders  where  that  of  his  own  school  was  much  less  successful. 

"  Dr.  Kidd  acknowledges  two  laws — that  oi coniraria  contrariis  and  similia  similiii/s  ;  but  the  cases  he  gives 
in  his  chapter  on  ars  medica  show  that,  like  a  sensible  practitioner,  he  does  not  allow  himself  blindly  to  follow 
either  the  one  or  the  other,  but  seeks  out  the  cause  of  disease,  and  tries  by  rational  measures  to  remove  it.  The 
cases  are  the  most  valuable  part  of  the  book." — London  Practitioner . 

LEGG,  ON  THE  URINE. 

Practical  Guide  to  the  Examination  of  the  Urine,  for  Practitioner  and  Student. 
By  J.  WiCKHAM  Legg,  M.D.     Fifth  Edition,  Enlarged.     Illustrated.     i2mo. 

Price  .75 

This  little  work  is  intended  to  supply  the  Physician  or  Student  with  a  concise  guide 

to  the  recognition  of  the  different  characteristics  of  the  urine,  and  though  small  and 

well  adapted  to  the  pocket,  contains,  probably,   everything  that  could  be  gleaned 

from  a  larger  work. 

LEARED,  IMPERFECT  DIGESTION. 

The  Causes  and  Treatment  of  Imperfect  Digestion.  By  Arthur  Leared,  m.d. 
The  Sixth  Edition.     Revised  and  Enlarged.     i2mo.  Price  g 1. 50 

LIEBREICH,  ATLAS  OF  OPHTHALMOSCOPY. 

An  Atlas  of  Ophthalmoscopy,  containing  12  Full-page  Chromo-Lithographic 
Plates,  with  59  Figures.  By  R.  Liebreich,  m.d.  Second  Edition,  Enlarged. 
Large  Quarto.  Price  $12.00 

LIVEING,  ON  SICK  HEADACHE. 

Megrim,  or  Sick  Headache  and  Some  Allied  Disorders.  By  Edward  Live- 
ING,  M.D.     With  Plates,  Tables,  etc.     8vo.  Price  $5.50 

LEBER  AND  ROTTENSTEIN,  DENTAL  CARIES. 

Dental  Caries  and  Its  Causes.  An  Investigation  into  the  Influence  of  Fungi 
in  the  Destruction  of  the  Teeth.  By  Drs.  Leber  and  Rottenstein.  Illustrated. 
8vo.  Price;?  1. 2  5 

"  The  work  gives  the  result  of  patient  observation,  presents  the  deductions  of  its  authors  with  a  perspicuity  and 
modesty  calculated  to  secure  for  its  positions  a  thoughtful  consideration.  We  heartily  commend  it  as  an  educa- 
tional work." — Dental  Cosmos. 


PUBLIC  A  TIONS. 


25 


LEWIN,  ON  SYPHILIS. 

The  Treatment  of  Syphilis.  By  Dr.  George  Lewin,  of  Berlin.  Translated 
by  Carl  Proegler,  m.d.,  and  E.  H.  Gale,  m.d.,  Surgeons  U.  S.  Army.  Illus- 
trated.    i2mo.  Price  $1.50 

"  When  such  authorities  as  Dr.  Drysdale  (as  we  quoted  a  few  weeks  ago)  condemn  the  use  of  mercury  in  syphilis 
as  "  too  dangerous,"  while,  on  the  other  hand,  eminent  surgeons,  such  as  Professor  Gross,  will  not  treat  a  case 
without  that  drug,  general  practitioners  will  gladly  welcome  any  vtedia.  via  which  gives  us  all  the  good  effects  of 
mercurials  without  any  danger  of  their  ill  results  appearing.  This  is  what  is  accomplished  by  Dr.  Lewin." — 
Philadelphia  Medical  and  Surgical  Reporter. 


LIZARS,  ON  TOBACCO. 

The  Use  and  Abuse  of  Tobacco. 


By  John  Lizars,  m.d.  i2mo.  Price  .50 


LONGLEY,  POCKET  MEDICAL  LEXICON. 

Students'  Pocket  Medical  Dictionary',  Giving  the  Correct  Definition  and  Pro- 
nunciation of  all  Words  and  Terms  in  General  Use  in  Medicine  and  the  Collate- 
ral Sciences,  with  an  Appendix,  containing  Poisons  and  their  Antidotes,  Abbre- 
viations Used  in  Prescriptions,  and  a  Metric  Scale  of  Doses.  By  Elms  Longley. 
24mo.  Price,  Cloth,  |i.oo;  Tucks  and  Pocket  $1.25 

This  is  an  entirely  new  Medical  Dictionar}%  containing  some  300  compactly 
printed  24mo  pages,  very  carefully  prepared  by  the  author,  who  has  had  much  ex- 
perience in  the  preparation  of  similar  works,  assisted  by  the  Professors  of  Chemistry 
and  of  Botany  in  one  of  our  leading  medical  colleges. 

"  It  is,  we  believe,  also  the  only  le.xicon  in  existence 

in  which  the  pronunciation  of  words   is  fully  and  dis- 
tinctly marked." — Canada  Medical  Review. 

"This  is  a  very  compact  and  complete  little  diction- 
arj'.  We  commend  it  as  particularly  useful  to  students." 
— Ne-w  York  Medical  yournal. 


"  This  little  book  will  be  welcomed  by  students  in 
medicine  and  pharmacy  as  a  convenient  pocket  com- 
panion, giving  the  pronunciation,  acceptation,  and 
definition  of  medical,  pharmaceutical,  chemical  and 
botanical  terms." — American  jfotirnal  of  Phannacy. 

"  It  would  seem  to  be  just  the  book  for  dentaj  and 
medical  students." — Dental  Advertiser. 


MARTIN,  ATLAS  OF  GYNiECOLOGY. 

An  Atlas  of  Obstetrics  and  Gynsecology.  By  Prof.  A.  Martin,  of  Berlin. 
Translated  and  edited  from  the  Second  German  Edition,  with  additions,  by  Fan- 
COURT  Barnes,  m.d.,  m.r.c.p.  With  98  Full-page  Lithographic  Plates,  con- 
taining over  400  figures,  many  being  colored.  With  full  letter-press  references 
to  and  explanations  of  each  figure  ;  forming  a  thick  quarto  volume.  Bound  in 
heavy  beveled  boards.     Sold  only  by  subscription.  Price  $12.00 


"This  valuable  and  classic  series  of  illustrations 
includes  98  pages  of  plates,  with  an  average  of  s  illus- 
trations on  each,  many  of  which  are  colored,  and  some 
drawn  on  a  large  scale,  so  as  to  occupy  the  whole  page. 
The  subjects  treated  range  through  the  whole  of  mid- 
wifery and  gynaecology,  beginning  with  normal  and  ab- 
normal pelvis,  and  ending  with  illustrations  of  some  of 
the  most  important  obstetric  gynaecologic  instruments 
used  in  Germany  and  in  this  country.  .  .  The  de- 
scriptive letter-press  is  very  full  and  accurate,  and  the 
whole  makes  an  extremely  handsome  volume." — Brit- 
ish Medical  yournal,  July  loth,  1880. 


"  The  atlas  is  the  most  complete  and  comprehensive 
work  of  its  kind.  .  .  Nearly  every  point,  anatoBli- 
cal,  physiological,  obstetrical,  and  gynsecological,  is 
illustrated  in  the  best  way,  by  well  known  authors, 
from  whose  works  the  late  Dr.  Martin  culled  his  illus- 
trations. As  a  work  of  reference,  to  the  practitioner, 
the  atlas  is  invaluable ;  while  to  the  student  v/ho  wishes 
to  refresh  his  memory  in  the  readiest  way  and  in  the 
shortest  time,  it  will  be  very  useful." — London  Medi- 
cal Record,  July  15th,  1880. 


MICROSCOPICAL      EXAMINATION      OF 


MACDONALD, 
WATER. 

A  Guide  to  the  Microscopical  Examination  of  Drinking  Water.  By  J.  D. 
Macdonald,  m.d.  With  Twenty  Full-page  Lithographic  Plates,  Reference 
Tables,  etc.     8vo.  Price  $2.75 

"  The  volume  is  an  excellent  hand-book  and  will  greatly  facilitate  the  study  of  the  subject." — Poiular  Scienct 

Monthly. 

MACEWEN,  ON  OSTEOTOMY. 

An  Inquiry  into  the  Etiology  and  Pathology  of  Knock-knee,  Bow-leg  and 
other  Osseous  Deformities  of  the  Lower  Limbs.  By  Wm.  Macewen,  m.d.  Il- 
lustrated.    Svo.  *       Price  S^.oo 


36  PRESLEY  BLAKISTON'S 


MACKENZIE,  ON  THE  THROAT  AND  NOSE. 

Including  the  Pharynx,  Larynx,  Trachea,  (Esophagus,  Nasal  Cavities,  and 
Neck.  By  Morell  Mackenzie,  m.d.,  London,  Senior  Physician  to  the  Hos- 
pital for  Diseases  of  the  Chest  and  Throat,  Lecturer  on  Diseases  of  the  Throat 
at  London  Hospital  Medical  College,  etc.,  etc.  Vol.  i,  containing  the  Pharynx, 
Larynx  and  Trachea,  with  112  Illustrations.     Now  ready. 

Price,  Cloth,  :J4.oo;  Sheep,  $5.00 

B@°° Author's  Edition,  with  the  Original  Illustrations.  Published  from  early 
sheets,  by  arrangement  with  Dr.  Mackenzie.     Vol.  2  in  preparation. 

"We  have  long  felt  the  want  of  a  thoroughly  practical  and  systematic  treatise  on  diseases  of  the  throat 
and  nasal  passages.  Admirable  essays  have  from  time  to  time  appeared  ;  no  standard  work  has  been  written. 
Any  one  familiar  with  laryngoscopic  work  must  appreciate  the  valuable  addition  now  made  to  this  special 
department  in  the  work  before  us.  The  entire  work  will  include  the  consideration  of  affections  of  the  pharj'flx, 
larj'nx,  trachea,  oesophagus,  nasal  cavities,  and  neck.  The  matter  now  presented  complete  for  the  first  time  is 
the  result  of  the  author's  large  and  unrivaled  experience,  both  in  hospital  and  private  practice,  extending  over 
a  period  of  twenty  years.  There  can  be  but  one  verdict  of  the  profession  on  this  manual — it  stands  without  any 
competitor  in  medical  literature,  as  a  standard  work  on  the  organs  it  professes  to  treat  of." — Dublin  yournal. 

"  It  is  both  practical  and  learned  ;  abundantly  and  well  illustrated  ;  its  descriptions  of  disease  are  graphic,  and 
the  diagnoses  the  best  we  have  anywhere  seen.  To  give  examples  of  the  thoroughness  of  Dr.  Mackenzie's  book, 
we  may  cite  the  chapter  on  diphtheria,  which  embraces  47  pages.  The  chapter  on  non-malignant  tumors  of  the 
larynx  would  appear  to  be  absolutely  e.xhaustive.  Nowhere  else  have  we  seen  so  elaborate  a  statement  of  the  sub- 
ject. We  can  predict  for  this  work  a  high  position,  and  congratulate  its  distinguished  author  upon  its  appear- 
ance."— Philadelphia  Medical  Times. 

BY   SAME  AUTHOR. 

THE  PHARMACOPCEIA  of  the  Hospital   for  Diseases  of  the 
Throat  and  Nose. 

The  Fourth  Edition,  much  enlarged,  containing  250  Formulae,  with  Directions 
for  their  Preparation  and  Use.     i6mo.  Price  $1.1^ 

DIPHTHERIA.     ITS  NATURE  AND  TREATMENT. 

i2mo.  Price  .7  5 

Contents. — i.  The  Definition  and  History.  2.  The  Etiology.  3.  The  Symptoms.  4.  The  Paralyses.  5. 
The  Diagnosis.  6.  The  Pathology.  7.  The  Prognosis.  8.  The  Treatment.  9.  Laryngo-Tracheal  Diphtheria. 
10.  Nasal  Diphtheria.     11.     Secondary  Diphtheria. 

"  The  terse  remarks  on  prognosis  are  excellent ;  and  what  the  Author  says  of  treatment,  general  and  local,  and 
tracheotomy,  we  commend  most  cordially." — New  York  Medical  yournal. 

GROWTHS  IN  THE  LARYNX. 

Their  History,  Causes,  Symptoms,  etc.  With  Reports  and  Analysis  of  one 
Hundred  Cases.     With  Colored  and  Other  Illustrations.     8vo.  Price  $2.00 

MACNAMARA,  DISEASES  OF  THE  EYE. 

A  Manual  of  the  Diseases  of  the  Eye.  By  C.  Macnamara,  m.d.  Third 
Edition,  Carefully  Revised ;  with  Additions  and  Numerous  Colored  Plates,  Dia- 
grams of  Eye,  Wood-cuts,  and  Test  Types.     Demi  8vo.  Price  $4.00 

"As  a  book  of  ready  reference  on  diseases  of  the  eye  it  has  no  superior,  and  we  may  safely  say,  no  equal  in  our 
language." — Cincinnati  Lancet  and  Observer. 

BY   SAME   AUTHOR. 

ON  THE  BONES  AND  JOINTS. 

Lectures  on  Diseases  of  the  Bones  and  Joints.     Second  Edition.      Demi  8vo. 

Price  1:4.25 

MADDEN,  HEALTH    RESORTS. 

Health  Resorts  for  the  Treatment  of  Chronic  Diseases.  A  Hand-Book,  the 
result  of  the  author's  own  observations  during  several  years  of  health  travel  in 
many  lands,  containing  also  remarks  on  climatology  and  the  use  of  mineral 
waters.     By  T.  M.  Madden,  m.d.     Svo.  Price  $2.50 

"  Rarely  have  we  encountered  a  book  containing  so  much  information  for  both  invalids  and  pleasure  seekers." 
.—  The  Sanitarian. 


PUBLICATIONS.   '  27 


MARSHALL  &  SMITH,  ON  THE  URINE. 

The  Chemical  Analysis  of  the  Urine.  By  John  Marshall,  m.d.,  and  Edgar 
F.  Smith,  m.d.,  of  the  Chemical  Laboratoty,  Medical  Department,  University  of 
Pennsylvania.     Illustrated  by  Phototj'pe  Plates.  i2mo.  Price  $1.00 

MARSHALL,  ANATOMICAL  PLATES; 

Or  Physiological  Diagrams.     Life  Size  (7  by  4  feet)  and  Beautifully  Colored. 
By  John  Marshall,  f.r.s.     An  Entirely  New  Edition,  Revised  and  Improved, 
Illustrating  the  Whole  Human  Body. 
The  Set,  Eleven  Maps,  in  Sheets,  Price  $50.00 

"  "  handsomely  Mounted  on  Canvas,  with 

Rollers,  and  Varnished,  Price  $80.00 
An  Explanatory  Key  to  the  Diagrams,  Price  .50 

Dr.  Marshall's  Plates,  from  their  size  and  perfection  of  drawing  and  coloring,  excel 
any  diagrams  that  have  been  published.  They  have  proved  invaluable  in  Medical 
Schools  and  Lecture  Rooms.  The  low  price  at  which  they  are  offered  brings  tlfem 
within  reach  of  all. 

No.  I.  The  Skeleton  and  Ligaments.  No.  2.  The  Muscles,  Joints,  and  Animal  Mechanics.  No.  3.  The  Vis- 
cera in  Position— The  Structure  of  the  Lungs.  No.  4.  The  Organs  of  Circulation.  No.  5.  The  Lymphatics  or 
Absorbents.  No.  6.  The  Digestive  Organs.  No.  7.  The  Brain  and  Nerves.  No.  8.  The  Organs  of  the  Senses 
and  Organs  of  the  Voice,  Plate  i.  No.  9.  The  Organs  of  the  Senses,  Plate  2.  No.  10.  The  Microscopic 
Structure  of  the  Textures,  Plater.     No.  11.  The  Microscopic  Structure  of  the  Textures,  Plate  2. 

MARSDEN,  ON  CANCER. 

A  New  and  Successful  Mode  of  Treating  Certain  Forms  of  Cancer.  By  Alex- 
ander Marsden,  m.d.     Second  Edition.     Colored  Plates.     8vo.        Price  $3.00 

MARTIN,  MICROSCOPIC  MOUNTING. 

A  Manual  of  Microscopic  Mounting.  With  Notes  on  the  Collection  and  Ex- 
amination of  Objects,  and  upwards  of  150  Illustrations.  By  John  H.  Martin. 
Second  Edition,  Enlarged.     8vo.  Price  $2.75 

MORRIS,  ON  THE  JOINTS. 

The  Anatomy  of  the  Joints  of  Man.     Comprising  a  Description  of  the  Liga- 
ments, Cartilages,  and  Synovial  Membranes ;  of  the  Articular  Parts  of  Bones, 
etc.     By  Henry  Morris,  f.r.c.s.     Illustrated  by  44  Large  Plates  and  Numerous 
Figures,  many  of  which  are  Colored.     8vo.  Price  ^5.50 

MUTER,    MEDICAL  AND    PHARMACEUTICAL  CHEMIS- 
TRY. 

An  Introduction  to  Pharmaceutical  and  Medical  Chemistry.  Part  One. — 
Theoretical  and  Descriptive.  Part  Two. — Practical  and  Analytical.  Arranged 
on  the  principle  of  the  Course  of  Lectures  on  Chemistry  as  delivered  at,  and  the 
Instruction  given  in  the  Laboratories  of,  the  South  London  School  of  Pharmacy, 
By  John  Muter,  m.d..  President  of  the  Society  of  Pubhc  Analysts.  A  Second 
Edition,  Enlarged  and  Rearranged.  The  Two  Parts  bound  in  one  large  octavo 
volume.  Price  $6.00 

Part  Two. — Practical  and  Analytical.  Bound  Separately,  for  the  Special  Con- 
venience of  Students.     Large  8vo.     Cloth.  Price  S2.50 

MAC  MUNN,  THE  SPECTROSCOPE. 

The  Spectroscope  in  Medicine.  By  Chas.  A.  Mac  Munn,  m.d.  With  3 
Chromo-lithographic  Plates  of  Physiological  and  Pathological  Spectra,  and  13 
Wood  Cuts.     8vo.  Price  ;?3.oo 

"  This  book  is,  without  question,  the  best  that  has  yet  been  published  on  the  subject;  to  those  not  familiar  with 
Physiological  Spectroscopy  it  will  prove  interesting,  while  to  those  who  are  worJlng  in  this  field  it  is  a  neces' 
sity." — Neiu  York  Medical  jfournal. 


28  PRESLEY  BLAKISTON'S 

It  is  eminently  a  book  which  will  teach  the  Student. — Practilioncr. 
It  forms  one  of  the  most  convenient,  practical,  and  concise  books  ye» 
published  on  the  subject.  —  London  Lancet. 

MEADOWS'  MANUAL  OF  OBSTETRICS. 
THE  THIED  EEVISED  AND  ENLAEGED  EDITION,  NOW  EEADT. 

WITH  ONE  HUNDRED  AND  FORTY-FIVE  ILLUSTRATIONS. 

INCLUDING   THE    SIGNS    AND    SYMPTOMS    OF    PREGNANCY, 
Obstetric  Operations,   Diseases  of  the  Puerperal  State,  &c.,  &c.     By 
Alfred  Meadows,  M.  D.,  Physician  to  the  Hospital  for  Women,  to 
•    the  General  Lying-in  Hospital,  &c.,  &c.     Revised  and  Enlarged  Edi- 
tion.    With  numerous  Illustrations.  Price  $2.00 

In  this  new  edition, ..  .not  merely  is  the  practical  treatment  of  Labor,  and  also  of  the  Dis- 
eases and  Accidents  of  Pregnancy,  well  and  clearly  taught,  but  the  anatomical  machinery 
of  parturition  is  more  eflfectively  explained  than  in  any  other  treatise  that  we  remember; 
besides  this,  tlie  book  is  honorably  distinguished  among  manuals  of  Jlidwifery  by  the  ful' 
ness  with  which  it  goes  into  the  subject  of  the  structure  and  development  of  the  ovum.  On 
all  questions  of  treatment,  whether  by  medicines,  by  hygienic  regimen,  or  by  mechanical  01^ 
operative  ap])Iiances,  tliis  treatise  is  as  satisfactory  as  a  work"  of  manual  size  could  be ;  students 
and  practitioners  can  hardly  do  better  than  adopt  it  as  their  vade-mecum. — The  Practitioner. 

Upwards  of  ninety  new  engravings  have  been  inserted  in  this  edition,  and,  with  a  view  to 
facilitate  reference,  the  author  has  furnished  it  with  a  very  full  and  complete  table  of  contents 
and  index.  We  can  cordially  recommend  this  manual  as  accurate  and  practical,  and  as  con- 
taining in  a  small  compass  a  large  amount  of  the  kind  of  information  suitable  alike  to  the 
student  and  practitioner. — London  Lancet. 

It  is  concise,  well  arranged,  and  remarkably  complete,  as  a  guide  to  the  student  diiring  his 
lecture  term ;  and  as  a  ready  reference  to  the  Physician,  no  work  of  similar  character  equals 
it  in  value. — Buffalo  Medical  Jotornal. 

The  systematic  arrangement  of  subjects,  and  the  concise,  practical  style  in  which  it  is 
written,  make  the  work  especially  valuable  as  a  student's  manual,  while  a  very  full  table 
of  contents  and  index  renders  it  easily  accessible  as  a  work  of  reference. — Chicago  Medical 
Examiner. 

There  can  be  no  doubt  that  this  maniial  will  be  generally  accepted  as  a  brief,  convenient, 
and  compendious  guide  to  the  study  and  practice  of  the  Obstetric  Art. — Richmond  and 
Louisville  Medical  Journal. 

We  cannot  but  feel  that  every  teacher  of  obstetrics  has  good  cause  to  congratulate  himself 
on  being  able  to  put  in  the  hands  of  the  student  a  book  which  contains  so  much  valuable 
and  reliable  information  in  so  condensed  a  form. — Philadelphia  Medical  Times. 

It  is  concisely  and  clearly  written,  and  the  information  is  on  the  whole  on  a  level  with  the 
most  recent  knowledge  of  the  day. — British  and  Foreign  3Iedical  Review. 

A  work  which  embodies  a  larger  amount  of  practical  information  than  any  other  book  on 
the  subject. — Pacific  Medical  and  Surgical  Jotcrnal. 

It  is  %vith  great  gratification  that  we  are  enabled  to  class  Dr.  Meadows'  Manual  as  a  rare 
exception,  and  to  pronounce  it  an  accurate,  practical,  and  creditable  work,  and  to  unhesi- 
tatingly recommend  it  to  both  student  and  practitioner. — American  Journal  of  Obstetrics. 

It  is  a  book  of  decided  merit :  every  page  teems  with  sound,  practical  common  sense,  advice 
and  suggestions. — Kansas  City  Medical  Journal. 


PUBLIC  A  TIONS. 


39 


MENDENHALL,  VADE  MECUM. 

The  Medical  Student's  Vade  Mecum.  A  Compend  of  Anatomy,  Physiology, 
Chemistry,  The  Practice  of  Medicine,  Surgery,  Obstetrics,  etc.  By  George 
Mendenhall,  m.d.     Eleventh  Edition.     224  Illustrations.     8vo,        Price  $2.00 

MEIGS  AND  PEPPER,  DISEASES  OF  CHILDREN. 

A  Practical  Treatise  on  the  Diseases  of  Children.  By  J.  Forsyth  Meigs,  m.d.. 
Fellow  of  the  College  of  Physicians  of  Philadelphia,  etc.,  etc.,  and  William 
Pepper,  m.d..  Physician  to  the  Philadelphia  Hospital,  Provost  University  of 
Pennsylvania.  Seventh  Edition,  thoroughly  Revised  and  Enlarged.  A  Royal 
Octavo  Volume  of  over  1000  pages.  Price,  Cloth,  $6.00;  Leather,  $7.00 

"  With  the  recent  additions  it  may  safely  be  pronounced  one  of  the  best  and  most  comprehensive  works  on  Dis- 
eases of  Children." — New  York  Medical  jfourtial. 

"  Must  be  regarded  as  the  most  complete  work  on  Diseases  of  Children  in  our  language." — Edinburgh  Medical 
Journal. 

"  We  have  seldom  met  with  a  text-book  so  complete,  so  just  and  so  readable  as  the  one  before  us." — American 
Journal  of  Obstetrics. 

MATHIAS,  LEGISLATIVE  MANUAL. 

A  Rule  for  Conducting  Business  in  Meetings  of  Societies,  Legislative  Bodies, 
Town  and  Ward  Meetings,  etc.  By  Benj.  Mathias,  a.m.  Sixteenth  Edition. 
i6mo.  Price  .50 

MORTON,  REFRACTION  OF  EYE. 

The  Refraction  of  the  Eye.  Its  Diagnosis  and  the  Correction  of  its  Enors. 
With  Chapter  on  Keratoscopy.     By  A.  Stanford  Morton,  m.b.,  f.r.c.s.     i2mo. 

Price  $1.00 

"  The  author  has  not  only  given  very  thorough  rules  for  the  objective  and  subjective  examinations  of  the  eye  in 
the  various  conditions  of  refraction  which  present  themselves,  but  has  entered  into  an  explanation  of  the  phenom- 
ena observed,  which  is  at  once  scientific  and  elementary." — Edijiburgh  Medical  Journal. 

MEARS,  PRACTICAL  SURGERY. 

Practical  Surgery.  Including:  Part  i. — Surgical  Dressings  ;  Part  11. — Band- 
aging ;  Part  iii. — Ligations  ;  Part,  iv. — Amputations.  With  227  Illustrations. 
By  J.  EwiNG  Mears,  m.d..  Demonstrator  of  Surgery  in  Jefferson  Medical  Col- 
lege, and  Professor  of  Anatomy  and  Clinical  Surgery  in  the  Pennsylvania  Col- 
lege of  Dental  Surgery.     i2mo.  Price  g2.oo 


"  Professor  Mears  has  written  a  convenient  and  use- 
ful book  for  students.  We  can  most  cordially  endorse 
it  as  fulfilling  well  the  promise  made  in  its  modest  pre- 
face."—  Cincinnati  Lancet  and  Clinic. 


"It  contains  a  great  deal  of  information  upon  the 
subjects  of  which  it  treats,  in  a  convenient  and  con- 
densed form.  Each  division  is  well  illustrated,  thereby 
rendering  the  text  doubly  clear." — New  York  Medical 
Record. 


OLDBERG,  PRESCRIPTION  BOOK. 

Three  Hundred  Prescriptions,  Selected  Chiefly  from  the  Best  Collections  of 
Formulae  used  in  Hospital  and  Out-patient-practice,  with  a  Dose  Table,  and  a 
Complete  Account  of  the  Metric  System.  By  Oscar  Oldberg,  phar.  d..  Late 
Medical  Purveyor,  United  States  Marine  Hospital  Service;  Professor  of  Materia 
Medica,  National  College  of  Pharmacy,  Washington,  D.  C. ;  Member  of  the 
American  Pharmaceutical  Association,  and  of  the  Sixth  Decennial  Committee 
of  Revision  and  Publication  of  the  Pharmacopoeia  of  the  United  States. 
i2mo.  Price  ^1.50 

The  prescriptions  given  in  this  work  are  selected  from  the  Pharmacopoeias  and 
formularies  of  the  great  Hospitals  of  New  York,  Philadelphia,  Boston  and  London, 
or  contributed  from  the  practice  of  medical  officers  of  the  United  States  Service.  The 
Dose  Table  includes  nearly  all  of  the  remedies  that  have  a  place  in  the  current 
Materia  Medica.  . 


30  PRESLEY  B LA KISTON'S 


BY   SAME   AUTHOR. 

THE  UNOFFICIAL  PHARMACOPCEIA. 

Comprising  over  700  Popular  and  Useful  Preparations,  not  Official  in  the 
United  States,  of  the  various  Elixirs,  Fluid  Extracts,  Mixtures,  Syrups,  Tinct- 
ures, Ointments,  Wines,  etc.,  etc.,  in  constant  demand  throughout  the  country. 
Thick  i2mo.     503  pp.     Half  Morocco.  Price  $3.50 

Sold  by  Subscription. 
j8@=*It  Will  Prove  a  Useful  Supplement  to  the  Pharmacopoeia  of  the 
United  States  ;  the  aim  has  been  to  make  it  as  complete  as  practicable.  The  form- 
ulae can,  with  a  minimum  of  labor,  be  used  with  any  system  of  weights  and  meas- 
ures. The  virtual  adoption  of  the  metric  system  in  the  forthcoming  Pharmacopoeia 
of  the  United  States  will  account  for  the  preference  given  to  that  system  in  this  vol- 
ume, which,  however,  does  not  prevent  the  ready  use  of  the  book  with  apothecaries' 
weights  and  measures.  An  extended  account  of  the  metric  system  has  been  given, 
accompanied  by  full  tables  of  equivalents.  The  sources  from  which  the  formulae 
have  been  gathered  are  believed  to  be  the  best.  They  include  the  Pharmacopoeias 
of  England,  Germany,  France  and  Sweden.  The  book  is  practically  equivalent  to 
the  possession  of  these  various  Pharmacopoeias,  and  the  formula  were  selected  with 
reference  to  their  popularity,  usefulness,  and  interesting  character. 

"  This  volume  is  one  of  the  most  practical  and  valuable  contributions  to  Pharmaceutical  work  of  recent  publica- 
tion. It  has  received  high  commendation  from  many  of  our  best  pharmacists," — Lazell,  Marsh  &=  Gardiner, 
Wholesale  Dri^gists,  New  York  City. 

OTT,  ACTION  OF  MEDICINES. 

The  Action  of  Medicines.  By  Isaac  Ott,  m.d.,  late  Demonstrator  of  Experi- 
mental Physiology  in  the  University  of  Pennsylvania.  With  22  Illustrations. 
8vo.  Price  $2.00 

"  This  work  is  the  only  one  in  the  English  language  which  can  offer,  with  any  degree  of  completeness,  that  assist- 
ance and  instruction  so  essential  to  the  correct  and  successful  study  of  pharmacology.  Filling,  as  it  does,  this  gap 
in  medical  literature  we  have  a  work  which  cannot  fail  to  be  of  the  greatest  value  to  students. 

"From  the  pen  of  a  man  himself  no  novice  in  the  subject  of  which  he  treats,  it  bears  upon  it  the  impress  of  relia- 
bility, due  to  the  author's  own  experience,  a  yirtue  too  often  wanting  in  mere  compilations  of  the  works  of  oth- 
ers."— American  Journal  of  Medical  Sciences. 

PAGET,  SURGICAL  PATHOLOGY. 

Lectures  on  Surgical  Pathology,  Delivered  at  the  Royal  College  of  Surgeons. 
By  James  Paget,  f.r.s.  Third  Edition.  Edited  by  William  Turner,  m.d. 
With  Numerous  Illustrations.     8vo.  Price,  Cloth,  $7.00;  Leather,  $8.00 

PARKES,  PRACTICAL  HYGIENE.     Fifth  Edition. 

A  Manual  of  Practical  Hygiene.  By  Edward  A.  Parkes,  m.d.  The  Fifth, 
Revised  and  Enlarged  Edition.     With  Many  Illustrations.     Svo.        Price  ;?6.oo 

"  Altogether  it  is  the  most  complete  work  on  Hygiene  which  we  have  %^^n."—New  York  Medical  Record. 

"  We  find  that  it  never  fails  to  throw  light  on  any  hygienic  question  which  may  be  proposed."— 5of/^  Medi- 
cal  and  Surgical  yourncA. 

"We  commend  the  book  heartily  to  all  needing  instruction  (and  who  does  not),  in  Hygiene  "—Chicago  Mtdi- 
eal  yournal. 

PIESSE,  THE  MANUFACTURE  OF  PERFUMERY.    Fourth 
Edition. 

The  Art  of  Perfumery;  or  the  Methods  of  Obtaining  the  Odors  of  Plants,  and 
Instruction  for  the  Manufacture  of  Perfumery,  Dentifrices,  Soap,  Scented  Pow- 
ders, Odorous  Vinegars  and  Salts,  Snuff,  Cosmetics,  etc.,  etc.  By  G.  W.  Septi- 
mus  PiESSE.     Fourth   Edition.      Enlarged.     366   Illustrations.     Svo.     Cloth. 

Price  $5.50 


"An  excellent  book." — Commercial  Advertiser. 
"  It  is  the  best  book  on  Perfumery  yet  published."- 
Scieniific  American. 


"  Exceedingly  useful  to  druggists  and  perfumers.  — 
Journal  of  Chemistry. 

"  Is  in  me  fullest  sense,  comprehensive,  —Medical 
Record. 


PUBLICA  TIONS.  31 


PENNSYLVANIA  HOSPITAL  REPORTS. 

Edited  by  a  Committee  of  the  Hospital  Staff.  J.  M.  DaCosta,  m.d.,  and 
William  Hunt,  m.d.  Vols,  i  and  2,  containing  Original  Articles  by  former 
and  present  Members  of  the  Staff.  With  Lithographic  and  other  Illustrations. 
3vo.  Price,  per  volume,  §2.00 

These  volumes  consist  of  papers  of  a  practical  character,  based  chiefly  on  obser- 
vations made  at  the  Hospital,  but  containing  the  further  experience  of  the  Members 
of  the  Staff.  In  issuing  the  second  volume  the  Editors  express  their  acknowledg- 
ments for  the  very  favorable  reception  of  the  first  by  the  profession  and  press  of 
this  country  and  Europe. 

PEREIRA,  PRESCRIPTION  BOOK.     Sixteenth  Edition. 

Physician's   Prescription  Book.      Containing  Lists  of  Terms,   Phrases,  Con- 
tractions and  Abbreviations  used  in  Prescriptions,  Explanatory  Notes,  Gram- 
matical Construction  of  Prescriptions,  Rules  for  the  Pronunciation  of  Pharma- 
ceutical   Terms.      By  Jonathan   Pereira,   m.d.,  f.r.s.      Sixteenth    Edition. 
Price,  Cloth,  §1.00;  Leather,  with  tucks  and  pocket,  $1.25 

PIGGOTT,  ON  COPPER. 

Copper  Mining  and  Copper  Ore.     With  a  full  Description  of  the  Principal 

Copper  Mines  of  the  United  States,  the  Art  of  Mining,  etc.  By  A.  Snowden 

PiGGOTT.     i2mo.  Price  $1.00 

PRINCE,  ORTHOPEDIC  SURGERY. 

Plastic  and  Orthopedic  Surgery.  By  David  Prince,  m.d.  Containing  a 
Report  on  the  Condition  of,  and  Advance  made  in.  Plastic  and  Orthopedic  Sur- 
gery, etc.,  etc.,  and  Numerous  Illustrations.     8vo.  Price  %\.'^o 

PHYSICIAN'S  VISITING  LIST,  PUBLISHED  ANNUALLY. 

THIRTY-FIRST  YEAR  OF  ITS  PUBLICATION. 
SIZES   AND    PRICES. 

For  25  Patients  weekly.  Tucks,  pockets,  and  pencil,       ...        -  $1.00 

50         "             "  «            «                      '.....  1.25 

75         "             "  ....                      .<....  1.50 

100         "             "  ....                      «'.__-  2.00 

.<             ..-,1  flan,  to  Tune]               „  „  -^ 

5°                           2  vols.  iJ^iytoDec.j                            ...        -  2.50 

loo         "  "2  vols.      Ite^^ftr}  "  -        .        -        -       3-00 


[  July  to  Dec. 

INTERLEAVED   EDITION. 

For  25  Patients  weekly,  interleaved,  tucks,  pockets,  etc.,         .        -        -        -       1.25 
50        "  "  "  .      "  ....  ....      1.50 

50   "     "2  vols.  j|^"•^R'"^      "     .   ...  3.00 

■'  IJuly  to  Dec.  J 

The  Visiting  List  contains  a  New  Table  of  Poisons  and  their  Antidotes.  ,  The 
Metric  or  French  Decimal  System  of  Weights  and  Measures. .  Posological  Tables, 
showing  the  relation  of  our  present  system  of  Apothecaries'  Weights  and  Measures 
to  that  of  the  Metric  System,  giving  the  Doses  in  both. 

This  last  is  a  most  valuable  addition,  and  will  materially  aid  the  Physician.  So 
many  writers  now  use  the  metric  system,  especially  in  foreign  books  and  journals, 
that  one  not  familiar  with  it  is  constantly  confused,  and  in  many  cases  unable  to 
understand  the  measurements  or  doses. 

"  The  book  is  convenient  in  form,  not  too  bulky,  and 
in  every  respect  the  very  best  Visiting  List  published." 
—  Canada,  Medical  and  Surgical  yournal. 

"This  standard  Visiting  List,  for  completeness,  eom- 
pactness,  and  simpheity  of  arrangement,  is  excelled  by 
none  in  the  market." — N'ew  York  Medical  Record. 


"  It  is  certainly  the  most  popular  Visiting  List  ex- 
tant."— New  York  Medical  Jot'.rnal. 

"  Its  compact  size,  convenience  of  arrangement,  dur- 
ability, and  neatness  of  manufacture  have  everywhere 
obtained  for  it  a  preference." — Canada  Lancet. 


32  PRESLEY  B LA KISTON'S 


POWER,   HOLMES,  ANSTIE  AND  BARNES  {Drs.). 

Reports  on  the  Progress  of  Medicine,  Surgery,  Physiology,  Midwifery,  Dis- 
eases of  Women  and  Children,  Materia  Medica,  Medical  Jurisprudence,  Ophthal- 
mology, etc.,  etc.     Reported  for  the  New  Sydenham  Society.     8vo.     Price  $2.00 

PURCELL,  ON  CANCER. 

Cancer.  Its  Allies  and  other  Tumors,  with  Specia  Reference  to  their  Medi- 
cal and  Surgical  Treatment.  By  F.  Albert  Purcell,  m.d.,  m.r.c.s.  Surgeon 
to  the  Cancer  Hospital,  Brompton,  England.     8vo.  Price  ^3.75 

RADCLIFFE,  ON  EPILEPSY. 

On  Epilepsy,  Pain,  Paralysis,  and  other  Disorders  of  the  Nervous  System. 
By  Charles  Bland  Radcliffe,  m.d.     Illustrated.     i2mo.  Price  $1.50 

"  To  no  authority  can  the  medical  inquirer  turn  for  an  analysis  of  the  phenomena  of  epilepsy  with  more  satisfac- 
tion than  to  the  admirable  essay  of  Dr.  Radcliffe." — American  Journal  Medical  Sciences. 

ROBERTS,  MANUAL  OF  MIDWIFERY. 

The  Student's  Guide  to  the  Practice  of  Midwifery.  By  D.  Lloyd  Roberts, 
M.D.,  F.R.C.P.,  Physician  to  St.  Mary's  Hospital,  Manchester,  etc.,  etc.  Second 
Edition.     With  95  Illustrations.     i2mo.  Price  $2.00 

"As  an  obstetrical  manual,  we  think  that  of  Dr.  Rob-    '        "The  present  edition  has  been  very  thoroughly  re- 
""       '         '      '^     '      '  '  vised,  some  chapters  having  been  entirely  re-written. 

For  its  size,  it  forms  a  remarkably  complete  compendi- 
um  of  the  subject,  and  can  hardly  be  surpassed  in  the 
simplicity  and  clearness  of  its  explanations." — Obstet- 
rical yozirnal  0/  Great  Britaifi  aiid  Ireland. 


erts  one  of  the  best  now  offered  to  the  Profession,  as  it 
comes  with  authority,  and  he  possesses  the  ability  to 
condense,  and  at  the  same  time  present  a  subject  clear- 
ly."— A»!crican  yournal  of  Medical  Science. 

"Concise,   clear,   and    practical." — Mediial  Press 
and  Circular. 


REYNOLDS,  ELECTRICITY. 

Lectures  on  the  Clinical  Uses  of  Electricity.  By  J.  Russell  Reynolds,  m.d., 
F.R.s.     Second  Edition,     l2mo.  Price  |i.oo 

"  It  is  thoroughly  reliable  as  a  guide,  very  concise,  and  will  be  found  exceedingly  useful  to  the  general  practi- 
tioner."—  Canada  Lancet. 

RICHARDSON,    MECHANICAL    DENTISTRY.      Third   Edi- 
tion. 

A  Practical  Treatise  on  Mechanical  Dentistry.  By  Joseph  Richardson,  d.d.s. 
Third  Edition.     With  185  Illustrations.    8vo.    Price,  Cloth,  ;g4.oo ;  Leather,  $4.75 

"  Taken  as  a  whole.  Professor  Richardson's  work  is  a  valuable  contribution  to  the  dental  art,  and  is  beyond  all 
question  the  best  treatise  extant  upon  the  general  subject  of  Mechanical  Dentistry." — Dental  Cosmos. 

RIGBY  AND  MEADOWS,  OBSTETRIC  MEMORANDA. 

Dr.  Rigby's  Obstetric  Memoranda.  Fourth  Edition.  Revised.  By  Alfred 
Meadows,  m.d.     32mo.  Price  .50 

RINDFLEISCH,  PATHOLOGICAL  HISTOLOGY. 

A  Text-Book  of  Pathological  Histology.  By  Dr.  Edward  Rindfleisch. 
Translated  by  Drs.  Wm.  C.  Kolman  and  F.  T.  Miller.  208  Illustrations. 
Svo.  Price,  Cloth,  ^5.00;  Leather,  $6.00 

Recommended  as  a  Text-Book  at  the  University  of  Pennsylvania  and  other  Med- 
ical Schools. 

"  To  be  up  with  the  times  our  Pathologists  must  make  themselves  familiar  with  the  thorough,  clear  and., almost 
exhaustive  teachings  of  Professor  Rindfleisch." — Ohio  Medical  and  Surgical  Reporter. 

"In  conclusion  we  cordially  recommend  it  as  the  best  treatise  on  the  subject." — American  jfournal  of  Medi- 
cal Science. 

RYAN,  ON  MARRIAGE. 

The  Philosophy  of  Marriage.  In  its  Social,  Moral  and  Physical  Relations, 
and  Diseases  of  the  Urinary  Organs.  By  Michael  Ryan,  m.d.  Member  of 
the  Royal  College  of  Physicians,  London.     i2mo.  Price  $1.00 


PUB  Lie  A  TIONS.  33 


ROBERTS'  PRACTICE  OF  MEDICINE. 

A  Ne^A?■  Enlarged  Edition, 

JUST  READY. 

Uniformly  commended  by  the  Profession  and  the  Press. 

A  HAND-BOOK  OF  THE  THEORY  AND  PRACTICE  OF  MEDI- 
CINE.    By  Frederick  T.  Roberts,  M.D.,  M.R.C.P.,  Assistant  Pro- 
fessor and  Teacher  of  Clinical  Medicine  in  University  College  Hospital, 
Assistant  Physician  in  Brompton  Consumptive  Hospital,  &c.,  &c. 
Third  Edition.     Octavo.     Price,  in  cloth       ....       $5.00 

leather      ....         6.00 
The  Publishers  are  in  receipt  of  numerous  letters  from  Professors  in  the  various  Med- 
ical Schools,  uniformly  commending  this  book;  whilst  the  following  extracts  from  the 
Medical  Press,  both  English  and  American,  fully  attest  its  superiority  and  great  value 
not  only  to  the  student,  but  also  to  the  busy  practitioner. 

This  is  a  good  book,  yea,  a  very  good  book.  It  is  not  so  full  in  its  Pathology  as  "  Aitken," 
so  charming  in  its  composition  as  "  Watson,"  nor  so  decisive  in  its  treatment  as  "  Tanner ; " 
but  it  is  more  compendious  than  any  of  them,  and  therefore  more  useful.  We  know  of  no 
other  work  in  the  Englisli  language,  or  in  any  other,  for  that  matter,  which  competes  with 
this  one.  — Edinburgh  Ifedical  Journal. 

We  have  much  pleasure  in  expressing  our  sense  of  the  author's  conscientious  anxiety  to 
make  his  work  a  faithful  representation  of  modern  medical  beliefs  and  practice.  In  this  he 
has  succeeded  in  a  degree  that  will  earn  the  gratitude  of  very  many  students  and  practition- 
ers: it  is  a  remarkable  evidence  of  industry,  experience,  and  research. — Practitioner. 

That  Dr.  Roberts's  book  is  admirably  fitted  to  supply  the  want  of  a  good  hand-book  of 
medicine,  so  much  felt  by  every  medical  student,  does  not  admit  of  a  question.  — Students' 
Journal  and  Hospital  Gazette. 

Dr.  Roberts  has  accomplished  his  task  in  a  satisfactory  manner,  and  has  produced  a  work 
mainly  intended  for  students  that  will  be  cordially  welcomed  by  them ;  most  of  the  observa- 
tions on  treatment  are  carefully  written  and  worthy  of  attentive  study;  the  arrangement  is 
good,  and  the  style  clear  and  simple.  —  London  Lancet. 

It  contains  a  vast  deal  of  capital  instruction  for  the  student,  much  valuable  matter  in  it  to 
commend,  and  merit  enough  to  insure  ioxitava^idsdA^.— London  Sledical  Times  and  Gazette. 

There  are  great  excellencies  in  this  book,  which  will  make  it  a  favorite  both  with  the 
accurate  student  and  busy  practitioner.  The  author  has  had  ample  experience. — Richmond 
and  Louisville  Journal. 

We  confess  ourselves  most  favorably  impressed  with  this  work.  The  author  has  performed 
his  task  most  creditably,  and  we  cordially  recommend  the  book  to  our  readers.  —  Canada 
Medical  and  Surgical  Journal. 

A  careful  reading  of  the  book  has  led  us  to  believe  that  the  author  has  written  a  work 
more  nearly  up  to  the  times  than  any  that  we  have  seen  ;  to  the  student,  it  will  be  a  gift  of 
priceless  value.  — Detroit  Review  of  Medicine. 

Our  opinion  of  it  is  one  of  almost  unqualified  praise.  The  style  is  clear,  and  the  amount  of 
useful  and,  indeed,  indispensable  information  which  it  contains  is  marvellous.  We  heartily 
recommend  it  to  students,  teachers,  and  practitioners.  — Boston  Med.  and  Surgical  Journal. 

It  is  of  a  much  higher  order  than  the  usual  compilations  and  abstracts  placedin  the  hands 
of  students.  It  embraces  many  suggestions  and  hints  from  a  carefully  compiled  hospital 
experience ;  the  style  is  clear  and  concise,  and  the  plan  of  the  work  very  judicious. — Medical 
and  Surgical  Reporter. 

It  is  unsurpassed  by  any  work  that  has  fallen  into  our  hands  as  a  compendium  for  students 
preparing  for  examination.   Itis'thoroughly  practical  and  fully  up  to  the  times. — The  Clinic. 

We  find  it  an  admirable  book.  Indeed,  we  know  of  no  hand-book  on  the  subject  just  now 
to  be  preferred  to  it.  We  particularly  commend  it  to  students  about  to  enter  upon  the 
practice  of  their  profession.  —  St.  Louis  Medical  and  Surgical  Journal. 

If  there  is  a  book  in  the  whole  of  medical  literature  in  which  so  much  is  said  in  so 
few  words,  it  has  never  come  within  our  reach.  So  clear,  terse,  and  pointed  is  the  style ; 
so  accurate  the  diction,  and  so  varied  the  matter  of  this  book,  that  it  is  almost  a  dictionary 
of  practical  medicine.  —  Chicago  Medical  Journal, 


34  PRESLEY  BLAKISTON'S 


SANDERSON  AND  FOSTER,  THE    PHYSIOLOGICAL  LA- 
BORATORY. 

A  Hand-book  of  the  Physiological  Laboratory.  Being  Practical  Exercises  for 
Students  in  Physiology  and  Histology.  By  J.  Burdon  Sanderson,  m.d.,  E. 
Klein,  m.d.,  Michael  Foster,  m.d.,  f.r.s.,  and  T.  Lauder  Brunton,  m.d. 
With  over  350  Illustrations  and  Appropriate  Letter-press  Explanations  and  Ref- 
erences. 

Price,  Two  Volumes,  Text  and  Plates,  separate,      -        -        -    $7.0x3 

"      One  "  "  "  bound  together.  Cloth,        6.00 

"         "  "  "  "  "  "  Leather,    7.00 

Adopted  as  a  Text-book  at  Yale  College,  and  used  at  other  Medical   Schools  in 

America  and  England. 


"  Recognizing  the  fact  that  Physiology  is  emphatic- 
ally an  experimental  science,  it  furnishes  minute  in- 
structions for  performing  a  great  variety  of  exper- 
iments. A  student  could  scarcely  desire  a  better  guide." 
— Boston  Medical  a?id  Surgical  Journal. 


"  We  confidently  recommend  it  to  the  attention  of  all 
who  are  interested  in  the  wide  and  fertile  field  of  Phy- 
siological research." — A'ezu  Y'ork  Medical  J ournal. 

"  This  is  a  most  superb  bonk,  and  fills  a  hiatus  which 
every  physiological  student  has  lamented." — Chicago 
Medical  yournal. 


SANDERSON,  PHYSIOLOGY.     Second  Edition. 

A  Syllabus  of  a  Course  of  Lectures  on  Physiology.  By  J.  Burdon  Sander- 
son, m.d.     For  the  Use  of  Students.     Second  Edition.     8vo.  Price  $1.50 

SANSOM,  PHYSICAL  DIAGNOSIS.     Third  Edition  just  ready. 

The  Physical  Diagnosis  of  Diseases  of  the  Heart.  Including  the  Use  of  the 
Sphygmograph  and  Cardiograph.  By  Arthur  Ernest  Sansom,  m.d.  Third 
Edition.     Revised  and  Enlarged.     With  Illustrations.     i2mo.  Price  $2.00 

"  Dr.  Sansom  is  favorably  known,  and  the  little  work  he  here  presents  reflects  creditably  on  his  skill  in  pre- 
senting with  singular  clearness,  one  of  the  most  difficult  branches  of  diagnosis." — Philadelphia  Medical  and  Sur- 
gical Reporter. 

BY   same   author. 

ON    CHLOROFORM. 

Chloroform.     Its  Action  and  Administration;     i2mo.  Price  $1.50 

SMITH,  MANUAL  OF  GYNECOLOGY. 

Practical  Gynaecology.  A  Hand-book  of  the  Diseases  of  Women.  By  Hey- 
WOOD  Smith,  m.d.  Physician  to  the  Hospital  for  Women  and  to  the  British 
Lying-in  Hospital.     With  Engravings.  Price  $1.5 

The  object  of  the  author  has  been  to  present  the  busy  practitioner  with  a  book 
systematically  arranged,  burdened  with  no  discussions  on  vexed  questions  of  pathol- 
ogy, and  giving  at  a  glance  the  salient  points  of  diagnosis  and  treatment  with  clear- 
ness and  brevity. 

Contents. — Chapter  i.  On  the  Means  of  Diagnosis  :  On  Touch — immediate  and  intermediate.  On  Sight 
— immediate  and  intermediate.  On  Hearing.— immediate  and  intermediate.  2.  General  Diseases.  3.  Local 
Diseases — Diseases  of  the  Ovary.  4.  Diseases  of  the  Oviduct.  5.  Diseases  of  the  Broad  Ligament.  6.  Diseases 
of  the  Uterus  (unimpregnated).  7.  Diseases  of  the  Vagina.  8.  Diseases  of  the  Vulva.  9.  Diseases  of  the  Mam- 
ma. 10.  Functional  Diseases.  11.  Diseases  connected  with  Pregnancy.  12.  Diseases  connected  with  Parturi- 
tion.    13.  Diseases  consequent  on  Parturition.     Appendix  of  Remedies. 

BY   SAME   AUTHOR. 

DYSMENORRHCEA.    Just  Issued. 

Its  Pathology  and  Treatment.     i2mo.  Price  $2.50 

SMITH,  RINGWORM. 

The  Diagnosis  and  Treatment  of  Ringworm.  By  Alder  Smith,  F.r.c.s. 
With  Illustrations.     i2mo.  Price  $1.00 

SMITH,  ON  NURSING. 

The  Efficient  Training  of  Nurses  for  Hospital  and  Private  Practice.  By  Wil- 
liam Robert  Smith.     Illustrated.     i2mo.  Price  p..Qo 


PUBLICA  TIONS. 


35 


SMITH,  ON  CHILDREN. 

Clinical  Studies  of  Diseases  in  Children.     By  Eustace  Smith,  m.d.     i2mo. 

Price  $2.50 

MEDICAL  HERESIES,  HISTORICALLY  CONSIDERED. 

A  Series  of  Critical  Essays  on  the  Origin  and  Evolution  of  Sectarian  Medi- 
cine, embracing  a  Special  Sketch  and  Review  of  Homoeopathy,  Past  and  Pres- 
ent. By  GONZALVO  C.  Smythe,  a.m.,  m.d.  Professor  of  the  Principles  and 
Practice  of  Medicine,  College  of  Physicians  and  Surgeons,  Indianapolis,  Indi- 
ana.    i2mo.     Cloth.  Price  $1.25 


"  This  book  gives,  in  a  small  compass,  an  excellent 
history  of  medicine,  from  its  earliest  day  to  the  present 
time/' — Buffalo  Medical  and  Surgical  Journal. 

"Cannot  fail  to  be  of  interest,  not  only  to  the  medi- 
cal profession,  but  to  the  general  reader." — -Baltimore 
Gazette. 

"  The  work  is  pleasantly  written,  in  an  easy,  familiar 
style,  and  has  cost  the  writer  much  literary  research." 
— New  York  Medical  Journal. 


"  Students  and  others  interested  in  the  subject  of 
medicine  will  find  a  digest  of  the  entire  controversy 
(between  the  various  schools  of  medi«;ine)  presented  in 
this  volume." — Journal  o/ Education. 

"  Professor  Smythe  has  succeeded  in  writing  a  brief, 
clear,  and  interesting  sketch  of  the  evolution  of  medical 
eccentricities,  and  of  modern  homoeopathy,  its  facts  and 
fallacies." — Philadelphia,  Medical  Times, 


SAVAGE,  FEMALE  PELVIC  ORGANS.     Author's  Edition. 

The  Surgery,  Surgical  Pathology  and  Surgical  Anatomy  of  the  Female  Pelvic 
Organs.  In  a  Series  of  Colored  Plates  taken  from  Nature,  with  Commentaries, 
Notes  and  Cases.  By  Henry  Savage,  m.d.,  f.r.c.s.  New  Edition.  Issued  by 
arrangement  with  the  Author,  from  the  original  Plates.     Quarto.        \Preparing. 

SAVORY  &  MOORE,  DOMESTIC  MEDICINE. 

A  Condensed  Compend  of  Domestic  Medicine,  and  Companion  to  the  Medi- 
cine Chest.     By  Drs.  Savory  and  Moore.     Illustrated.  *  i6mo.  Price  .50 

SCHULTZE,  OBSTETRICAL  PLATES. 

Obstetrical  Diagrams.  Life  Size.  By  Prof.  B.  S.  Schultze,  m.d.,  of  Berlin. 
Twenty  in  the  Set.     Colored. 

Price,  in  Sheets,  $15.00;  Mounted  on  Rollers  $25.00 

SCANZONI,  DISEASES  OF  WOMEN. 

A  Practical  Treatise  on  the  Diseases  of  the  Sexual  Organs  of  Women.  By 
Dr.  F.  W.  Von  Scanzoni.     Translated  by  A.  K.  Gardiner,  m.d.     8vo. 

Price  $5.00 

SIEVEKING,  LIFE  ASSURANCE. 

The  Medical  Adviser  in  Life  Assurance.     By  E.  H.  Sieveking,  m.d.     i2mo. 

Price  $2.00 

SHEPPARD,  ON  MADNESS. 

Madness,  in  its  Medical,  Social  and  Legal  Aspects.  A  Series  of  Lectures  de- 
livered at  King's  Medical  College,  London.     By  Edgar  Sheppard,  m.d.     8vo. 

Price  $2.25 

STOCKEN,  DENTAL  MATERIA  MEDICA.     Second  Edition. 

The  Elements  of  Dental  Materia  Medicaand  Therapeutics  with  Pharmacopoeia. 
By  James  Stocken,  d.d.s.     Second  Edition.     i2mo.  •  Price  $2.25 

The  first  edition  of  this  book  was  disposed  of  in  a  little  less  than  four  months.  In 
making  this  revision  the  author  has  endeavored  to  make  it  still  more  useful  by  the 
addition  of  considerable  new  matter. 

SUTTON,  VOLUMETRIC  ANALYSIS.     Fourth  Edition. 

A  Systematic  Handbook  of  Volumetric  Analysis,  or  the  Quantitative  Estima- 
tion of  Chemical  Substances  by  Measure,  Applied  to  Liquids,  Solids  and  Gases. 
By  Francis  Sutton,  f.c.s.  Fourth  Edition.  Revised  and  Enlarged,  with  Illus- 
trations.    8vo.  {Preparing. 


36  PRESLEY  BLAKISTON'S 

SEWELL,  DENTAL  ANATOMY  AND  SURGERY. 

A  Manual  of  Dental  Anatomy  and  Surgery,  Including  the  Extraction  of  Teeth. 
By  H.  E.  Sewell,  d.d.s.,  m.d.     With  ']^  Illustrations.     i2mo.  Price  $1.50 

"A  valuable  book  for  the  general  Practitioner  who    1  "  It  will  be  found  useful  to  the  general  Practitioner  in 

te  in  want  of  a  practical  manual  relating  especially  to  the  management  of  many  incidental  affections  connected 

diseases  of  the  teeth." — Medical  By iej.  with   the   teeth   and   mouth,  which  cannot  always  be 

I  handed  over  to  the  specialist." — Pacific  Med.  yournul. 

STILLE,  ON  MENINGITIS. 

Epidemic  Meningitis,  or  Cerebro-spinal  Meningitis.  By  Alfred  Stille,  m.d., 
Professor  of  Practice  at  the  University  of  Pennsylvania.     8vo.  Price  $2.00 

"  The  name  of  the  author  is  a  sufficient  guarantee  that  this  monograph  is  elegant  in  style,  exhaustive  of  its  sub- 
ject and  rich  with  practical  suggestions." — Philade/phia  Medical  and  Surgical  Reporter. 

STOKES,  DISEASES  OF  THE  HEART. 

The  Diseases  of  the  Heart  and  Aorta.  By  William  Stokes,  m.d.  Thick 
8vo.  ■  Price  ^53.00 

SWAIN,  SURGICAL  EMERGENCIES. 

Surgical  Emergencies:  Concise  Descriptions  of  the  Various  Accidents  and 
Emergencies,  with  Directions  for  their  Treatment.  By  Wm.  Paul  Swain,  f.r. 
C.s.     Eighty-two  Illustrations.     i2mo.  Price  |,2.oo 

Contents. — Chapter  I.  Injuries  to  the  Head.  II.  Injuries  to  the  Eye.  III.  Injuries  to  the  Mouth, 
Pharynx,  CEsophagus,  and  Laryn.x.  IV.  The  Chest.  V.  The  Upper  Extremity.  VI.  The  Abdomen.  VII. 
The  Pelvis.  VIII.  The  Lower  Extremity.  IX.  Emergencies  connected  with  Parturition.  X.  Poisoning. 
XI.  Antiseptic  Treatment.     XII.  Apparatus  and  Dressing. 

"  Many  surgeons  will  thank  Dr.  Swain  for  the  trouble  he  has  taken  to  put  them  easily  in  possession  of  this  re- 
fresher of  half  forgotten  knowledge. —  The   Practitioner. 

SWERINGEN,  PHARMACEUTICAL  LEXICON. 

A  Pharmaceutical  Lexicon  or  Dictionary  of  Pharmaceutical  Science.  Contain- 
ing explanations  of  the  various  subjects  and  terms  of  Pharmacy,  with  appropriate 
selections  from  the  Collateral  Sciences.  Formulae  for  Officinal,  Empirical,  and 
Dietetic  Preparations,  etc.,  etc.     By  Hiram.  V.  Sweringen,  m.d.     8vo. 

Price,  Cloth,  $3.00 ;  Leather,  $4.CK) 

"  It  is  worthy  of  a  welcome,  and  sure  of  a  ready  recognition  of  its  merits." — Lcmdon  Pharmaceutical  yournal, 
"  It  will  prove  of  great  service  to  the  pharmaceutical  student,  apprentice,  pharmacist,  druggist  and  physician,  as 
a  book  of  ready  reference  and  as  an  aid  to  the  study  of  scientific  works." — American  yournal  of  Pharmacy. 

THOMPSON,  LITHOTOMY  AND  LITHOTRITY. 

Practical  Lithotomy  and  Lithotrity ;  or,  an  Inquiry  into  the  best  Modes  of 
Removing  Stone  from  the  Bladder.  By  Sir  Henry  Thompson,  f.r. c.s..  Emer- 
itus Professor  of  Clinical  Surgery  in  University  College.  Third  Edition.  Svo. 
With  87  Engravings.  Price  $3.50 

"  The  chapters  of  most  interest  are  those  in  which  Bigelow's  operation  is  discussed,  and  the  final  one,  in 
which  is  a  record  of  500  operations  for  stone  in  cases  of  male  adults  under  the  author's  care.  Such  a  table  has 
never  before  been  compiled  by  any  surgeon." — La^icet. 

BY   SAME   AUTHOR. 

URINARY  ORGANS. 

Diseases  of  the  Urinary  Organs.  Clinical  Lectures.  Fifth  LondoH  Edition. 
Svo.     With  2  Plates  and  71  Engravings.  Price  53- 5° 

ON  THE  PROSTATE. 

Diseases  of  the  Prostate.  Their  Pathology  and  Treatment.  Fourth  London 
Edition.     8vo.     With  numerous  Plates.  Price  ^4.00 

CALCULOUS  DISEASES. 

The  Preventive  Treatment  of  Calculous  Disease,  and  the  Use  of  Solvent 
Remedies.     Second  Edition.     i6mo.  Price  $1.00 

"  Catholic  in  his  investigation  of  the  fruit  of  the  labor  of  others,  cautious  in  all  his  deductions,  rejecting  all  spe- 
cious theories  in  the  effort  to  obtain  practically  useful  results,  as  clever  with  his  pen  as  he  is  with  the  sound  or 
Uthotrite,  one  can  scarcely  wonder  that  he  is  esteemed  the  master  that  he  is." — American  your?ial  of  Medicai- 
Science. 


PUB  Lie  A  TIONS.  37 


TROUSSEAU'S   CLINICAL    MEDICINE. 

COMPLETE. 
In  Two  Large  Eoyal  Octavo  Yolumes. 

EMBRACING  ALL  THE  LECTURES  CONTAINED  IN  THE  FIVE 

VOLUME  EDITION  AS  ISSUED  BY  THE 

SYDENHAM  SOCIETY. 

Price,  haudsomely  bound  in  cloth %  8.00 

"  "  leather 10.00 

Lectures  on  Clinical  Medicine. 

Delivered  at  the  Hotel  Dieu,  Paris,  by  A.  Trousseau,  Professor  of  Clin- 
ical Medicine  to  the  Faculty  of  Medicine,  Paris,  &c.,  &c.  Translated 
from  the  Third  Revised  and  Enlarged  Edition  by  P.  Victor  Bazire, 
M.  D.,  Jyjndon  and  Paris ;  and  John  Rose  Cormack,  M.  D.,  Edinburgh, 
F.  R.  S.,  &c.     With  a  full  Index,  Table  of  Contents,  &c. 

Trousseau's  Lectures  have  attained  a  reputation  both  in  England  and  in  this  country  far 
greater  than  any  work  of  a  similar  character  heretofore  ■written,  and,  notwithstanding  but  few 
medical  men  could  afford  to  purchase  the  expensive  edition  issued* by  the  Sydenham  Soci- 
ety, it  has  had  an  extensive  sale.  In  order,  however,  to  bring  the  work  within  the  reach  of  all 
the  profession,  the  publishers  now  issue  this  edition,  containing  all  the  lectures  as  contained 
in  the  five-volume  edition,  at  one-half  the  price.  Below  are  a  few  only  of  the  many  favora- 
ble opinious  expressed  of  the  woik  : 

"It  treats  of  diseases  of  daily  occurrence  and  of  the  most  vital  interest  to  the  practitioner. 
And  we  sliould  think  any  medical  library  absurdly  incomplete  now  which  did  not  have 
alongside  of  Watson,  Graves,  and  Tanner,  the  '  Clinical  Medicine'  of  Trousseau. 

"  The  work  is  full  of  the  results  of  the  richest  natural  observation,  and  is  the  production 
of  one  who  was  enlightened  enough  to  combine  with  new  methods  of  investigation  the  vigor- 
ous and  independent  ideas  of  the  old  physicians  whom  he  so  eloquently  inagnifi.e.s.  It  is  an 
extremely  rich  and  valuable  addition  to  the  library  of  p  nysicians  and  practitioners  genei-ally." 

—  LondUm  Lancet. 

"  This  book  furnishes  an  example  of  the  best  kind  c  f  clinical  teaching.  It  deserves  to  be 
popularized.  We  scarcely  know  of  any  work  better  fitted  for  presentation  to  a  young  man 
when  entering  upon  the  practical  work  of  his  life.  The  delineation  of  the  recorded  cases  ia 
graphic,  and  their  narration  devoid  of  that  prolixity  wAich,  desirable  as  it  is  for  purposes  of 
extended  analysis,  is  highly  undesirable  when  the  object  is  to  point  to  a  practical  lesson."— 
London  Medical  Times  and  Gazette. 

"  The  publication  of  Trousseau's  Lectures  furnishes  medical  men  with  one  of  the  besr 
practical  treatises  on  disease  as  seen  at  the  bedside.  The  conversational  style  adopted  by 
the  author  lends  animation  to  the  work,  and  the  translator  deserves  credit  for  having  so  well 
preserved  the  easy  and  ready  style  of  the  original."  —  British  and  Foreign  Medico- Chirur 
gical  Review. 

"  The  great  reputation  of  Prof.  Trousseau  as  a  practitioner  and  teacher  of  Medicine  in  all 
its  b-anches,  renders  the  present  appearance  of  his  Clinical  Lectures  particularly  welcome." 

—  Medical  Press  and  OirciUar. 

''  A  clever  translation  of  Prof.  Trousseau's  admirable  and  exhaustive  work,  the  best  book 
W  reference  upon  the  Practice  of  Medicine."  — Indian  Medical  Gazette. 


^8  PRESLEY  BLAKISTON'S 

riLT,  THE  CHANGE  OF  LIFE   IN  WOMEN. 

The  Change  of  Life  in  Health  and  Disease.  A  Practical  Treatise  on  the 
Diseases  Incidental  to  Women  at  the  Decline  of  Life.  By  Edward  John  Tilt, 
M.D.     Third  London  Edition.     8vo.  Price  $3.00 

BY   SAME  AUTHOR. 

UTERINE  THERAPEUTICS  AND  DISEASES  OF  WOMEN. 

A  Hand-book  of  Diseases  of  Women  and  Uterine  Therapeutics.  Fourth 
London  Edition.     i2mo.  Price  J553. 50 

TOMES,  DENTAL  ANATOMY.     New  Edition. 

A  Manual  of  Dental  Anatomy,  Human  and  Comparative.  By  C.  S.  Tomes, 
D.D.S.     With  179  Illustrations.     Second  Edition.     i2mo.  {Preparing?^ 

TOMES,  DENTAL  SURGERY. 

A  System  of  Dental  Surgery.  By  John  Tomes,  f.r.s.  The  Second  Edition, 
Revised  and  Enlarged.     By  C.  S.  Tomes,  d.d.s.    With  263  Illustrations.    i2mo. 

Price  $5.00 

"We  rejoice  that  such  books  as  these  (Dr.  Tomes'  Works)  are  demanded  by  the  profession,  and  that  the  men 
to  write  them  are  furnished  by  the  profession." — Dental  Cosmos. 

TAFT,  OPERATIVE  DENTISTRY.     Third  Edition. 

A  Practical  Treatise  on  Operative  Dentistry.  By  Jonathan  Taft,  d.d.S. 
Third  Revised  and  Enlarged  Edition.     Over  100  Illustrations.     Svo. 

Price,  Cloth,  M-^S ;  Leather,  5.00 

"  It  is  a  thorough  and  complete  treatise  on  the  Art 
of  Practical  Dentistry." — London  Medical  Times  and 
Gazette. 


"All  the  important  operations,  in  all  their  modifica- 
tions, are  clearly  discussed  by  the  author,  and  the 
work  is  highly  practical  throughout." — Dental  Regis- 
ter. 


TANNER,  INDEX  OF  DISEASES.     Second  Edition. 

An  Index  of  Diseases  and  their  Treatment.  By  Thos.  Hawkes  Tanner,  m.D., 

F.R.c.P.     Sixth  Edition.     Revised  and  Enlarged.     By  W,  H.  Broadbent,  m.D. 

With  Additions.     Appendix  of  Formulae,  etc.     Svo.  Price  $3.00 

By  this  useful  hand-book  the  character  of  any  disease  may  be  determined  in  a 

moment,  and  the  general  outline  of  treatment  pursued  by  the  best  authorities  made 

apparent. 

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in  truth  what  its  title  indicates." — New  York  Medical  invalids,  makes  this  work  the  most  complete  practi- 
Record.  doner's  manual  that  we  have  yet  seen. — Chicago  Medi- 

\  cal  Titnes. 

BY   SAME  AUTHOR. 

THE  DISEASES  OF  INFANCY. 

A  Practical  Treatise  on  the  Diseases  of  Infancy  and  Childhood.  Third  Edi- 
tion. Carefully  Revised  and  much  Enlarged.  By  Alfred  Meadows,  m.d. 
Svo.  Price  I3.00 

Recommended  as  a  Text-book  at  Jefferson  Medical  College  and  other  schools  of 
Medicine. 

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I    Boston  Medical  and  Surgical  Jotirnal. 

MEMORANDA  OF  POISONS. 

A  Memoranda  of  Poisons  and  their  Antidotes  and  Tests.  Fourth  American 
from  the  Last  London  Edition.     Revised  and  Enlarged.  Price  .75 

This  most  complete  Toxicological  Manual  should  be  within  reach  of  all  physi- 
cians and  pharmacists,  and  as  an  addition  to  every  family  library,  would  be  the 
means  of  saving  life  and  allaying  pain  when  the  delay  of  sending  for  a  physician 
would  prove  fatal. 


PUBLICA  TIONS.  39 


TIBBETS,  MEDICAL  ELECTRICITY. 

A  Hand-book  of  Medical  Electricity.  Giving  full  directions  for  its  Applica- 
tion, etc.     By  Herbert  Tibbets,  m.d.     64  Illustrations.     8vo.  Price  ^1.50 

TOLAND,  PRACTICAL  SURGERY. 

Lectures  on  Practical  Surgery,  By  H.  H,  Toland,  m.d.,  Professor  of  Surgery, 
University  of  California.  Second  Edition.  With  Additions  and  Numerous  Illus- 
trations.    8vo.  Price,  Cloth,  $4.50;  Leather,  ^5.00 

TRANSACTIONS  OF  THE  COLLEGE  OF  PHYSICIANS. 

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Vols.  I,  II,  III,  IV  and  V.     8vo.  Price,  per  volume,  $2.50 

TYSON,  BRIGHT'S  DISEASE  AND  DIABETES. 

A  Treatise  on  Diabetes  and  Bright's  Disease.  With  Especial  Reference  to 
Pathology  and  Therapeutics.  By  James  Tyson,  m.d.,  Professor  of  Pathology 
and  Morbid  Anatomy  in  the  University  of  Pennsylvania.  With  Coloj^ed  Plates 
and  many  Wood  Engravings.     8vo.  Price  I3.50 


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"The  symptoms  are  clearly  defined,  and  the  treat- 
ment is  exceedingly  well  described,  so  that  every  one 
reading  the  book  must  be  profited." — Cincinnati  Lan- 
cet and  Clinic. 


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GUIDE  TO  THE  EXAMINATION  OF   URINE. 

A  Practical  Guide  to  the  Examination  of  Urine.  For  the  use  of  Physicians  and 

Students.    With  Colored  Plate,  and  Numerous  Illustrations  Engraved  on  Wood. 

Third  Edition.     i2mo.  Price  ^^1.50 

Advantage  has  been  taken,  in  bringing  out  a  new  edition  of  this  work,  not  only  to 

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"  Dr.  Tyson  commences  with  a  short  account  of  the  theory  of  renal  secretion,  the  physical  and  chemical  charac- 
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the  presence  of  albumen,  sugar,  coloring-matters,  bile,  urea,  uric  acid,  chlorides,  phosphates  and  sulphates  ;  and 
minute  instructions  for  approximative  and  quantitative  determination  of  most  of  those  ingredients  by  volumetric 
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Dublin  Journal  of  Medical  Science. 

THE  CELL  DOCTRINE.    Second  Edition. 

The  Cell  Doctrine.  Its  History  and  Present  State.  With  a  Copious  Biblio- 
graphy of  the  subject.  Illustrated  by  a  Colored  Plate  and  Wood  Cuts.  Second 
Edition.     8vo.  Price  ^2.00 

TURNBULL,  ARTIFICIAL  ANAESTHESIA. 

The  Advantages  and  Accidents  of  Artificial  Anaesthesia ;  Its  Employment  in 
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tive Risks;  Tests  of  Purity;  Treatment  of  Asphyxia;  Spasms  of  the  Glottis; 
Syncope,  etc.  By  Laurence  Turnbull,  m.d.,  ph.g.,  Aural  Surgeon  to  Jeffer- 
son College  Hospital,  etc.  Second  Edition.  Revised  and  Enlarged.  With  27 
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the  study  of  the  subject,  and  it  presents  the  subject  up  to  the  present  hour." — Dental  Register. 

TEALE,  DANGERS   TO    HEALTH.     Third  Edition. 

A  Pictorial  Guide  to  Domestic  Sanitary  Defects.  By  T.  Pridjin  Teale,  m.d., 
F.R.c.s.     With  Colored  Plates.     8vo.  Price  $3.50 


'  Its  low  price  and  portability  make  it  accessible  and 
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40  PRESLEY  BLAKISTON'S 

VACHER,  CHEMISTRY. 

A  Primer  of  Chemistry,     Including  Analysis.     By  Arthur  Vacher.     i8mo. 

Price  .50 

VIRCHOW,  POST-MORTEM  EXAMINATIONS.  Second  Edi- 
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Post  mortem  Examinations.  A  Description  and  Explanation  of  the  Method 
of  Performing  them  in  the  Dead  House  of  the  Berlin  Charite  Hospital,  with 
especial  reference  to  Medico-legal  Practice.  By  Prof.  Virchow.  Translated 
by  Dr.  T.  P.  Smith.     Second  Edition.     i2mo.     With  4  Plates.  Price  $1.25 

"A  most  useful  manual  from    the  pen  of  a  master. 

.  .  .  .  For  thorough  and  systematic  method  in 
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no  guide  like  it." — Lancet. 

WAGSTAFFE,  HUMAN  OSTEOLOGY. 

The  Student's  Guide  to  Human  Osteology.  By  William  Warwick  Wag- 
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\A^ALTON,  DISEASES  OF  THE  EYE.     Third  Edition. 

A  Practical  Treatise  on  Diseases  of  the  Eye.  By  Haynes  Walton,  m.d. 
Third  Edition.  Rewritten  and  Enlarged.  With  five  plain  and  three  colored 
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WARNER,  CASE  TAKING. 

The  Student's  Guide  to  Medical  Case  Taking.  By  Francis  Warner,  m.d., 
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General  Diseases. — Class  i.  Class  2.  Arthritic  Diseases.  Diseases  of  the  Nervous  System.  Of  the  Vas- 
cular System.  Of  the  Respiratory  System.  Of  the  Digestive  System.  Of  the  Liver.  Of  the  Urinary  System. 
Instruction  for  Case  Taking. 

WATERS,  DISEASES  OF  THE  CHEST.     Second  Edition. 

The  Diseases  of  the  Chest.  Their  Clinical  History,  Pathology  and  Treat- 
ment. By  A.  T.  H.  Waters,  m.d..  Fellow  Royal  College  of  Physicians.  With 
Numerous  Illustrative  Cases  and  Lithographic  Plates.     8vo.  Price  $4.00 

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ton Medical  and  Surgical  journal. 

WEDL,  ATLAS  OF  THE  TEETH. 

An  Atlas  of  the  Pathology  of  the  Teeth.  By  Prof.  Carl  Wedl,  of  Leipsig. 
16  Full-page  Lithographs,  containing  many  figures,  some  colored.     Quarto. 

Price  $10.00 

BY   same   AUTHOR. 

DENTAL  PATHOLOGY. 

With  Special  Reference  to  the  Anatomy  and  Physiology  of  the  Teeth.  With 
Notes  by  Thos.  B.  Hitchcock,  m.d.,  of  Harvard  University.  105  Illustra- 
trations.     8vo.  Price,  Cloth,  $3.50;  Leather,  M.50 

WHITTAKER,  ON  THE  URINE. 

Student's  Primer  on  the  Urine.  By  J.  Travis  Whittaker,  m.d.,  Physician  to 
Anderson's  College  Dispensary.     With  Illustrations  Etched  on  Copper.     i6mo. 

Price  $1.50 

Physiological  Study  of  Urine — Sensation  in  Passing.  Quantity.  Color.  Odor.  Specific  Gravity.  History 
and  Behavior.  Sediment  or  Deposits.  Chemical  Study  of  Urine — Reaction.  Albumen.  Chlorides.  Ammonia. 
Urea.  Phosphates.  Blood.  Sugar.  Bile.  Microscopical  Study  of  Urine  and  Urinary  Deposits — Amorphous 
Urates.  Uric  Acid.  Triple  Phosphates.  Phosphate  of  Lime.  Feathery  Phosphates.  Oxalate  of  Lime.  Urate 
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of  the  etching  needle  for  delineation  of  microscopical  appearances." — Boston  Med.  and  Surg,  yournal. 


PUBLICA  TIONS.  41 


WEST,  THE  DISEASES  OF  WOMEN.     Fourth  Edition. 

Lectures  on   the   Diseases   of  Women.     By  Charles  West,  m.d.     Fourth 
London  Edition.     Revised  and  in  part  re-written  by  the  Author.     With  Numer- 
ous Additions  by  J.  Mathews  Duncan,  m.d..  Obstetric  Physician  to  St.  Bar- 
tholomew's Hospital     8vo.  Price  $5.00 
Drs.  West  and  Duncan   are,  perhaps,  the  most  celebrated    London  physicians 
giving  attention  to  the  Diseases  of  Women,  and  together  have  made  a  most  com- 
plete work,  either  for  the  physician  or  student. 

WILKES,  PATHOLOGICAL  ANATOMY. 

Lectures  on  Pathological  Anatomy.  By  Samuel  Wilkes,  f.r.s.  Second 
Edition.  Revised  and  Enlarged  by  Walter  Moxon,  m.d.,  f.r.s..  Physician  to 
and  Lecturer  at  Guy's  Hospital,  London.     8vo.  Price  ^5.00 

BY   SAME   author. 

DISEASES  OF  THE  NERVOUS  SYSTEM. 

Lectures  on  Diseases  of  the  Nervous  System,  Delivered  at  Guy's  Hospital, 
London.     New  Edition,  with  Additions,  Numerous  Illustrative  Cases,  etc.     8vo. 

{^Preparing. 

"A  book  of  great  value,  embodying  as  It  does  the  results  of  the  experience  and  observation  of  one  of  the  most 
accomplished  of  the  London  Hospital  Physicians." — American  your nal  of  Medical  Science. 

WRIGHT,  ON  HEADACHES.     Ninth  Thousand. 

Headaches,  their  Causes,  Nature  and  Treatment.  By  Henry  G,  Wright, 
m.d     i2mo.  Price  .50 

WILSON,  ON  DRAINAGE. 

Drainage  for  Health ;  or,  Easy  Lessons  in  Sanitary  Science,  with  Numerous 
Illustrations.  By  Joseph  Wilson,  m.d..  Medical  Director  United  States  Navy. 
One  Vol.     Octavo.  Price  $1.00 

"Dr.  Wilson  is  favorably  known  as  one  of  the  lead- 
ing American  writers  on  hygiene  and  public  health. 
The  book  deserves  popularity." — Medical  and  Surr- 
eal Reporter. 

"Well  written  and  well  illustrated.  Attention  to  its 
teachings  may  save  much  disease  and  perhaps  many 
li ves . " — Cincinnati  Gazette. 

"  Interesting  as  well  as  useful." — Philadelphia  Led- 
ger. 

BY   SAME   AUTHOR 


"  Easily  understood,  and  briefly  and  concisely  pre- 
sented."— Providence  journal. 

"Will  be  found  of  value." — Boston  Transcript. 

"Worthy  of  praise  as  a  popular  statement  of  the 
subject." — Boston  yournal  of  Chemistry. 

"  Will  be  sure  to  be  a  harbinger  of  good  in  every  fam- 
ily whose  good  fortune  it  may  be  to  possess  a  copy." — 
Builder  and  Wood  Worker. 


NAVAL  HYGIENE. 

Naval  Hygiene,  or.  Human  Health  and  Means  for  Preventing  Disease.  With 
Illustrative  Incidents  derived  from  Naval  Experience.  Illustrated.  Second 
Edition.     Bvo.  Price  $3.00 

W^ILSON,  DOMESTIC  HYGIENE. 

Health  and  Healthy  Homes.  A  Guide  to  Personaf  and  Domestic  Hygiene. 
By  George  Wilson,  m.d.,  Medical  Officer  of  Health.  Edited  by  Jos.  G. 
Richardson,  m.d..  Professor  of  Hygiene  at  the  University  of  Pennsylvania. 
314  pages.     i2mo.  Price  $1.00 

Chapter  i. — Introductory,  page  17.  11.  The  Human  Body,  33.  iii.  Causes  of  Disease,  66.  iv.  Food  and 
Diet,  iig.  V.  Cleanliness  and  Clothing,  169.  VI.  Exercise,  Recreation  and  Training,  187.  vil.  Home  and  Its 
Surroundings,  Drainage,  Warming,  etc.,  221.     viii.  Infectious  Diseases  and  their  Prevention,  269. 

"A  most  useful,  and  in  every  way,  acceptable  book." — New  York  Herald. 

"  Marked  throughout  by  a  sound,  scientific  spirit,  and  an  absence  of  all  hasty  generalizations,  sweeping  asser- 
tions, and  abuse  of  statistics  in  support  of  the  writer's  particular  views.  .  .  .  We  cannot  speak  too  highly  of 
a  work  which  we  have  read  with  entire  satisfaction." — Medical  Times  and  Gazette. 

BY    SAME    AUTHOR. 

A  HAND-BOOK  OF  HYGIENE 

And  Sanitary  Science.  With  Illustrations.  Fourth  Edition.  Revised  and 
Enlarged.     8vo.  Price  ^2.75 


£fl  PRESLE  V  BLA  KIS  TON '  S 


WILSON,  HUMAN  ANATOMY.     Tenth  Edition. 

The  Anatomist's  Vade-Mecum.  General  and  Special.  By  Prof.  Erasmus  Wil- 
son. Edited  by  George  Buchanan,  Professor  of  Clinical  Surgery  in  the  Uni- 
versity of  Glasgow;  and  Henry  E.  Clark,  Lecturer  on  Anatomy  at  the  Royal 
Infirmary  School  of  Medicine,  Glasgow.  Tenth  Edition.  With  450  Engravings 
(including  26  Colored  Plates).     Crown  8vo.  Price  |6.oo 

Recommended  as  a  Text-book  at  Rush  Medical  College,  Chicago  ;  Bellevue  Hos- 
pital, New  York;  St.  Louis  Medical  College;  Yale  and  Dartmouth  Schools;  and 
many  other  Colleges. 

"The  present  edition  of  the  'Anatomist's  Vade-mecum,'  has  been  prepared  under 
the.  same  editorial  control  as  the   Ninth  Edition. 

"Numerous  additional  wood  cuts  have  been  introduced,  and  full-page  engravings 
of  the  bones,  which  have  been  drawn  and  engraved  with  great  care,  to  secure  ac- 
curacy, and  to  make  them  not  mere  anatomical  diagrams,  but  artistic  pictures." 

BY   SAME  author. 

HEALTHY  SKIN.     Eighth  Edition. 

A  Practical  Treatise  on  the  Skin  and  Hair ;  their  Preservation  and  Manage- 
ment.    Eighth  Edition.     i2mo.     Paper.  Price  $1.00 

WILSON,  SEA  VOYAGES  FOR  HEALTH. 

The  Ocean  as  a  Health  Resort.  A  Hand-book  of  Practical  Information  as  to 
Sea  Voyages,  for  the  Use  of  Tourists  and  Invalids.  By  Wm.  S.  Wilson,  l.r.c.p. 
Lond.,  M.R.c.s.E.  With  a  Chart  showing  the  Ocean  Routes,  and  Illustrating  the 
Physical  Geography  of  the  Sea.     Crown  8vo.  Price  $2.50 

Chapter  I.  Curative  Efifects  of  the  Ocean  Climate.  2.  The  Various  Health  Voyages.  3.  Time  of  Starting — 
Choosing  a  Ship.  4.  Preliminary  Arrangements.  5.  Life  at  Sea.  6.  Climate  and  Weather.  7.  Management  of 
the  Health  at  Sea.  8.  Occupations  and  Amusements  at  Sea.  9.  Objects  of  Interest  at  Sea.  10.  End  nf  the 
Voyage — Future  Plans.  11.  The  Homeward  Voyage.  12.  Australia:  its  Climate,  Cities,  and  Health  Resorts. 
13,  South  Africa  and  its  Climate.     14.  The  Meteorology  of  the  Ocean. 

Appendix  A. — Outfit  Required  for  a  Voyage  to  Australia.  B.  Names  and  Addresses  of  some  of  the  Principal 
Shipping  Firms. 

"All  the  information  is  supplied  by,  or  based  upon,  the  actual  experience  of  the  author;  and  the  book  may  b« 
confidently  recommended  to  all  who  have  to  undertake,  without  previous  experience,  a  sea  voyage  of  any  length. 
Medical  men  may  consult  it  with  advantage,  and  commend  it  to  those  patients  whom  they  may  advise  to  try  the 
effect  of  a  long  voyage  at  sea." — Medical  Times  and  Gazette. 

"  We  have  read  every  page  of  this  book,  and  have  derived  both  instruction  and  amusement." — Lancet. 

WELLS,  OVARIAN  AND  UTERINE  TUMORS. 

The  Diagnosis  and  Surgical  Treatment  of  Ovarian  and  Uterine  Tumors.     By 

T.  Spencer  Wells,  m.d.  ^To  be  issued  shortly. 

So  long  a  time  having  elapsed  since  Dr.  Wells  has  collected  the  results  of  his 

large  experience  in  book  form,  the  present  volume  will  be  eagerly  looked  for  by  all 

interested  in  this  very  important  subject. 

WOLFE,  ON  DISEASES  OF  THE  EYE. 

A  Practical  Treatise  on  Diseases  and  Injuries  of  the  Eye.  Being  a  Course  of 
Systematic  and  Clinical  Lectures  to  Students  and  Medical  Practitioners.  By  M. 
Wolfe,  f.r.c.p.e.,  Senior  Surgeon  to  the  Glasgow  Ophthalmic  Institution,  etc. 
With  10  Colored  Plates,  and  numerous  other  Illustrations.  Octavo.       Price  J?7.oo 

WALKER,  INTERMARRIAGE. 

Intermarriage,  or.  The  Mode  in  which,  and  the  Causes^why,  Beauty,  Health 
and  Intellect  result  from  certain  Unions  ;  and  Deformity ,'Disease  and  Insanity 
from  others.     Illustrated.     i2mo.  Price  $i  .00 


PUB  Lie  A  TIONS.  43 


WOODMAN  and  TIDY,  MEDICAL  JURISPRUDENCE. 

Forensic  Medicine  and  Toxicology.  By  W.  Bathurst  Woodman,  m.d., 
Physician  to  the  London  Hospital,  and  Charles  Meymott  Tidy,  f.c.s.,  Pro- 
fessor of  Chemistry  and  Medical  Jurisprudence  at  the  London  Hospital.  With 
Chromo-Lithographic  Plates,  representing  the  Appearance  of  the  Stomach  in 
Poisoning  by  Arsenic,  Corrosive  Sublimate,  Nitric  Acid,  Oxalic  Acid ;  the  Spectra 
of  Blood  and  the  Microscopic  Appearance  of  Human  and  other  Hairs ;  and 
116  other  Illustrations.     Large  octavo. 

Price,  Cloth,  $7.50;  Medical  Sheep,  $8.50;  Law  Leather,  $8.50 

"  We  have  no  hesitation  in  pronpuncing  the  work  to  be  one  of  unusual  merit.  More  readable  than  Taylor, 
more  systematic  in  its  arrangement,  and  more  practical  in  its  instruction,  it  will  prove  to  the  medical  jurist,  not 
less  than  to  the  general  practitioner,  a  storehouse  of  useful  knowledge,  conveyed  in  an  unusually  graphic  style." — 
Dublin  journal  of  Medical  Science. 

"  The  authors  of  this  truly  great  work  have  largely  supplied  the  want  felt,  sooner  or  later,  by  almost  every 
doctor." — Cincinnati  Lancet  and  Observer. 

"All  the  best  known  works  on  Medical  Jurisprudence  have  been  laid  under  contribution  for  the  production  of 
the  present  volume.  It  contains  almost  everything  that  can  be  found  in  other  works  on  the  subject;  but  it  is  no 
mere  compilation.  Dr.  Woodman  and  Dr.  Tidy  have  both  thought  out  the  subject  for  themselves,  and,  with  rare 
industry  and  acumen,  have  brought  together  a  mass  of  facts  which  is  little  short  of  astounding.  The  book  is 
worthy  to  take  its  place  alongside  of  any  work  on  the  same  subject,  and  must  prove  of  great  use  to  all  who  prac- 
tice in  criminal  courts,  and  to  all  medical  practitioners.  We  have  no  hesitation  in  recommending  it  to  our  read- 
ers."— London  Lancet. 

"Altogether  the  work  will  rank  with  the  best  of  its  class  as  a  medico-legal  hand-book,  and  cannot  fail  to  gain 
a  wide  pspularity." — Nevj  York  Medical  Record. 

"  It  cannot  be  otherwise  than  a  valuable  contribution  to  the  boundless  subject  of  medical  jurisprudence." — 
Albany  Laiu  yournal. 

"The  scope  of  this  book  is  very  wide,  and  its  execution  worthy  of  all  commendation." — Philadelphia  Legal 
Intelligencer. 

WYTHE,  ON  THE  MICROSCOPE. 

The  Microscopist.  A  Manual  of  Microscopy  and  Compendium  of  the  Micro- 
scopic Sciences,  Micro-Mineralogy,  Micro-Chemistry,  Biology,  Histology,  and 
Practical  Medicine.  By  Joseph  H.  Wythe,  a.m.,  m.d.  Fourth  Edition.  252 
Illustration»:~^8vo.  Price,  Cloth,  $5.00 ;  Leather,  $6.00 

An  Index  and  Glossary  have  been  combined  in  this  edition,  so  as  to  be  a  source 
of  valuable  information.  Notices  of  recent  additions  to  the  microscope,  together 
with  the  genera  of  microscopic  plants,  have  been  given  in  an  Appendix. 


"  From  what  we  knew  of  the  author  of  this  work,  as 
a  skilled  practical  ^licroscopist,  a  successful  teacher  of 
the  science,  and  a  practitioner  of  medicine  and  surgery 
of  long  and  varied  experience,  we  had  a  right  to  expect 
agood  book  from  his  hands.  Our  expectations  are  fully 
realized  in  the  volume  before  us.  The  style  is  clear 
and  distinct,  and  one  reads  the  book  with  the  utmost 
facility  of  comprehension.     It  is  the  more  valuable  to 


"  This  is  one  of  the  most  valuable  taR -books  on  mi- 
croscopy ever  offered  to  students  or  practitioners  of 
medicine.  This  edition  has  been  greatly  enhanced  in 
value  by  the  addition  of  chapters  on  the  use  of  the 
microscope  in  pathology,  diagnosis,  and  etiology,  and 
numerous  new  illustrations,  some  of  which  are  from 
Rindfleisch. 

"  The  author  very  carefully  brings  out  every  neces- 


the  physician  and   medical  student  on  account  of  its    i    sary  fact  and  principle  relating  to  the  use  of  the  micro- 
closer  application  of  the  microscope  to  medical  subjects       scope,  and  now  that  this  instrument  has  become  an  es- 


than  we  find  elsewhere.  The  numerous  plates,  many 
of  which  are  beautifully  colored,  are  not  to  be  excelled. 
We  feel  proud  of  it  as  an  American  production." — 
Pacific  Medical  and  Surgical  yournal. 


sentiai  part  of  every  practitioner's  armamentarium,  a 
practical  guide  and  reference  book  is  also  a  necessity, 
and  we  are  fully  warranted  in  reiterating  the  statement 
that  this  is  one  of  the  most  valuable  text-books  ever 
offered  to  students  and  practitioners  of  medicine." — 
The  Cincinnati  Lancet  and  Clinic. 


BY  SAME   AUTHOR. 

DOSE  AND  SYMPTOM  BOOK.     Eleventh  Edition. 

The  Physician's  Pocket  Dose  and  Symptom  Book.  Containing  the  Doses  and 
Uses  of  all  the  Principal  Articles  of  the  Materia  Medica,  and  Original  Prepara- 
tions.    Eleventh  Revised  Edition. 

Price,  Cloth,  $1.00;  Leather,  with  Tucks  and  Pocket,  ^1.25 

"  The  chapter  on  Dietetic  Preparations  will  be  found  useful  to  all  practicing  physicians,  most  of  whom  have  but 
Httle  acquaintance  with  the  modeiof  preparing  the  various  articles  of  diet  for  tne  sick." — Boston  Medical  and 
Surgical  Journal. 

"  Many  a  hard-worked  practitioner  will  find  it  a  useful  little  work  to  have  onhis  study  tahlt."— Canada  Medical 
and  Surgical  yournal. 


44  PRESLE  V  BLAKISTON  'S  PUBLIC  A  TIONS. 

WHEELER,   MEDICAL  CHEMISTRY. 

Medical  Chemistry,  Including  the  Outlines  of  Organic  and  Physiological 
Chemistry.     By  C.  Gilbert  Wheeler,  m.d.     Second  Edition.     i2mo. 

Price  I3.00 
WOAKES,  ON  DEAFNESS  AND  GIDDINESS. 

On  Deafness,  Giddiness  and  Noises  in  the  Head.  By  EuWARD  WoAKES,  M.D., 
London,  Surgeon  to  the  Ear  Department  of  the  Hospital  for  Diseases  of  the 
Throat  and  Chest.  Second  Edition.  Revised  and  Enlarged,  with  additional 
Illustrations.     i2mo.  Price  $2.50 


"  The  early  demand  for  a  fresh  edition  of  Dr. 
Woakes'  volume  is  a  sufficient  criticism  of  its  merits. 
.  .  .  No  brief  summary  of  his  views  could  do  full 
justice  to  the  cogency  and  subtlety  of  his  reasons. 
We  prefer  to  commend  the  whole  work  to  the  thought- 
ful perusal  of  all  intelligent  medical  practitioners  who 
desire  to  rise  above  the  level  of  mere  routine  empiri- 
cism."— Lancet,  August  28th,  1880. 


"This  book,  although  small,  is  evidently  the  result 
of  much  careful  thought  and  observation.  .  .  .  We 
cordially  recommend  the  work  as  original  and  suggest- 
ive, and  as  being  likely  to  prove  very  useful  in  explain- 
ing both  the  causation  of  symptoms  otherwise  puzzling, 
and  their  appropriate  treatment." — Practitioner ,  July, 
1879. 


ILLUSTRATED    BOOKS. 

MEDICINAL  PLANTS. 

Being  Descriptions,  with  original  Figures,  of  the  Principal  Plants  employed  in 
Medicine,  and  an  account  of  their  Properties  and  Uses.  By  Robert  Bentley, 
F.L.S.,  Professor  of  Botany  in  the  King's  College,  and  to  the  Pharmaceutical 
Society,  and  Henry  Trimens,  m.b.,  f.l.s.,  late  Lecturer  on  Botany  at  St. 
Mary's  Hospital  Medical  School.  In  42  Parts,  each,  $2.00,  or  in  4  vols.,  large 
8vo,  with    306  Colored  Plates,  bound  in  half  morocco,  gilt  edged.  I90.00 

AN  ATLAS  OF  TOPOGRAPHICAL  ANATOMY. 

After  Plane  Sections  of  Frozen  Bodies.  By  William  Braune,  Professor  of  Anatomy 
in  the  University  of  Leipzig.  Translated  by  Edward  Bellamy,  f.r.c.s..  Sur- 
geon to  and  Lecturer  on  Anatomy  at  Charing  Cross  Hospital.  With  34  Photo- 
lithographic Plates  and  46  Wood  cuts.     Large  imp.  8vo.  ^10.00 

ATLAS  OF  SKIN  DISEASES. 

Consisting  of  a  Series  of  Illustrations,  with  Descriptive  Text  and  Notes  upon 
Treatment.  By  Tilbury  Fox,  m.d.,  f.r.c.p.,  late  Physician  to  the  Department 
for  Skin  Diseases  in  University  College  Hospital.  With  72  Colored  Plates.^ 
In  18  Parts,  each,  §2.00  or,  i  Vol.,  Royal  4to,  Cloth.  $30.00 

AN  ATLAS  OF  HUMAN  ANATOMY. 

Illustrating  most  of  the  ordinary  Dissections,  and  many  not  usually  practiced  by 
the  Student.  By  Rickman  J.  Godlee,  m.s.,  f.r.c.s..  Assistant  Surgeon  to 
University  College  Hospital,  and  Senior  Demonstrator  of  Anatomy  in  Universi- 
ty' College.  With  48  imp.  4to  Colored  Plates  (112  Figures),  and  a  volume  of  Ex- 
planatory Text.  ;^30-oo 

A  COURSE  OF  OPERATIVE  SURGERY. 

By  Christopher  Heath,  f.r.c.s..  Home  Professor  of  Clinical  Surgery  in  Uni- 
versity College,  and  Surgeon  to  the  Hospital.  With  20  Plates  drawn  from 
Nature  by  M.  Leveille,  and  colored  by  hand  under  his  direction.     4to.     $14.00 

ILLUSTRATIONS  OF  CLINICAL  SURGERY. 

Consisting  of  Plates,  Photographs,  Wood  cuts.  Diagrams,  etc.,  etc.,  illustrat- 
ing Surgical  Diseases,  Symptoms,  and  Accidents  ;  also  Operative  and  other 
Methods  of  Treatment,  with  Descriptive  Letterpress.  By  Jonathan  Hutchin- 
son, f.r.c.s.,  Senior  Surgeon  to  the  London  Hospital.  Vol.  I,  containing  fas- 
ciculi I  to  X,  bound,  with  Appendix  and  Index.  $25.00 
Fasciculi  XI  to  XIV.     Ready.                                                              Each,  $2.50 


The  MicROscoPiST 


WITH  TWO  HUNDRED  AND  FIFTY  ILLUSTRATIONS, 

Greatly  Enlarged  lt>y  tlie  Addition  of  over  200  Pages  of  New  Matter. 

By  J.  H.  WYTHE,  A.M.,  M.D., 

Professor  of  Microscopy  and  Histology  in  the  Medical  College  of  the  Pacific, 
San  Francisco,  California. 


This  Manual  of  Microscopy  and  Compendium  of  tlie  Microscopic  Sciences, 
Micro-Mineralogy,  Micro-Chemistry,  Biology,  Histology,  and  Practical  Med- 
icine, in  which  the  Practice  of  Medicine  receives  the  largest  attention, 
makes  this  work  one  of  the  most  complete  Text-Books  known  on  the  sub- 
ject. Matters  of  mere  curiosity  have  been  but  briefly  referred  to,  while 
every  necessary  fact  or  principle  relating  to  the  microscope  has  been  care- 
fully stated  and  classified. 

The  chapters  on  the  use  of  the  microscope  in  Pathology,  Diagnosis,  and 
Etiology,  which  have  been  added  to  this  edition,  have  been  largely  illus- 
trated with  wood-cuts  from  Rindfleisch. 

The  Index  and  Glossary  have  been  combined  in  this  edition  so  as  to  be  a 
source  of  valuable  information,  and  notices  of  recent  additions  to  the  mi- 
croscope, together  with  the  genera  of  microscopic  plants,  have  been  given 
in  an  Appendix. 

No  pains  have  been  spared  to  render  this  manual  a  useful  companion  to 
the  student  of  Nature,  and  an  aid  to  the  progress  of  real  science.  Cloth, 
$5.00 ;  Sheep,  $6.00. 

"From  what  we  knew  of  the  author  of  this  work,  as  a  skilled  practical  Microscopist, 
a  successful  teacher  of  the  science,  and  a  practitioner  of  medicine  and  surgery  of  long 
and  varied  experience,  we  had  a  right  to  expect  a  good  book  from  his  hands.  Our  ex- 
pectations are  fully  realized  in  the  volume  before  us.  In  a  little  over  400  pages  he  has 
condensed  almost  everything  of  importance  relating  to  the  subject.  The  style,  though 
almost  aphorismal,  is  clear  and  distinct,  and  one  reads  the  book  with  the  utmost  facility 
of  comprehension.  It  is  the  more  valuable  to  the  physician  and  medical  student  on 
account  of  its  closer  application  of  the  microscope  to  medical  subjects  than  we  find  else- 
where. Too  much  praise  cannot  be  bestowed  on  the  mechanical  execution  of  the  volume. 
The  numerous  plates,  many  of  which  are  beautifully  colored,  are  not  to  be  excelled. 
Added  to  this,  the  large  and  clear  type  and  the  fine  quality  of  paper  make  it  a  most 
comely  book.  We  feel  proud  of  it  as  an  American  production,  dividing  its  authorship 
and  execution  between  the  extreme  west  and  east  territorial  limits  of  the  Eepublic." — 
Pacific  Medical  and  Surgical  Journal. 

"This  is  one  of  the  most  valuable  text-books  on  microscopy  ever  offered  to  students  or 
practitioners  of  medicine.  This  edition  has  been  greatly  enhanced  in  value  by  the  ad- 
dition of  chapters  on  the  use  of  the  microscope  in  pathology,  diagnosis,  and  etiology, 
and  numerous  new  illustrations,  some  of  which  are  from  Rindfleisch. 

"  The  author  very  carefully  brings  out  every  necessary  fact  and  principle  relating  to 
the  use  of  the  microscope,  and  now  that  this  instrument  has  become  an  essential  part  of 
every  practitioner's  armamentarium,  a  practical  guide  and  reference  book  is  also  a  ne- 
cessity, and  we  are  fully  warranted  in  reiterating  the  statement  that  this  is  one  of  the 
most  valuable  text-books  ever  offered  to  students  and  practitioners  of  medicine." — Th« 
Cincinnati  Lancet  and  Olinic. 

P.  BLAKISTON,  SON  &  CO.,  Publishers, 

PHILADELPHIA. 


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Day,  Diseases  of  Children.     A  Practical  and  Systematic  Text-book.     8vo.     Cloth,  ^5.00ji 

leather,  $6.00. 
Mackenzie,  Diseases  of  the  Throat  and  Nose.     Author's  Edition,  with  the   112  Original 

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Holden,  Practical  Anatomy.     Fourth  Edition.     Illustrated.     Cloth,  ^5.50. 
Bloxam,   Chemistry,  Organic   and    Inorganic.     The  most  complete  Text-book.     Fourth 

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with  New  Illustrations.     Svo.     Cloth,  ^5.00;    leather,  ;^6.oo. 

Carpenter,    The   Microscope   and    Its   Revelations.     Sixth   Edition.     500   Illustrations. 

Cloth,  $5.50. 
Beale,  How  To  Work  With  the   Microscope.     Fifth   Edition.     400  Illustrations.     Svo. 

Wilson,   Human  Anatomy.     Tenth  London  Edition.     450  Wood-cuts  and   26  Full-page 

Colored  Plates.     Clotli,  6.00;  leather,  $7.00. 
Roberts,  Handbook  of  the  Practice  of  Medicine.     Octavo.     Cloth,  ;^5.oo;  leather,  $6.00. 
Trousseau,  Clinical  Medicine.     Complete  in  two  volumes.    Octavo.     Cloth,  ^S.oo;  leather, 

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Sanderson,  Handbook   for  the   Physiological   Laboratory.      Exercises  for  Students  in 

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Waring,  Practical  Therapeutics.     From  the  Third  London  Edition.    Cloth,  ^4.00;  leather, 

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Meigs  and  Pepper,  Practical  Treatise  on  the  Diseases  of   Children.     Sixth  Edition. 

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The  principles  and  practice  of  dentistry 


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